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Abstract

The current severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) pandemic has stressed the global supply chain for specialized equipment, including flocked swabs.

Saliva could be a potential alternative specimen source for diagnosis of SARS-CoV-2 infection by reverse-transcriptase PCR (RT-PCR).

To compare the detection efficiency of SARS-CoV-2 RNA in saliva and oro-nasopharyngeal swab (ONPS) specimens.

Patients recruited from hospital provided paired saliva and ONPS specimens. We performed manual or automated RT-PCR with prior proteinase K treatment without RNA extraction using the Seegene Allplex 2019 nCoV assay.

Of the 773 specimen pairs, 165 (21.3 %) had at least one positive sample. Additionally, 138 specimens tested positive by both sampling methods. Fifteen and 12 cases were detected only by nasopharyngeal swab and saliva, respectively. The sensitivity of ONPS (153/165; 92.7 %; 95 % CI: 88.8–96.7) was similar to that of saliva (150/165; 90.9 %; 95 % CI: 86.5–95.3; =0.5). In patients with symptoms for ≤ 10 days, the sensitivity of ONPS (118/126; 93.7 %; 95 % CI: 89.4–97.9) was similar to that of saliva (122/126; 96.8 %; 95 % CI: 93.8–99.9 %; =0.9). However, the sensitivity of ONPS (20/22; 95.2 %; 95 % CI: 86.1–100) was higher than that of saliva (16/22; 71.4 %; 95 % CI: 52.1–90.8) in patients with symptoms for more than 10 days.

Saliva sampling is an acceptable alternative to ONPS for diagnosing SARS-CoV-2 infection in symptomatic individuals displaying symptoms for ≤ 10 days. These results reinforce the need to expand the use of saliva samples, which are self-collected and do not require swabs.

Keyword(s): detection , RT-PCR , saliva and SARS-CoV-2
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The Microbiology Society waived the open access fees for this article.
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2021-08-09
2024-11-02
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References

  1. Esbin MN, Whitney ON, Chong S, Maurer A, Darzacq X et al. Overcoming the bottleneck to widespread testing: a rapid review of nucleic acid testing approaches for COVID-19 detection. RNA 2020; 26:771–783 [View Article] [PubMed]
    [Google Scholar]
  2. Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M et al. Saliva or nasopharyngeal swab specimens for detection of SARS-CoV-2. N Engl J Med 383:1283–1286 [View Article] [PubMed]
    [Google Scholar]
  3. Frazee BW, Rodriguez-Hoces de la Guardia A, Alter H, Chen CG, Fuentes EL et al. Accuracy and discomfort of different types of intranasal specimen collection methods for molecular influenza testing in emergency department patients. Ann Emerg Med 2018; 71:509–517e1 [View Article] [PubMed]
    [Google Scholar]
  4. To KKW, Yip CCY, Lai CYW, Wong CKH, Ho DTY et al. Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: A diagnostic validity study. Clin Microbiol Infect 2019; 25:372–378 [View Article] [PubMed]
    [Google Scholar]
  5. Kim YG, Yun SG, Kim MY, Park K, Cho CH et al. Comparison between saliva and nasopharyngeal swab specimens for detection of respiratory viruses by multiplex reverse transcription-PCR. J Clin Microbiol 2017; 55:226–233 [View Article] [PubMed]
    [Google Scholar]
  6. Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi AE et al. Saliva as a candidate for COVID-19 diagnostic testing: A meta-analysis. Front Med 2020; 7:465 [View Article]
    [Google Scholar]
  7. To KK-W, Tsang OT-Y, Yip CC-Y, Chan K-H, Wu T-C et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis 2020; 71:841–843 [View Article] [PubMed]
    [Google Scholar]
  8. Yokota I, Shane PY, Okada K, Unoki Y, Yang Y et al. Mass screening of asymptomatic persons for SARS-CoV-2 using saliva. Clin Infect Dis 2020 [View Article] [PubMed]
    [Google Scholar]
  9. Jamal AJ, Mozafarihashjin M, Coomes E, Powis J, Li AX et al. Sensitivity of nasopharyngeal swabs and saliva for the detection of severe acute respiratory syndrome coronavirus 2. Clin Infect Dis 2020; 72:1064–1066 [View Article] [PubMed]
    [Google Scholar]
  10. Freppel W, Merindol N, Rallu F, Bergevin M. Efficient SARS-CoV-2 detection in unextracted oro-nasopharyngeal specimens by rRT-PCR with the Seegene AllplexTM 2019-nCoV assay. Virol J 2020; 17:196 [View Article] [PubMed]
    [Google Scholar]
  11. Larremore DB, Wilder B, Lester E, Shehata S, Burke JM et al. Test sensitivity is secondary to frequency and turnaround time for COVID-19 surveillance. medRxiv 2020 [View Article] [PubMed]
    [Google Scholar]
  12. Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect 2020; 81:357–371 [View Article] [PubMed]
    [Google Scholar]
  13. Li L, Lowe CF, Ritchie G, Stefanovic A, Champagne S et al. SARS-CoV-2 molecular testing for the diagnosis of COVID-19: One test does not fit all. J Med Virol 2002; 93:712–713 [View Article] [PubMed]
    [Google Scholar]
  14. Babady NE, McMillen T, Jani K, Viale A, Robilotti EV et al. Performance of severe acute respiratory syndrome coronavirus 2 real-time RT-PCR tests on oral rinses and saliva samples. J Mol Diagn 2020; 23:3–9 [View Article] [PubMed]
    [Google Scholar]
  15. Cheng H-Y, Jian S-W, Liu D-P, Ng T-C, Huang W-T et al. Contact tracing assessment of covid-19 transmission dynamics in Taiwan and risk at different exposure periods before and after symptom onset. JAMA Intern Med 2020; 180:1156–1163 [View Article] [PubMed]
    [Google Scholar]
  16. McCormick-Baw MK, Gaffney D, Cazares Y, Jaworski K, Byrd A. Saliva as an alternate specimen source for detection of SARS-CoV-2 in symptomatic patients using Cepheid Xpert Xpress SARS-CoV-2. J Clin Microbiol 2020; 58: [View Article] [PubMed]
    [Google Scholar]
  17. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 2020; 368:860–868 [View Article] [PubMed]
    [Google Scholar]
  18. Bullard J, Dust K, Funk D, Strong JE, Alexander D et al. Predicting infectious severe acute respiratory syndrome coronavirus 2 from diagnostic samples. Clin Infect Dis 2020; 71:2663–2666 [View Article] [PubMed]
    [Google Scholar]
  19. Caulley L, Corsten M, Eapen L, Whelan J, Angel JB et al. Salivary detection of COVID-19. Ann Intern Med 2020; 174:131–133 [View Article] [PubMed]
    [Google Scholar]
  20. La Scola B, Le Bideau M, Andreani J, Hoang VT, Grimaldier C et al. Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards. Eur J Clin Microbiol Infect Dis 2020; 39:1059–1061 [View Article] [PubMed]
    [Google Scholar]
  21. Huang CG, Lee KM, Hsiao MJ, Yang SL, Huang PN et al. Culture-based virus isolation to evaluate potential infectivity of clinical specimens tested for COVID-19. J Clin Microbiol 2020; 58: [View Article] [PubMed]
    [Google Scholar]
  22. Zheng S, Fan J, Yu F, Feng B, Lou B et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020; 369:m1443 [View Article] [PubMed]
    [Google Scholar]
  23. Zou L, Ruan F, Huang M, Liang L, Huang H et al. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. N Engl J Med 2020; 382:1177–1179 [View Article] [PubMed]
    [Google Scholar]
  24. Folgueira MD, Luczkowiak J, Lasala F, Perez-Rivilla A, Delgado R. Persistent SARS-CoV-2 replication in severe COVID-19. medRxiv 2020 [View Article]
    [Google Scholar]
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