Self‐collected saliva for SARS‐CoV‐2 detection: A prospective study in the emergency room

Abstract

Current diagnostic standards involve severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in nasopharyngeal swabs (NPS), but saliva is an attractive and noninvasive option for diagnosis. The objectives were to determine the performance of saliva in comparison with NPS for detecting SARS-CoV-2 and to compare the optimized home brew reverse-transcription polymerase chain reaction (RT-PCR) with a commercial RT-PCR. Paired NPS and saliva specimens were prospectively collected and tested by RT-PCR from patients presenting at an emergency room with signs and symptoms compatible with coronavirus disease-2019. A total of 348 samples from 174 patients were tested by RT-PCR assays. Among 174 patients with symptoms, 63 (36%) were SARS-CoV-2 positive in NPS using the optimized home-brew PCR. Of these 63 patients, 61 (98%) were also positive in saliva. An additional positive SARS-CoV-2 saliva was detected in a patient with pneumonia. Kappa Cohen's coefficient agreement between NPS and saliva was 0.96 (95% confidence interval [CI], 0.90-0.99). Median Ct values in NPS versus saliva

Perceptions of COVID-19 Self-Testing and Recommendations for Implementation and Scale up Among Black/African Americans: Implications for the COVID-19 STEP Project

“…This preference is mainly because this approach of specimen collection is considered to be minimally invasive and can be reliably selfadministered [12]. However, there are mixed reports on the sensitivity of saliva specimens for COVID-19 testing, as the virus is only detectable during the acute phase of infection using saliva specimens [34,35].…”

ESCMID COVID-19 guidelines: diagnostic testing for SARS-CoV-2

“… In patients with signs and symptoms compatible with severe or critical COVID-19 for the diagnosis of COVID-19 infection, we suggest the use of NAAT in nasopharyngeal swab samples versus NAAT in saliva samples for diagnosis of COVID-19. Weak against Very low [ 13 , 92 , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] ] 22 In patients with signs and symptoms compatible with COVID-19 of equal or less than 7 days onset , should saliva sampling be used, compared with nasopharyngeal swab sampling for diagnosis of COVID-19 with NAAT? In patients with signs and symptoms compatible with COVID-19 of equal or less than 7 days-onset, we suggest the use of NAAT in saliva samples versus NAAT in nasopharyngeal swab samples for diagnosis of COVID-19.…”

Testing Saliva to Reveal the Submerged Cases of the COVID-19 Iceberg

“…Clear collection instructions are imperative; mucus contamination can make samples difficult to work with (Landry et al, 2020 ). True saliva thereby reduces biases from sample processing, increasing both the overall sensitivity of SARS-CoV-2 detection and the agreement with nasopharyngeal swab (Wyllie et al, 2020 ; Echavarria et al, 2021 ; Petrone et al, 2021 ). Many of the comparative studies however, show a reduced sensitivity when true saliva is self-collected by means of devices containing a transport or stabilizing media (Williams et al, 2020 ; Caulley et al, 2021 ; Dogan et al, 2021 ) likely at least in part a result from diluting the saliva sample.…”