Viral dynamics of SARS-CoV-2 in saliva from infected patients

Zhu, Jialou; Guo, Jiubiao; Xu, Yuzhong; Chen, Xinchun

doi:10.1016/j.jinf.2020.06.059

Cited by 139 publications

(169 citation statements)

References 8 publications

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“…Several recent studies have showed that OF could be an appropriate sample for diagnosis of SARS-CoV-2 [ 6 , 22 ]. The meta-analysis by Czumbel et al on the reliability and consistency of SARS-CoV-2 viral RNA detection in OF specimens found 91% (95%CI = 80%–99%) sensitivity for OF tests and 98% (95%CI 89%–100%) sensitivity for NPS in previously confirmed COVID-19 infected patients [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The WHO currently recommends RT-PCR testing using nasopharyngeal (NPS) and oropharyngeal swabs (OPS) as gold standard for SARS-CoV-2 diagnosis and for monitoring viral load [ 4 , 5 ]. OF has been suggested as an alternate clinical sample, easy and safer to collect, minimizing exposure of healthcare workers and could be useful for making a diagnosis and measuring SARS-CoV-2 viral load and viral shedding during the course of the illness and convalescence [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. To et al, demonstrated that SARS-CoV-2 was present in OF specimen of 11 out of 12 patients, with viral load being higher during the first week after symptoms onset and declining thereafter, being detectable until 25 days after symptoms onset (DSO) [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Frequency and Duration of SARS-CoV-2 Shedding in Oral Fluid Samples Assessed by a Modified Commercial Rapid Molecular Assay

Bordi

Sberna

Lalle

et al. 2020

Viruses

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Background: RT-PCR on nasopharyngeal (NPS)/oropharyngeal swabs is the gold standard for diagnosis of SARS-CoV-2 infection and viral load monitoring. Oral fluid (OF) is an alternate clinical sample, easy and safer to collect and could be useful for COVID-19 diagnosis, monitoring viral load and shedding. Methods: Optimal assay conditions and analytical sensitivity were established for the commercial Simplexa™ COVID-19 Direct assay adapted to OF matrix. The assay was used to test 337 OF and NPS specimens collected in parallel from 164 hospitalized patients; 50 bronchoalveolar lavage (BAL) specimens from a subgroup of severe COVID-19 cases were also analysed. Results: Using Simplexa™ COVID-19 Direct on OF matrix, 100% analytical detection down to 1 TCID50/mL (corresponding to 4 × 103 copies (cp)/mL) was observed. No crossreaction with other viruses transmitted through the respiratory toute was observed. Parallel testing of 337 OF and NPS samples showed highly concordant results (κ = 0.831; 95 % CI = 0.771–0.891), and high correlation of Ct values (r = 0.921; p < 0.0001). High concordance and elevated correlation was observed also between OF and BAL. Prolonged viral RNA shedding was observed up to 100 days from symptoms onset (DSO), with 32% and 29% positivity observed in OF and NPS samples, respectively, collected between 60 and 100 DSO. Conclusions: Simplexa™ COVID-19 Direct assays on OF have high sensitivity and specificity to detect SARS-CoV-2 RNA and provide an alternative to NPS for diagnosis and monitoring SARS-CoV-2 shedding.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frequency and Duration of SARS-CoV-2 Shedding in Oral Fluid Samples Assessed by a Modified Commercial Rapid Molecular Assay

Bordi

Sberna

Lalle

et al. 2020

Viruses

View full text Add to dashboard Cite

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“…The difference in sensitivity probably reflects differences in the clinical background and timing of sampling in each study. In fact, several studies reported reduced viral load in saliva with time Iwasaki et al 2020;Nagura-Ikeda et al 2020;Williams et al 2020;Yoon et al 2020;Zhang et al 2020;Zhu et al 2020). However, the specificity ranging from 97% to 100% suggests reliable detection limits of current assays for detecting the absence of SARS-CoV-2 viral loads in saliva samples.…”

Section: Population-level Employable Rapid Testing Strategy: Advantagmentioning

confidence: 99%

Saliva in the Diagnosis of COVID-19: A Review and New Research Directions

et al. 2020

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This review presents literature that highlights saliva’s utility as a biofluid in the diagnosis and monitoring of COVID-19. A systematic search was performed in 5 electronic databases (PubMed, Embase, LILACS, Scopus, and Web of Science). Studies were eligible for inclusion if they assessed the potential diagnostic value and/or other discriminatory properties of biological markers in the saliva of patients with COVID-19. As of July 22, 2020, a total of 28 studies have investigated the presence of SARS-CoV-2 RNA in saliva. Several of those studies confirmed reliable detection of SARS-CoV-2 in the saliva of patients with COVID-19. Saliva offered sensitivity and specificity for SARS-CoV-2 detection comparable to that of the current standard of nasopharyngeal and throat swabs. However, the utility of saliva in diagnosing COVID-19 infection remains understudied. Clinical studies with larger patient populations that measure recordings at different stages during the disease are still necessary to confirm the accuracy of COVID-19 diagnosis with saliva. Nevertheless, the utility of saliva as a diagnostic tool opens the possibility of using rapid and less invasive diagnostic strategies by targeting bioanalytes rather than the pathogen.

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“…2020 ; Nagura-Ikeda et al 2020 ; Pasomsub et al 2020 ; Williams et al 2020 ; Wyllie et al 2020 ). Most of these studies reported the results of analyses conducted with small- and medium-sized patient cohorts (i.e., 200 subjects or fewer), although studies with larger cohorts (i.e., about 1,000 subjects) have been recently published ( Caulley et al 2020 ; Zhu, Guo, et al 2020 ).…”

Section: The Detection Of Sars-cov-2 In Salivamentioning

confidence: 99%

Diagnostic Salivary Tests for SARS-CoV-2

et al. 2020

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The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.

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Viral dynamics of SARS-CoV-2 in saliva from infected patients

Cited by 139 publications

References 8 publications

Frequency and Duration of SARS-CoV-2 Shedding in Oral Fluid Samples Assessed by a Modified Commercial Rapid Molecular Assay

Frequency and Duration of SARS-CoV-2 Shedding in Oral Fluid Samples Assessed by a Modified Commercial Rapid Molecular Assay

Saliva in the Diagnosis of COVID-19: A Review and New Research Directions

Diagnostic Salivary Tests for SARS-CoV-2

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