USEFULNESS OF SALIVA SAMPLES FOR DETECTING SARS-CoV-2 RNA AMONG LIVER DISEASE PATIENTS

Villar, Lívia Melo; Costa, Vanessa Duarte da; Marques, Bianca Cristina Leires; Silva, Lucas Lima da; Santos, Alanna Calheiros; Mendonça, Ana Carolina da Fonseca; Marques, Vanessa Alves; Nascimento, Giselle Prado do; Lewis-Ximenez, Lia Laura; Paula, Vanessa Salete de

doi:10.1016/j.jinf.2020.07.017

Cited by 14 publications

(12 citation statements)

References 4 publications

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“…However, its collection requires trained personnel, which are exposed to a potential risk of nosocomial transmission and may create discomfort for the patient. Saliva circumvents these problems, but its sensitivity and thus suitability has been differentially reported [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. We recently conducted a large-scale head-to-head comparison of SARS-CoV-2 detection by RT-PCR in NPS and saliva and could show that saliva is a valid alternate specimen for SARS-CoV-2 detection by RT-PCR with particular advantages for testing children [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent Cochrane study reported a sensitivity of only 56.2% (95% confidence interval (CI): 29.5–79.8%) for point-of-care antigen tests [ 33 ]. Several studies have evaluated saliva as an alternative to NPS for detection of SARS-CoV-2 with antigen tests, including automated tests [ 11 , 12 , 13 , 14 , 15 , 20 , 36 , 37 , 38 , 40 , 42 , 43 , 44 ]. However, none of the current Emergency Use Authorization (EUA) tests for SARS-CoV-2 antigen detection is authorized for saliva.…”

Section: Discussionmentioning

confidence: 99%

“…Our study shows that lower sensitivity can occur in antigen tests using saliva as a medium and highlights the need for developers to establish appropriate protocols for saliva testing. It must be considered that a reduced sensitivity of SARS-CoV-2 antigen testing in saliva is likely not restricted to the assay evaluated here, as several studies noted lower sensitivity in saliva [ 11 , 12 , 13 , 14 , 15 , 20 , 22 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. Alternate saliva sampling strategies that allow concentrated saliva processing may thus be of advantage in combination with antigen tests to overcome the sensitivity restrictions.…”

Section: Discussionmentioning

confidence: 99%

“…A considerable advantage of saliva is that it does not require trained personnel for sampling and is amenable for home-collection. The overall sensitivity and thus suitability of saliva as an alternative to NPS has been differentially debated, with most studies reporting an acceptable performance of saliva despite a generally lower sensitivity and viral load compared to NPS [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ], some studies showing a substantially lower sensitivity [ 17 , 18 ], and others reporting higher viral loads in saliva relative to NPS [ 19 , 20 ]. Differential saliva collection strategies, RT-PCR test systems, and small and heterogeneous study populations may cause discrepancies in the sensitivity of detecting SARS-CoV-2 infection in saliva.…”

Section: Introductionmentioning

confidence: 99%

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Reduced Relative Sensitivity of the Elecsys SARS-CoV-2 Antigen Assay in Saliva Compared to Nasopharyngeal Swabs

et al. 2021

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Early identification and isolation of SARS-CoV-2-infected individuals is central to contain the COVID-19 pandemic. Nasopharyngeal swabs (NPS) serve as a specimen for detection by RT-PCR and rapid antigen screening tests. Saliva has been confirmed as a reliable alternative specimen for RT-PCR and has been shown to be valuable for diagnosing children and in repetitive mass testing due to its non-invasive collection. Combining the advantages of saliva with those of antigen tests would be highly attractive to further increase test capacities. Here, we evaluated the performance of the Elecsys SARS-CoV-2 Antigen assay (Roche) in RT-PCR-positive paired NPS and saliva samples (N = 87) and unpaired NPS (N = 100) with confirmed SARS-CoV-2 infection (Roche cobas SARS-CoV-2 IVD test). We observed a high positive percent agreement (PPA) of the antigen assay with RT-PCR in NPS, reaching 87.2% across the entire cohort, whereas the overall PPA for saliva was insufficient (40.2%). At Ct values ≤ 28, PPA were 100% and 91.2% for NPS and saliva, respectively. At lower viral loads, the sensitivity loss of the antigen assay in saliva was striking. At Ct values ≤ 35, the PPA for NPS remained satisfactory (91.5%), whereas the PPA for saliva dropped to 46.6%. In conclusion, saliva cannot be recommended as a reliable alternative to NPS for testing with the Elecsys Anti-SARS-CoV-2 Antigen assay. As saliva is successfully used broadly in combination with RT-PCR testing, it is critical to create awareness that suitability for RT-PCR cannot be translated to implementation in antigen assays without thorough evaluation of each individual test system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reduced Relative Sensitivity of the Elecsys SARS-CoV-2 Antigen Assay in Saliva Compared to Nasopharyngeal Swabs

et al. 2021

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“…Of note, two studies comparing naso-/oropharyngeal swabs and saliva samples in symptomatic children found an overall saliva sensitivity of 85.2% (up to 95.2% in patients with high viral load (≥10 4 copies/mL) in nasopharyngal swabs) and 87.7%, respectively [17,18]. The Salivette ® system has been proposed as a device for collecting saliva for SARS-CoV-2 testing in adults [19][20][21][22]. However, feasibility and diagnostic performance of this system in children and for routine testing in educational settings have not been assessed.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Diagnostic Accuracy of Saliva-Based SARS-CoV-2 Screening in Educational Settings and Children Aged <12 Years

Hoch¹,

Vogel²,

Eberle³

et al. 2021

Diagnostics

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Children have been disproportionately affected during the COVID-19 pandemic. We aimed to assess a saliva-based algorithm for SARS-CoV-2 testing to be used in schools and childcare institutions under pandemic conditions. A weekly SARS-CoV-2 sentinel study in primary schools, kindergartens, and childcare facilities was conducted over a 12-week-period. In a sub-study covering 7 weeks, 1895 paired oropharyngeal and saliva samples were processed for SARS-CoV-2 rRT-PCR testing in both asymptomatic children (n = 1243) and staff (n = 652). Forty-nine additional concurrent swab and saliva samples were collected from SARS-CoV-2 infected patients (patient cohort). The Salivette® system was used for saliva collection and assessed for feasibility and diagnostic performance. For children, a mean of 1.18 mL saliva could be obtained. Based on results from both cohorts, the Salivette® testing algorithm demonstrated the specificity of 100% (95% CI 99.7–100) and sensitivity of 94.9% (95% CI 81.4–99.1) with oropharyngeal swabs as reference. Agreement between sampling systems was 100% for moderate to high viral load situations (defined as Ct-values <33 from oropharyngeal swabs). Comparative analysis of Ct-values derived from saliva vs. oropharyngeal swabs demonstrated a significant difference (mean 4.23; 95% CI 2.48–6.00). In conclusion, the Salivette® system proved to be an easy-to-use, safe and feasible saliva collection method and a more pleasant alternative to oropharyngeal swabs for SARS-CoV-2 testing in children aged 3 years and above.

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Pooled saliva samples as an approach to reduce the spread of infections with SARS-CoV-2

Möst¹,

Eigentler²,

Orth‐Höller³

2021

Infection

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USEFULNESS OF SALIVA SAMPLES FOR DETECTING SARS-CoV-2 RNA AMONG LIVER DISEASE PATIENTS

Cited by 14 publications

References 4 publications

Reduced Relative Sensitivity of the Elecsys SARS-CoV-2 Antigen Assay in Saliva Compared to Nasopharyngeal Swabs

Reduced Relative Sensitivity of the Elecsys SARS-CoV-2 Antigen Assay in Saliva Compared to Nasopharyngeal Swabs

Feasibility and Diagnostic Accuracy of Saliva-Based SARS-CoV-2 Screening in Educational Settings and Children Aged <12 Years

Pooled saliva samples as an approach to reduce the spread of infections with SARS-CoV-2

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