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Mori M, Yokoyama K, Sanuki R, Inoue F, Maekawa T, Moriyama T. Analyzing factors affecting positivity in drive-through COVID-19 testing: a cross-sectional study. Virol J 2024; 21:111. [PMID: 38745200 PMCID: PMC11094999 DOI: 10.1186/s12985-024-02388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/09/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Demand for COVID-19 testing prompted the implementation of drive-through testing systems. However, limited research has examined factors influencing testing positivity in this setting. METHODS From October 2020 to March 2023, a total of 1,341 patients, along with their clinical information, were referred from local clinics to the Sasebo City COVID-19 drive-through PCR center for testing. Association between clinical information or factors related to the drive-through center and testing results was analyzed by Fisher's exact test and logistic regression models. RESULTS Individuals testing positive exhibited higher frequencies of upper respiratory symptoms; cough (OR 1.5 (95% CI 1.2-1.8), p < 0.001, q = 0.005), sore throat (OR 2.4 (95% CI 1.9-3.0), p < 0.001, q < 0.001), runny nose (OR 1.4 (95% CI 1.1-1.8), p = 0.002, q = 0.009), and systemic symptoms; fever (OR 1.5 (95% CI 1.1-2.0), p = 0.006, q = 0.02), headache (OR 1.9 (95% CI 1.4-2.5), p < 0.001, q < 0.001), and joint pain (OR 2.7 (95% CI 1.8-4.1), p < 0.001, q < 0.001). Conversely, gastrointestinal symptoms; diarrhea (OR 0.2 (95% CI 0.1-0.4), p < 0.001, q < 0.001) and nausea (OR 0.3 (95% CI 0.1-0.6), p < 0.001, q < 0.001) were less prevalent among positives. During omicron strain predominant period, higher testing positivity rate (OR 20 (95% CI 13-31), p < 0.001) and shorter period from symptom onset to testing (3.2 vs. 6.0 days, p < 0.001) were observed compared to pre-omicron period. Besides symptoms, contact history with infected persons at home (OR 4.5 (95% CI 3.1-6.5), p < 0.001, q < 0.001) and in office or school (OR 2.9 (95% CI 2.1-4.1), p < 0.001, q < 0.001), as well as the number of sample collection experiences by collectors (B 7.2 (95% CI 2.8-12), p = 0.002) were also associated with testing results. CONCLUSIONS These findings underscore the importance of factors related to drive-through centers, especially contact history interviews and sample collection skills, for achieving higher rates of COVID-19 testing positivity. They also contribute to enhanced preparedness for next infectious disease pandemics.
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Affiliation(s)
- Masahiko Mori
- Department of Internal Medicine, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan.
| | - Kazuaki Yokoyama
- Sasebo city medical association, Sasebo, Nagasaki, 857-0801, Japan
| | - Riri Sanuki
- Department of Health and Welfare, Sasebo city office, Sasebo, Nagasaki, 857-0042, Japan
| | - Fumio Inoue
- Sasebo city Health Center, Sasebo, Nagasaki, 857-0042, Japan
| | - Takafumi Maekawa
- Department of Surgery, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan
- Department of Surgery, Fukuoka Central Hospital, Fukuoka, Fukuoka, 810-0022, Japan
| | - Tadayoshi Moriyama
- Department of Neurosurgery, Sasebo Memorial Hospital, Sasebo, Nagasaki, 858-0922, Japan
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Fung CYJ, Scott M, Lerner-Ellis J, Taher J. Applications of SARS-CoV-2 serological testing: impact of test performance, sample matrices, and patient characteristics. Crit Rev Clin Lab Sci 2024; 61:70-88. [PMID: 37800891 DOI: 10.1080/10408363.2023.2254390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023]
Abstract
Laboratory testing has been a key tool in managing the SARS-CoV-2 global pandemic. While rapid antigen and PCR testing has proven useful for diagnosing acute SARS-CoV-2 infections, additional testing methods are required to understand the long-term impact of SARS-CoV-2 infections on immune response. Serological testing, a well-documented laboratory practice, measures the presence of antibodies in a sample to uncover information about host immunity. Although proposed applications of serological testing for clinical use have previously been limited, current research into SARS-CoV-2 has shown growing utility for serological methods in these settings. To name a few, serological testing has been used to identify patients with past infections and long-term active disease and to monitor vaccine efficacy. Test utility and result interpretation, however, are often complicated by factors that include poor test sensitivity early in infection, lack of immune response in some individuals, overlying infection and vaccination responses, lack of standardization of antibody titers/levels between instruments, unknown titers that confer immune protection, and large between-individual biological variation following infection or vaccination. Thus, the three major components of this review will examine (1) factors that affect serological test utility: test performance, testing matrices, seroprevalence concerns and viral variants, (2) patient factors that affect serological response: timing of sampling, age, sex, body mass index, immunosuppression and vaccination, and (3) informative applications of serological testing: identifying past infection, immune surveillance to guide health practices, and examination of protective immunity. SARS-CoV-2 serological testing should be beneficial for clinical care if it is implemented appropriately. However, as with other laboratory developed tests, use of SARS-CoV-2 serology as a testing modality warrants careful consideration of testing limitations and evaluation of its clinical utility.
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Affiliation(s)
- Chun Yiu Jordan Fung
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Mackenzie Scott
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Taher
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Ansil BR, George CE, Chandrasingh S, Viswanathan A, Thattai M, Raghu P, Devadiga S, Harikumar AG, Harsha PK, Nair I, Ramakrishnan U, Mayor S. Validating saliva as a biological sample for cost-effective, rapid and routine screening for SARS-CoV-2. Indian J Med Microbiol 2023; 45:100384. [PMID: 37573057 PMCID: PMC10231307 DOI: 10.1016/j.ijmmb.2023.100384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/12/2022] [Accepted: 05/11/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR based SARS-CoV-2 detection. METHODS We collected paired nasopharyngeal/oropharyngeal swabs and saliva samples from suspected positive SARS-CoV-2 patients and tested using RT-PCR. We used generalized linear models to investigate factors that explain result agreement. Further, we used simulations to evaluate the effectiveness of saliva-based screening in restricting the spread of infection in a large campus such as an educational institution. RESULTS We observed a 75.4% agreement between saliva and N/OPS-VTM, that increased drastically to 83% in samples stored for less than three days. Such samples processed within two days of collection showed 74.5% test sensitivity. Our simulations suggest that a test with 75% sensitivity, but high daily capacity can be very effective in limiting the size of infection clusters in a workspace. Guided by these results, we successfully implemented a saliva-based screening in the Bangalore Life Sciences Cluster (BLiSC) campus. CONCLUSION These results suggest that saliva may be a viable alternate source for SARS-CoV-2 surveillance if samples are processed immediately. Although saliva shows slightly lower sensitivity levels when compared to N/OPS-VTM, saliva collection is logistically advantageous. We strongly recommend the implementation of saliva-based screening strategies for large workplaces and in schools, as well as for population-level screening and routine surveillance as we learn to live with the SARS-CoV-2 virus.
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Affiliation(s)
- B R Ansil
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Carolin Elizabeth George
- Community Health and Research Division, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | - Sindhulina Chandrasingh
- Department of Microbiology, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | | | - Mukund Thattai
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Padinjat Raghu
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Santhosha Devadiga
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Arun Geetha Harikumar
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Pulleri Kandi Harsha
- COVID-19 Testing Laboratory, Institute for Stem Cell Science and Regenerative Medicine, Bangalore Life Science Cluster, Bangalore, Karnataka, 560065, India.
| | - Indu Nair
- Department of Medicine and Infectious Diseases, Bangalore Baptist Hospital, Bangalore, Karnataka, 560024, India.
| | - Uma Ramakrishnan
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
| | - Satyajit Mayor
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, 560065, India.
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Seaman WT, Keener O, Mei W, Mollan KR, Jones CD, Pettifor A, Bowman NM, Wang F, Webster-Cyriaque J. Oral SARS-CoV-2 host responses predict the early COVID-19 disease course. RESEARCH SQUARE 2023:rs.3.rs-3154698. [PMID: 37645853 PMCID: PMC10462189 DOI: 10.21203/rs.3.rs-3154698/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Objectives Oral fluids provide ready detection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host responses. This study sought to determine relationships between oral virus, oral anti-SARS-CoV-2-specific antibodies, and symptoms. Methods Saliva/throat wash (saliva/TW) were collected from asymptomatic and symptomatic, nasopharyngeal (NP) SARS-CoV-2 RT-qPCR+, subjects (n=47). SARS-CoV-2 RT-qPCR, N-antigen detection by immunoblot and lateral flow assay (LFA) were performed. RT-qPCR targeting viral subgenomic RNA (sgRNA) was sequence confirmed. SARS-CoV-2-anti-S protein RBD LFA assessed IgM and IgG responses. Structural analysis identified host salivary molecules analogous to SARS-CoV-2-N-antigen. Statistical analyses were performed. Results At baseline, LFA-detected N-antigen was immunoblot-confirmed in 82% of TW. However, only 3/17 were saliva/TW qPCR+. Sixty percent of saliva and 83% of TW demonstrated persistent N-antigen at 4 weeks. N-antigen LFA signal in three negative subjects suggested potential cross-detection of 4 structurally analogous salivary RNA binding proteins (alignment 19-29aa, RMSD 1-1.5 Angstroms). At entry, symptomatic subjects demonstrated replication-associated sgRNA junctions, were IgG+ (94%/100% in saliva/TW), and IgM+ (75%/63%). At 4 weeks, SARS-CoV-2 IgG (100%/83%) and IgM (80%/67%) persisted. Oral IgG correlated 100% with NP+PCR status. Cough and fatigue severity (p=0.0008 and 0.016), and presence of nausea, weakness, and composite upper respiratory symptoms (p=0.005, 0.037 and 0.017) were negatively associated with oral IgM. Female oral IgM levels were higher than male (p=0.056). Conclusion Important to transmission and disease course, oral viral replication and persistence showed clear relationships with select symptoms, early Ig responses, and gender during early infection. N-antigen cross-reactivity may reflect mimicry of structurally analogous host proteins.
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Affiliation(s)
- William T Seaman
- National Institute of Dental and Craniofacial Research, National Institutes of Health
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Faruque MRJ, Bikker FJ, Laine ML. Comparing SARS-CoV-2 Viral Load in Human Saliva to Oropharyngeal Swabs, Nasopharyngeal Swabs, and Sputum: A Systematic Review and Meta-Analysis. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:5807370. [PMID: 37600753 PMCID: PMC10435302 DOI: 10.1155/2023/5807370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/04/2022] [Accepted: 07/27/2023] [Indexed: 08/22/2023]
Abstract
A systematic review and meta-analysis were conducted to investigate the SARS-CoV-2 viral load in human saliva and compared it with the loads in oropharyngeal swabs, nasopharyngeal swabs, and sputum. In addition, the salivary viral loads of symptomatic and asymptomatic COVID-19 patients were compared. Searches were conducted using four electronic databases: PubMed, Embase, Scopus, and Web of Science, for studies published on SARS-CoV-2 loads expressed by CT values or copies/mL RNA. Three reviewers evaluated the included studies to confirm eligibility and assessed the risk of bias. A total of 37 studies were included. Mean CT values in saliva ranged from 21.5 to 39.6 and mean copies/mL RNA ranged from 1.91 × 101 to 6.98 × 1011. Meta-analysis revealed no significant differences in SARS-CoV-2 load in saliva compared to oropharyngeal swabs, nasopharyngeal swabs, and sputum. In addition, no significant differences were observed in the salivary viral load of symptomatic and asymptomatic COVID-19 patients. We conclude that saliva specimen can be used as an alternative for SARS-CoV-2 detection in oropharyngeal swabs, nasopharyngeal swabs, and sputum.
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Affiliation(s)
- Mouri R. J. Faruque
- Department of Periodontology, Academic Center for Dentistry Amsterdam, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
| | - Floris J. Bikker
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
| | - Marja L. Laine
- Department of Periodontology, Academic Center for Dentistry Amsterdam, Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
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Seaman WT, Keener O, Mei W, Mollan KR, Jones CD, Pettifor A, Bowman NM, Wang F, Webster-Cyriaque J. Oral SARS-CoV-2 host responses predict the early COVID-19 disease course. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.06.23286853. [PMID: 37609199 PMCID: PMC10441495 DOI: 10.1101/2023.03.06.23286853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Objectives Oral fluids provide ready detection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host responses. This study sought to determine relationships between oral virus, oral anti-SARS-CoV-2-specific antibodies, and symptoms. Methods Saliva/throat wash (saliva/TW) were collected from asymptomatic and symptomatic, nasopharyngeal (NP) SARS-CoV-2 RT-qPCR+, subjects (n=47). SARS-CoV-2 RT-qPCR, N-antigen detection by immunoblot and lateral flow assay (LFA) were performed. RT-qPCR targeting viral subgenomic RNA (sgRNA) was sequence confirmed. SARS-CoV-2-anti-S protein RBD LFA assessed IgM and IgG responses. Structural analysis identified host salivary molecules analogous to SARS-CoV-2-N-antigen. Statistical analyses were performed. Results At baseline, LFA-detected N-antigen was immunoblot-confirmed in 82% of TW. However, only 3/17 were saliva/TW qPCR+. Sixty percent of saliva and 83% of TW demonstrated persistent N-antigen at 4 weeks. N-antigen LFA signal in three negative subjects suggested potential cross-detection of 4 structurally analogous salivary RNA binding proteins (alignment 19-29aa, RMSD 1-1.5 Angstroms). At entry, symptomatic subjects demonstrated replication-associated sgRNA junctions, were IgG+ (94%/100% in saliva/TW), and IgM+ (75%/63%). At 4 weeks, SARS-CoV-2 IgG (100%/83%) and IgM (80%/67%) persisted. Oral IgG correlated 100% with NP+PCR status. Cough and fatigue severity (p=0.0008 and 0.016), and presence of nausea, weakness, and composite upper respiratory symptoms (p=0.005, 0.037 and 0.017) were negatively associated with oral IgM. Female oral IgM levels were higher than male (p=0.056). Conclusion Important to transmission and disease course, oral viral replication and persistence showed clear relationships with select symptoms, early Ig responses, and gender during early infection. N-antigen cross-reactivity may reflect mimicry of structurally analogous host proteins.
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Liu Y, Kumblathan T, Tao J, Xu J, Feng W, Xiao H, Hu J, Huang CV, Wu Y, Zhang H, Li XF, Le XC. Recent advances in RNA sample preparation techniques for the detection of SARS-CoV-2 in saliva and gargle. Trends Analyt Chem 2023; 165:117107. [PMID: 37317683 PMCID: PMC10204347 DOI: 10.1016/j.trac.2023.117107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023]
Abstract
Molecular detection of SARS-CoV-2 in gargle and saliva complements the standard analysis of nasopharyngeal swabs (NPS) specimens. Although gargle and saliva specimens can be readily obtained non-invasively, appropriate collection and processing of gargle and saliva specimens are critical to the accuracy and sensitivity of the overall analytical method. This review highlights challenges and recent advances in the treatment of gargle and saliva samples for subsequent analysis using reverse transcription polymerase chain reaction (RT-PCR) and isothermal amplification techniques. Important considerations include appropriate collection of gargle and saliva samples, on-site inactivation of viruses in the sample, preservation of viral RNA, extraction and concentration of viral RNA, removal of substances that inhibit nucleic acid amplification reactions, and the compatibility of sample treatment protocols with the subsequent nucleic acid amplification and detection techniques. The principles and approaches discussed in this review are applicable to molecular detection of other microbial pathogens.
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Affiliation(s)
- Yanming Liu
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Teresa Kumblathan
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jeffrey Tao
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jingyang Xu
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Wei Feng
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Huyan Xiao
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jianyu Hu
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Camille V Huang
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Yiping Wu
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Hongquan Zhang
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Xing-Fang Li
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - X Chris Le
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
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Caixeta DC, Paranhos LR, Blumenberg C, Garcia-Júnior MA, Guevara-Vega M, Taveira EB, Nunes MAC, Cunha TM, Jardim ACG, Flores-Mir C, Sabino-Silva R. Salivary SARS-CoV-2 RNA for diagnosis of COVID-19 patients: a systematic revisew and meta-analysis of diagnostic accuracy. JAPANESE DENTAL SCIENCE REVIEW 2023:S1882-7616(23)00016-9. [PMID: 37360001 PMCID: PMC10284464 DOI: 10.1016/j.jdsr.2023.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Accurate, self-collected, and non-invasive diagnostics are critical to perform mass-screening diagnostic tests for COVID-19. This systematic review with meta-analysis evaluated the accuracy, sensitivity, and specificity of salivary diagnostics for COVID-19 based on SARS-CoV-2 RNA compared with the current reference tests using a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS). An electronic search was performed in seven databases to find COVID-19 diagnostic studies simultaneously using saliva and NPS/OPS tests to detect SARS-CoV-2 by RT-PCR. The search resulted in 10,902 records, of which 44 studies were considered eligible. The total sample consisted of 14,043 participants from 21 countries. The accuracy, specificity, and sensitivity for saliva compared with the NPS/OPS was 94.3% (95%CI= 92.1;95.9), 96.4% (95%CI= 96.1;96.7), and 89.2% (95%CI= 85.5;92.0), respectively. Besides, the sensitivity of NPS/OPS was 90.3% (95%CI= 86.4;93.2) and saliva was 86.4% (95%CI= 82.1;89.8) compared to the combination of saliva and NPS/OPS as the gold standard. These findings suggest a similarity in SARS-CoV-2 RNA detection between NPS/OPS swabs and saliva, and the association of both testing approaches as a reference standard can increase by 3.6% the SARS-CoV-2 detection compared with NPS/OPS alone. This study supports saliva as an attractive alternative for diagnostic platforms to provide a non-invasive detection of SARS-CoV-2.
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Affiliation(s)
- Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Luiz Renato Paranhos
- School of Dentistry, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marcelo Augusto Garcia-Júnior
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marco Guevara-Vega
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Elisa Borges Taveira
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marjorie Adriane Costa Nunes
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- School of Dentistry, CEUMA University, Sao Luiz, MA, Brazil
| | - Thúlio Marquez Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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Snipaitiene K, Zablockiene B, Sabaliauskaite R, Zukauskaite K, Matulyte E, Smalinskaite T, Paulauskas M, Zablockis R, Lopeta M, Gagilas J, Puriene A, Jancoriene L, Jarmalaite S. SARS-CoV-2 RT-qPCR Ct values in saliva and nasopharyngeal swab samples for disease severity prediction. J Oral Microbiol 2023; 15:2213106. [PMID: 37213664 PMCID: PMC10193917 DOI: 10.1080/20002297.2023.2213106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
Background Comparison of clinical value of RT-qPCR-based SARS-CoV-2 tests performed on saliva samples (SSs) and nasopharyngeal swab samples (NPSs) for prediction of the COVID-19 disease severity. Methods Three paired SSs and NPSs collected every 3 days from 100 hospitalised COVID-19 patients during 2020 Jul-2021 Jan were tested by RT-qPCR for the original SARS-CoV-2 virus and compared to 150 healthy controls. Cases were divided into mild+moderate (Cohort I, N = 47) and severe disease (Cohort II, N = 53) cohorts and compared. Results SARS-CoV-2 was detected in 65% (91/140) vs. 53% (82/156) of NPSs and 49% (68/139) vs. 48% (75/157) of SSs collected from Cohort I and II, respectively, resulting in the total respective detection rates of 58% (173/296) vs. 48% (143/296) (P = 0.017). Ct values of SSs were lower than those of NPSs (mean Ct = 28.01 vs. 30.07, P = 0.002). Although Ct values of the first SSs were significantly lower in Cohort I than in Cohort II (P = 0.04), it became negative earlier (mean 11.7 vs. 14.8 days, P = 0.005). Multivariate Cox proportional hazards regression analysis showed that Ct value ≤30 from SSs was the independent predictor for severe COVID-19 (HR = 10.06, 95% CI: 1.84-55.14, P = 0.008). Conclusion Salivary RT-qPCR testing is suitable for SARS-CoV-2 infection control, while simple measurement of Ct values can assist in prediction of COVID-19 severity.
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Affiliation(s)
- Kristina Snipaitiene
- Institute of Biomedical Sciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Laboratory of Genetic Diagnostic, National Cancer Institute of Lithuania, Vilnius, Lithuania
| | - Birute Zablockiene
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Sabaliauskaite
- Laboratory of Genetic Diagnostic, National Cancer Institute of Lithuania, Vilnius, Lithuania
| | - Kristina Zukauskaite
- Institute of Biomedical Sciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Laboratory of Genetic Diagnostic, National Cancer Institute of Lithuania, Vilnius, Lithuania
| | - Elzbieta Matulyte
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Mindaugas Paulauskas
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rolandas Zablockis
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Alina Puriene
- Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ligita Jancoriene
- Center of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sonata Jarmalaite
- Institute of Biomedical Sciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Laboratory of Genetic Diagnostic, National Cancer Institute of Lithuania, Vilnius, Lithuania
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10
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Calvet G, Ogrzewalska M, Tassinari W, Guaraldo L, Resende P, Fuller T, Penetra S, Borges M, Pina-Costa A, Martins E, Moraes I, Santos H, Damasceno L, Medeiros-Filho F, Espindola O, Mota F, Nacife V, Pauvolid-Corrêa A, Whitworth J, Smith C, Siqueira M, Brasil P. Accuracy of saliva for SARS-CoV-2 detection in outpatients and their household contacts during the circulation of the Omicron variant of concern. BMC Infect Dis 2023; 23:295. [PMID: 37147601 PMCID: PMC10161980 DOI: 10.1186/s12879-023-08271-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND While nasopharyngeal (NP) swabs are considered the gold standard for severe acute respiratory coronavirus 2 (SARS-CoV-2) real-time reverse transcriptase-polymerase chain reaction (RT-PCR) detection, several studies have shown that saliva is an alternative specimen for COVID-19 diagnosis and screening. METHODS To analyze the utility of saliva for the diagnosis of COVID-19 during the circulation of the Omicron variant, participants were enrolled in an ongoing cohort designed to assess the natural history of SARS-CoV-2 infection in adults and children. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa coefficient were calculated to assess diagnostic performance. RESULTS Overall, 818 samples were collected from 365 outpatients from January 3 to February 2, 2022. The median age was 32.8 years (range: 3-94 years). RT-PCR for SARS-CoV-2 was confirmed in 97/121 symptomatic patients (80.2%) and 62/244 (25.4%) asymptomatic patients. Substantial agreement between saliva and combined nasopharyngeal/oropharyngeal samples was observed with a Cohen's kappa value of 0.74 [95% confidence interval (CI): 0.67-0.81]. Sensitivity was 77% (95% CI: 70.9-82.2), specificity 95% (95% CI: 91.9-97), PPV 89.8% (95% CI: 83.1-94.4), NPV 87.9% (95% CI: 83.6-91.5), and accuracy 88.5% (95% CI: 85.0-91.4). Sensitivity was higher among samples collected from symptomatic children aged three years and older and adolescents [84% (95% CI: 70.5-92)] with a Cohen's kappa value of 0.63 (95% CI: 0.35-0.91). CONCLUSIONS Saliva is a reliable fluid for detecting SARS-CoV-2, especially in symptomatic children and adolescents during the circulation of the Omicron variant.
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Affiliation(s)
- Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil.
| | - Maria Ogrzewalska
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Wagner Tassinari
- Federal Rural University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lusiele Guaraldo
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Paola Resende
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Trevon Fuller
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Stephanie Penetra
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Michele Borges
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Anielle Pina-Costa
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Ezequias Martins
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Isabella Moraes
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Heloisa Santos
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Luana Damasceno
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Fernando Medeiros-Filho
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Otavio Espindola
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
| | - Fernando Mota
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Valéria Nacife
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Alex Pauvolid-Corrêa
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Jimmy Whitworth
- Departments of Clinical Research and Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Smith
- Departments of Clinical Research and Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marilda Siqueira
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
- SARS-CoV-2 National Reference Laboratory for the Brazilian Ministry of Health (MoH) and Regional Reference Laboratory in Americas for the Pan-American Health Organization (PAHO/WHO), Rio de Janeiro, Brazil
| | - Patrícia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21045-900, Brazil
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11
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Coker MO, Subramanian G, Davidow A, Fredericks-Younger J, Gennaro ML, Fine DH, Feldman CA. Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies. JDR Clin Trans Res 2023; 8:188-197. [PMID: 35191352 PMCID: PMC10029133 DOI: 10.1177/23800844211071111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs). METHODS A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping). RESULTS SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01). CONCLUSIONS Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings. KNOWLEDGE TRANSFER STATEMENT Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.
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Affiliation(s)
- M O Coker
- Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - G Subramanian
- Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - A Davidow
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - J Fredericks-Younger
- Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - M L Gennaro
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Public Health Research Institute and New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - D H Fine
- Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - C A Feldman
- Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Rutgers School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
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12
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Quantitative analysis of different respiratory specimens on two automated test systems for detection of SARS-CoV-2 RNA. Diagn Microbiol Infect Dis 2023; 105:115800. [PMID: 36252283 PMCID: PMC9411103 DOI: 10.1016/j.diagmicrobio.2022.115800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 12/04/2022]
Abstract
Molecular testing of SARS-CoV-2 RNA is essential during the pandemic. Here, we compared the results of different respiratory specimens including anterior nasal swabs, pharyngeal swabs, saliva swabs, and gargle lavage samples to nasopharyngeal swabs on two automated SARS-CoV-2 test systems. Samples were collected and tested simultaneously from a total of 36 hospitalized symptomatic COVID-19 patients. Detection and quantification of SARS-CoV-2 was performed on cobas®6800 (Roche) and NeuMoDx™ (Qiagen) systems. Both assays showed reliable detection and quantification of SARS-CoV-2 RNA, with nasopharyngeal swabs showing the highest sensitivity. SARS-CoV-2 RNA concentrations in other respiratory specimens were lower (mean 2.5 log10 copies/ml) or even undetectable in up to 20%. These data clearly indicate that not all respiratory materials are equally suitable for the management of hospitalized patients, especially, in the late phase of COVID-19, when the viral phase subsides and inflammation becomes the predominant factor, making detection of even lower viral loads increasingly important.
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13
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Migueres M, Mansuy JM, Vasseur S, Claverie N, Lougarre C, Soulier F, Trémeaux P, Izopet J. Omicron Wave SARS-CoV-2 Diagnosis: Evaluation of Saliva, Anterior Nasal, and Nasopharyngeal Swab Samples. Microbiol Spectr 2022; 10:e0252122. [PMID: 36318040 PMCID: PMC9769796 DOI: 10.1128/spectrum.02521-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The Omicron variant differs from earlier strains of SARS-CoV-2 in the way it enters host cells and grows in vitro. We therefore reevaluated its diagnosis using saliva, nasopharyngeal swab (NPs), and anterior nasal swab (ANs) specimens from 202 individuals (64.9% symptomatic) tested at the Toulouse University Hospital SARS-CoV-2 drive-through testing center. All tests were done with the Thermo Fisher TaqPath COVID-19 reverse transcription-PCR (RT-PCR) kit. Overall, 92 subjects (45.5%) had one or more positive specimens. Global sensitivities of saliva, NPs, and ANs were 94.6%, 90.2%, and 82.6%, respectively. Saliva provided significantly greater sensitivity among symptomatic patients tested within 5 days of symptom onset (100%) than did ANs (83.1%) or NPs (89.8%). We obtained follow-up samples for 7/20 individuals with discordant results. Among them, 5 symptomatic patients were diagnosed positive on saliva sample only, soon after symptom onset; NPs and ANs became positive only later. Thus, saliva samples are effective tools for the detection of the Omicron variant. In addition to its many advantages, such as improved patient acceptance and reduced cost, saliva sampling could help limit viral spread through earlier viral detection. IMPORTANCE Diagnostic testing for SARS-CoV-2 is an essential component of the global strategy for the prevention and control of COVID-19. Since the beginning of the pandemic, numerous studies have evaluated the diagnostic sensitivity of different respiratory and oral specimens for SARS-CoV-2 detection. The pandemic has been since dominated by the emergence of new variants, the latest being the Omicron variant characterized by numerous mutations and changes in host tropism in vitro that might affect the diagnostic performance of tests depending on the sampling location. In this prospective study, we evaluated the clinical performance of NPs, ANs, and saliva for SARS-CoV-2 diagnosis during the Omicron wave. Our results highlight the effectiveness of saliva-based RT-PCR for the early detection of the Omicron variant. These findings may help to refine guidelines and support the use of a highly sensitive diagnostic method that allows earlier diagnosis, when transmission is the most critical.
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Affiliation(s)
- Marion Migueres
- CHU Toulouse, Hôpital Purpan, Institut fédératif de Biologie, Laboratoire de virologie, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Jean-Michel Mansuy
- CHU Toulouse, Hôpital Purpan, Institut fédératif de Biologie, Laboratoire de virologie, Toulouse, France
| | - Sandrine Vasseur
- CHU Toulouse, Hôpital Purpan, Centre de prélèvement COVID, Toulouse, France
| | - Nicolas Claverie
- CHU Toulouse, Hôpital Purpan, Centre de prélèvement COVID, Toulouse, France
| | - Catherine Lougarre
- CHU Toulouse, Hôpital Purpan, Centre de prélèvement COVID, Toulouse, France
| | - Françoise Soulier
- CHU Toulouse, Hôpital Purpan, Centre de prélèvement COVID, Toulouse, France
| | - Pauline Trémeaux
- CHU Toulouse, Hôpital Purpan, Institut fédératif de Biologie, Laboratoire de virologie, Toulouse, France
| | - Jacques Izopet
- CHU Toulouse, Hôpital Purpan, Institut fédératif de Biologie, Laboratoire de virologie, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
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14
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Del Vecchio C, Cracknell Daniels B, Brancaccio G, Brazzale AR, Lavezzo E, Ciavarella C, Onelia F, Franchin E, Manuto L, Bianca F, Cianci V, Cattelan AM, Dorigatti I, Toppo S, Crisanti A. Impact of antigen test target failure and testing strategies on the transmission of SARS-CoV-2 variants. Nat Commun 2022; 13:5870. [PMID: 36198689 PMCID: PMC9533294 DOI: 10.1038/s41467-022-33460-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
Population testing remains central to COVID-19 control and surveillance, with countries increasingly using antigen tests rather than molecular tests. Here we describe a SARS-CoV-2 variant that escapes N antigen tests due to multiple disruptive amino-acid substitutions in the N protein. By fitting a multistrain compartmental model to genomic and epidemiological data, we show that widespread antigen testing in the Italian region of Veneto favored the undetected spread of the antigen-escape variant compared to the rest of Italy. We highlight novel limitations of widespread antigen testing in the absence of molecular testing for diagnostic or confirmatory purposes. Notably, we find that genomic surveillance systems which rely on antigen population testing to identify samples for sequencing will bias detection of escape antigen test variants. Together, these findings highlight the importance of retaining molecular testing for surveillance purposes, including in contexts where the use of antigen tests is widespread.
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Affiliation(s)
- Claudia Del Vecchio
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Bethan Cracknell Daniels
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | | | - Enrico Lavezzo
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Constanze Ciavarella
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Francesco Onelia
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Elisa Franchin
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Laura Manuto
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Federico Bianca
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy
| | - Vito Cianci
- ER Unit, Emergency-Urgency Department, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis and Jameel Institute, School of Public Health, Imperial College London, London, UK.
| | - Stefano Toppo
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy. .,CRIBI Biotech Center, University of Padua, V.le G. Colombo, 3, Padua, 35131, Italy.
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padua, Via Gabelli, 63, Padua, 35121, Italy. .,Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, Padua, 35128, Italy. .,Department of Life Science, Imperial College London, South Kensington Campus, Imperial College Road, SW7 AZ, London, UK.
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15
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Collins E, Galipeau Y, Arnold C, Bosveld C, Heiskanen A, Keeshan A, Nakka K, Shir-Mohammadi K, St-Denis-Bissonnette F, Tamblyn L, Vranjkovic A, Wood LC, Booth R, Buchan CA, Crawley AM, Little J, McGuinty M, Saginur R, Langlois MA, Cooper CL. Cohort profile: Stop the Spread Ottawa (SSO) -a community-based prospective cohort study on antibody responses, antibody neutralisation efficiency and cellular immunity to SARS-CoV-2 infection and vaccination. BMJ Open 2022; 12:e062187. [PMID: 36691221 PMCID: PMC9461086 DOI: 10.1136/bmjopen-2022-062187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/16/2022] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To investigate the robustness and longevity of SARS-CoV-2 immune responses conferred by natural infection and vaccination among priority populations such as immunocompromised individuals and people with post-acute sequelae of COVID-19 in a prospective cohort study (Stop the Spread Ottawa-SSO) in adults living in the Ottawa region. In this paper, we describe the study design, ongoing data collection and baseline characteristics of participants. PARTICIPANTS Since October 2020, participants who tested positive for COVID-19 (convalescents) or at high risk of exposure to the virus (under surveillance) have provided monthly blood and saliva samples over a 10-month period. As of 2 November 2021, 1026 adults had completed the baseline survey and 976 had attended baseline bloodwork. 300 participants will continue to provide bimonthly blood samples for 24 additional months (ie, total follow-up of 34 months). FINDINGS TO DATE The median age of the baseline sample was 44 (IQR 23, range: 18-79) and just over two-thirds (n=688; 67.1%) were female. 255 participants (24.9%) had a history of COVID-19 infection confirmed by PCR and/or serology. Over 600 participants (60.0%) work in high-risk occupations (eg, healthcare, teaching and transportation). 108 participants (10.5%) reported immunocompromising conditions or treatments at baseline (eg, cancer, HIV, other immune deficiency, and/or use of immunosuppressants). FUTURE PLANS SSO continues to yield rich research potential, given the collection of pre-vaccine baseline data and samples from the majority of participants, recruitment of diverse subgroups of interest, and a high level of participant retention and compliance with monthly sampling. The 24-month study extension will maximise opportunities to track SARS-CoV-2 immunity and vaccine efficacy, detect and characterise emerging variants, and compare subgroup humoral and cellular response robustness and persistence.
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Affiliation(s)
- Erin Collins
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yannick Galipeau
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Corey Arnold
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Bosveld
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Aliisa Heiskanen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexa Keeshan
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kiran Nakka
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Sprott Center for Stem Cell Research, Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Khatereh Shir-Mohammadi
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Laura Tamblyn
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Agatha Vranjkovic
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leah C Wood
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ronald Booth
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Immunology Section, Eastern Ontario Regional Laboratory Association (EORLA), Ottawa, Ontario, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Angela M Crawley
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Knowledge Synthesis and Application Unit (KSAU), University of Ottawa, Ottawa, Ontario, Canada
| | - Michaeline McGuinty
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raphael Saginur
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Science Network Research Ethics Board (OHSN-REB), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology & Immunology, University of Ottawa, Ottawa, Ontario, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, Ontario, Canada
| | - Curtis L Cooper
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Coronavirus Variants Rapid Response Network (CoVaRR-Net), Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Infection, Immunity and Inflammation (CI3), University of Ottawa, Ottawa, Ontario, Canada
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16
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Shirvaliloo M, Sheervalilou R, Ahmadpour E, Safiri S, Bannazadeh Baghi H. Diagnostic accuracy of clinically applied nanoparticle-based biosensors at detecting SARS-CoV-2 RNA and surface proteins in pharyngeal swabs compared to RT-PCR as a reference test. Expert Rev Mol Diagn 2022; 22:881-894. [PMID: 36224104 DOI: 10.1080/14737159.2022.2135434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Nanoparticle-based biosensors (NPBs) are point-of-care diagnostic platforms that can be used for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with high accuracy. AREAS COVERED EBSCOhost Web, Embase, ProQuest, PubMed/MEDLINE, Scopus, Web of Science, and WHO Global Literature on Coronavirus Disease 2019 (COVID-19) were searched for relevant records published from 1 November 2019 to 30 April 2022. Records reporting original data on the accuracy of clinically applied nanoparticle-based biosensors at detecting SARS-CoV-2 RNA and surface proteins from pharyngeal swab specimens were considered. Findings were reported based on the PRISMA 2020 statement. The QUADAS-2 tool was used for assessment of quality and risk of bias among the included studies. EXPERT OPINION A total of 50 relevant records were identified, of which 13 were included. The included studies explored the diagnostic performance of 13 clinically applied distinct nanoparticle-based biosensors in a total of 789 pharyngeal swabs collected from 376 COVID-19 patients and 413 otherwise healthy individuals. The mean sensitivity, specificity, and accuracy were 97.07%, 94.43%, and 96.91%, respectively, in comparison to RT-qPCR as the reference test. Considering their ease-of-operation, portability, low-cost manufacturing, NPBs could be considered suitable candidate diagnostic platforms for substituting RT-qPCR.
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Affiliation(s)
- Milad Shirvaliloo
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Future Science Group, Unitec House, 2 Albert Place, London, N3 1QB, UK
| | | | - Ehsan Ahmadpour
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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17
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Duncan DB, Mackett K, Ali MU, Yamamura D, Balion C. Performance of saliva compared with nasopharyngeal swab for diagnosis of COVID-19 by NAAT in cross-sectional studies: Systematic review and meta-analysis. Clin Biochem 2022; 117:84-93. [PMID: 35952732 PMCID: PMC9359767 DOI: 10.1016/j.clinbiochem.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/14/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
Nucleic acid amplification testing (NAAT) is the preferred method to diagnose coronavirus disease 2019 (COVID-19). Saliva has been suggested as an alternative to nasopharyngeal swabs (NPS), but previous systematic reviews were limited by the number and types of studies available. The objective of this systematic review and meta-analysis was to assess the diagnostic performance of saliva compared with NPS for COVID-19. We searched Ovid MEDLINE, Embase, Cochrane, and Scopus databases up to 24 April 2021 for studies that directly compared paired NPS and saliva specimens taken at the time of diagnosis. Meta-analysis was performed using an exact binomial rendition of the bivariate mixed-effects regression model. Risk of bias was assessed using the QUADAS-2 tool. Of 2683 records, we included 23 studies with 25 cohorts, comprising 11,582 paired specimens. A wide variety of NAAT assays and collection methods were used. Meta-analysis gave a pooled sensitivity of 87 % (95 % CI = 83-90 %) and specificity of 99 % (95 % CI = 98-99 %). Subgroup analyses showed the highest sensitivity when the suspected individual is tested in an outpatient setting and is symptomatic. Our results support the use of saliva NAAT as an alternative to NPS NAAT for the diagnosis of COVID-19.
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Affiliation(s)
- Donald Brody Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada
| | - Katharine Mackett
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Deborah Yamamura
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario L8L 2X2, Canada; Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario L8V 1C3, Canada
| | - Cynthia Balion
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8S 4K1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8S 4K1, Canada.
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18
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Delaunay‐Moisan A, Guilleminot T, Semeraro M, Briand N, Bader‐Meunier B, Berthaud R, Morelle G, Quartier P, Galeotti C, Basmaci R, Benoist G, Gajdos V, Lorrot M, Rifai M, Crespin M, M'Sakni Z, Padavia F, Savetier‐Leroy C, Lorenzi M, Maurin C, Behillil S, de Pontual L, Elenga N, Bouazza N, Moltrecht B, van der Werf S, Leruez‐Ville M, Sermet‐Gaudelus I. Saliva for molecular detection of
SARS‐CoV
‐2 in preschool and school‐age children. Environ Microbiol 2022; 24:4725-4737. [PMID: 36065993 PMCID: PMC9538513 DOI: 10.1111/1462-2920.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022]
Abstract
SARS‐CoV‐2 diagnosis is a cornerstone for the management of coronavirus disease 2019 (COVID‐19). Numerous studies have assessed saliva performance over nasopharyngeal sampling (NPS), but data in young children are still rare. We explored saliva performance for SARS‐CoV‐2 detection by RT‐PCR according to the time interval from initial symptoms or patient serological status. We collected 509 NPS and saliva paired samples at initial diagnosis from 166 children under 12 years of age (including 57 children under 6), 106 between 12 and 17, and 237 adults. In children under 12, overall detection rate for SARS‐CoV‐2 was comparable in saliva and NPS, with an overall agreement of 89.8%. Saliva sensitivity was significantly lower than that of NPS (77.1% compared to 95.8%) in pre‐school and school‐age children but regained 96% when considering seronegative children only. This pattern was also observed to a lesser degree in adolescents but not in adults. Sensitivity of saliva was independent of symptoms, in contrary to NPS, whose sensitivity decreased significantly in asymptomatic subjects. Performance of saliva is excellent in children under 12 at early stages of infection. This reinforces saliva as a collection method for early and unbiased SARS‐CoV‐2 detection and a less invasive alternative for young children.
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Affiliation(s)
- Agnes Delaunay‐Moisan
- Université Paris‐Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC) Gif‐sur‐Yvette France
| | - Tiffany Guilleminot
- Virology laboratory. Hospital Necker‐Enfants‐Malades. Assistance Publique Hôpitaux de Paris UMR 7328 Imagine Paris Cité
| | - Michaela Semeraro
- Unité de Recherche Clinique‐ Centre Investigation Clinique. Hôpital Necker‐Enfants Malades. Assistance Publique Hôpitaux de Paris France
| | - Nelly Briand
- Unité de Recherche Clinique‐ Centre Investigation Clinique. Hôpital Necker‐Enfants Malades. Assistance Publique Hôpitaux de Paris France
| | - Brigitte Bader‐Meunier
- Department of Paediatric Hematology‐Immunology and Rheumatology Necker‐Enfants Malades Hospital AP‐ HP Paris France
- Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Imagine Institute, Inserm Paris France
| | - Romain Berthaud
- Unité de Recherche Clinique‐ Centre Investigation Clinique. Hôpital Necker‐Enfants Malades. Assistance Publique Hôpitaux de Paris France
| | - Guillaume Morelle
- Service de Pédiatrie Générale. Hôpital Kremlin Bicêtre. Assistance Publique Hôpitaux de Paris. France
| | - Pierre Quartier
- Department of Paediatric Hematology‐Immunology and Rheumatology Necker‐Enfants Malades Hospital AP‐ HP Paris France
| | - Caroline Galeotti
- Service de Pédiatrie Générale. Hôpital Kremlin Bicêtre. Assistance Publique Hôpitaux de Paris. France
| | - Romain Basmaci
- Service de Pédiatrie Générale. Hôpital Louis Mourier. Assistance Publique Hôpitaux de Paris. France
| | - Gregoire Benoist
- Service de Pédiatrie Générale. Hôpital Ambroise Paré. Assistance Publique Hôpitaux de Paris. France
| | - Vincent Gajdos
- Service de Pédiatrie Générale. Hôpital Antoine Beclère. Assistance Publique Hôpitaux de Paris. France
| | - Mathie Lorrot
- Service de Pédiatrie Générale. Hôpital Armand Trousseau. Assistance Publique Hôpitaux de Paris. France
| | - Mahmoud Rifai
- Service de Pneumo‐Allergologie Pédiatrique. CHU Necker Enfants Malades. Assistance Publique Hôpitaux de Paris. France
| | - Matis Crespin
- Service de Pneumo‐Allergologie Pédiatrique. CHU Necker Enfants Malades. Assistance Publique Hôpitaux de Paris. France
| | - Zakary M'Sakni
- Service de Pneumo‐Allergologie Pédiatrique. CHU Necker Enfants Malades. Assistance Publique Hôpitaux de Paris. France
| | - Faheema Padavia
- Unité de Recherche Clinique‐ Centre Investigation Clinique. Hôpital Necker‐Enfants Malades. Assistance Publique Hôpitaux de Paris France
| | | | | | | | - Sylvie Behillil
- Centre de Référence des Virus émergents. Institut Pasteur France
| | - Loic de Pontual
- Service de Pédiatrie Générale. Hôpital Jean Verdier. Assistance Publique Hôpitaux de Paris. Université Sorbonne Paris Nord. France
| | - Narcisse Elenga
- Service de Pédiatrie Générale. Centre Hospitalier de Cayenne Andrée Rosemon. France
| | - Naim Bouazza
- Unité de Recherche Clinique‐ Centre Investigation Clinique. Hôpital Necker‐Enfants Malades. Assistance Publique Hôpitaux de Paris France
| | | | | | - Marianne Leruez‐Ville
- Virology laboratory. Hospital Necker‐Enfants‐Malades. Assistance Publique Hôpitaux de Paris UMR 7328 Imagine Paris Cité
| | - Isabelle Sermet‐Gaudelus
- Service de Pneumo‐Allergologie Pédiatrique. CHU Necker Enfants Malades. Assistance Publique Hôpitaux de Paris. France
- Institut Necker Enfants Malades. INSERM UMR‐SU1151. Université Paris Cité. France
- European Reference Network for Rare Respiratory Diseases. Belgium
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19
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Trajman A, Felker I, Alves LC, Coutinho I, Osman M, Meehan SA, Singh UB, Schwartz Y. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis 2022; 26:710-719. [PMID: 35898126 PMCID: PMC9341497 DOI: 10.5588/ijtld.22.0006] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Together, SARS-CoV-2 and M. tuberculosis have killed approximately 5.7 million people worldwide over the past 2 years. The COVID-19 pandemic, and the non-pharmaceutical interventions to mitigate COVID-19 transmission (including social distancing regulations, partial lockdowns and quarantines), have disrupted healthcare services and led to a reallocation of resources to COVID-19 care. There has also been a tragic loss of healthcare workers who succumbed to the disease. This has had consequences for TB services, and the fear of contracting COVID-19 may also have contributed to reduced access to TB services. Altogether, this is projected to have resulted in a 5-year setback in terms of mortality from TB and a 9-year setback in terms of TB detection. In addition, past and present TB disease has been reported to increase both COVID-19 fatality and incidence. Similarly, COVID-19 may adversely affect TB outcomes. From a more positive perspective, the pandemic has also created opportunities to improve TB care. In this review, we highlight similarities and differences between these two infectious diseases, describe gaps in our knowledge and discuss solutions and priorities for future research.
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Affiliation(s)
- A Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - I Felker
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
| | - L C Alves
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA
| | - I Coutinho
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, School of Human Sciences, Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Y Schwartz
- WHO Collaborating Centre, Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation
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20
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3D-printed simulator for nasopharyngeal swab collection for COVID-19. Infect Dis Now 2022; 52:138-144. [PMID: 35149235 PMCID: PMC8824092 DOI: 10.1016/j.idnow.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection. PATIENTS AND METHODS Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population. RESULTS Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly. CONCLUSION Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.
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21
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Ahmadieh A, Dincer S, Navazesh M. Is saliva collected passively without forceful coughing sensitive to detect SARS-CoV-2 in ambulatory cases? A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:530-538. [PMID: 35227640 PMCID: PMC8743389 DOI: 10.1016/j.oooo.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This systematic review was conducted to assess the sensitivity rate of SARS-CoV-2 detection in the saliva of ambulatory asymptomatic and mildly symptomatic patients, with saliva being collected passively without any forceful coughing. STUDY DESIGN A literature search was performed from January 2020 to July 2021. Prospective studies excluding letters to editors were included in our review only if saliva and nasopharyngeal samples were collected simultaneously and sensitivity was reported using reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic or mildly symptomatic ambulatory cases. RESULTS A total of 436 studies were assessed; 10 (4 cohorts and 6 cross-sectional) studies met our inclusion criteria. The sensitivity rate of saliva to detect SARS-CoV-2 varied from 85.7% to 98.6% in all except for 3 studies. Lower sensitivity levels were attributed to low viral load (51.9% and 63.8%) or lack of supervision while collecting saliva (66.7%). CONCLUSIONS Passively collected saliva in the absence of coughing has a high sensitivity rate to detect SARS-CoV-2 in asymptomatic and mildly symptomatic patients compared with nasopharyngeal swabs. Limitations of previous studies, such as lack of attention to the method of saliva collection, stages, and severity of the disease at the time of sample collection, can be researched in future investigations.
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Affiliation(s)
- Azadeh Ahmadieh
- Clinical Assistant Professor of Dentistry, Division of Biomedical Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA.,Corresponding author
| | - Sibel Dincer
- Clinical Assistant Professor of Dentistry, Division of Biomedical Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Mahvash Navazesh
- Executive Associate Dean for Academic, Faculty & Student Affairs, Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Professor of Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
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22
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Park H, Jung W, Jang H, Namkoong K, Choi KY. One-Step RT-qPCR for Viral RNA Detection Using Digital Analysis. Front Bioeng Biotechnol 2022; 10:837838. [PMID: 35340840 PMCID: PMC8948435 DOI: 10.3389/fbioe.2022.837838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
The rapid detection of viruses is becoming increasingly important to prevent widespread infections. However, virus detection via reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is time-consuming, as it involves independent nucleic acid extraction and complementary DNA synthesis. This process limits the potential for rapid diagnosis and mass analysis, which are necessary to curtail viral spread. In this study, a simple and rapid thermolysis method was developed to circumvent the need for extraction and purification of viral RNA. The developed protocol was applied to one-chip digital PCR (OCdPCR), which allowed thermolysis, RT, and digital PCR in a single unit comprising 20,000 chambers of sub-nanoliter volume. Two viruses such as tobacco mosaic virus and cucumber mosaic virus were tested as model viral particles. First, the temperature, exposure time, and template concentration were optimized against tobacco mosaic viral particles, and the most efficient conditions were identified as 85°C, 5 min, and 0.01 μg/nL with a cycle threshold of approximately 33. Finally, the OCdPCR analysis yielded 1,130.2 copies/µL using 10−2 μg/nL of viral particles in a 30 min thermolysis-RT reaction at 70°C. This novel protocol shows promise as a quick, accurate, and precise method for large-scale viral analysis in the future.
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Affiliation(s)
- Hyuna Park
- Department of Environmental Engineering, College of Engineering, Ajou University, Suwon-si, South Korea
| | - Wonjong Jung
- Device Research Center, Advanced Sensor Lab, Samsung Advanced Institute of Technology, Samsung Electronics Co.Ltd., Suwon-si, South Korea
| | - Hyeongseok Jang
- Device Research Center, Advanced Sensor Lab, Samsung Advanced Institute of Technology, Samsung Electronics Co.Ltd., Suwon-si, South Korea
| | - Kak Namkoong
- Device Research Center, Advanced Sensor Lab, Samsung Advanced Institute of Technology, Samsung Electronics Co.Ltd., Suwon-si, South Korea
| | - Kwon-Young Choi
- Department of Environmental Engineering, College of Engineering, Ajou University, Suwon-si, South Korea
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23
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Lippi G, Nocini R, Henry BM, Plebani M. Virucidal effects of mouthwashes or mouth rinses: a world of caution for molecular detection of SARS-CoV-2 in saliva. Diagnosis (Berl) 2022; 9:285-287. [PMID: 35092657 DOI: 10.1515/dx-2022-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology-Unit of Otorhinolaryngology, University of Verona, Verona, Italy
| | - Brandon M Henry
- Clinical Laboratory, Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Disease Intervention & Prevention and Population Health Programs, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Mario Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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24
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Yang J, Kidd M, Nordquist AR, Smith SD, Hurth C, Modlin IM, Zenhausern F. A Sensitive, Portable Microfluidic Device for SARS-CoV-2 Detection from Self-Collected Saliva. Infect Dis Rep 2021; 13:1061-1077. [PMID: 34940407 PMCID: PMC8701218 DOI: 10.3390/idr13040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/13/2022] Open
Abstract
Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in December 2019, the spread of SARS-CoV2 infection has been escalating rapidly around the world. In order to provide more timely access to medical intervention, including diagnostic tests and medical treatment, the FDA authorized multiple test protocols for diagnostic tests from nasopharyngeal swab, saliva, urine, bronchoalveolar lavage and fecal samples. The traditional diagnostic tests for this novel coronavirus 2019 require standard processes of viral RNA isolation, reverse transcription of RNA to cDNA, then real-time quantitative PCR with the RNA templates extracted from the patient samples. Recently, many reports have demonstrated a direct detection of SARS-Co-V2 genomic material from saliva samples without any RNA isolation step. To make the rapid detection of SARS-Co-V2 infection more accessible, a point-of-care type device was developed for SARS-CoV-2 detection. Herein, we report a portable microfluidic-based integrated detection-analysis system for SARS-CoV-2 nucleic acids detection directly from saliva samples. The saliva cartridge is self-contained and capable of microfluidic evaluation of saliva, from heating, mixing with the primers to multiplex real-time quantitative polymerase chain reaction, detecting SARS-CoV-2 with different primer sets and internal control. The approach has a detection sensitivity of 1000 copies/mL of SARS-CoV-2 RNA or virus, with consistency and automation, from saliva sample-in to result-out.
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Affiliation(s)
- Jianing Yang
- Center for Applied NanoBioscience and Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (A.R.N.); (S.D.S.); (C.H.)
| | - Mark Kidd
- WREN Laboratories, Branford, CT 06405, USA; (M.K.); (I.M.M.)
| | - Alan R. Nordquist
- Center for Applied NanoBioscience and Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (A.R.N.); (S.D.S.); (C.H.)
| | - Stanley D. Smith
- Center for Applied NanoBioscience and Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (A.R.N.); (S.D.S.); (C.H.)
| | - Cedric Hurth
- Center for Applied NanoBioscience and Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (A.R.N.); (S.D.S.); (C.H.)
| | - Irvin M. Modlin
- WREN Laboratories, Branford, CT 06405, USA; (M.K.); (I.M.M.)
| | - Frederic Zenhausern
- Center for Applied NanoBioscience and Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (A.R.N.); (S.D.S.); (C.H.)
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25
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Schienkiewitz A, Jordan S, Hornbacher A, Perlitz H, Zeisler ML, Sandoni A, Kubisch U, Wess B, Kuttig T, Schaffrath-Rosario A, Damerow S, Rattay P, Varnaccia G, Loer AKM, Wormsbächer J, Cohrdes C, Wetzstein M, Albrecht S, Hey I, Michel J, Schrick L, Gößwald A, Allen J, Schlaud M, Busch MA, Butschalowsky H, Wernitz J, Otte im Kampe E, Buchholz U, Haas W, Schaade L, Wieler LH, Ziese T, Lampert T, Loss J. SARS-CoV-2 Transmissibility Within Day Care Centers-Study Protocol of a Prospective Analysis of Outbreaks in Germany. Front Public Health 2021; 9:773850. [PMID: 34976930 PMCID: PMC8717701 DOI: 10.3389/fpubh.2021.773850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA ("Corona outbreak-related examinations in day care centers") is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.
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Affiliation(s)
- Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Susanne Jordan
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anselm Hornbacher
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hanna Perlitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Marie-Luise Zeisler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anna Sandoni
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ulrike Kubisch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Barbara Wess
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Tim Kuttig
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Stefan Damerow
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Petra Rattay
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gianni Varnaccia
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anne-Kathrin M. Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jan Wormsbächer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Carolin Cohrdes
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Matthias Wetzstein
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Isabell Hey
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Janine Michel
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Antje Gößwald
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jennifer Allen
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Hans Butschalowsky
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Jörg Wernitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Eveline Otte im Kampe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Udo Buchholz
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Walter Haas
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Lothar H. Wieler
- Leadership Robert Koch Institute, Robert Koch Institute, Berlin, Germany
- Department of Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Castelnuovo F, Tiecco G, Storti S, Fumarola B, Brianese N, Bertelli D, Castelli F. Pneumocystis jirovecii pneumonia in breast cancer mimicking SARS-CoV-2 pneumonia during pandemic. LE INFEZIONI IN MEDICINA 2021; 29:614-617. [PMID: 35146372 PMCID: PMC8805466 DOI: 10.53854/liim-2904-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 06/14/2023]
Abstract
Pneumocystis jirovecii pneumonia (PJP) is one of the most common HIV-related opportunistic infection. Apart from HIV patients, subjects treated with an associated therapy of high doses glucocorticoids and immunosuppressive drugs should be considered at risk. SARS-CoV-2 has become worldly known as the responsible of the pandemic that hit the world in late 2019 and that is still ongoing. Italy, and especially Brescia, was one of the area most struck by the pandemic, with a significant number of cases being reported (more than 112,648 as of October 2021). The diagnosis of SARS-CoV-2 is mainly based on RT-PCR assays performed on nasopharyngeal swab, X-ray of the chest and clinical manifestations. We describe two cases of PJP in two immunocompromised patients with breast cancer who were admitted at Spedali Civili of Brescia hospital, Italy, with an initial diagnosis of SARS-CoV-2 pneumonia, despite testing negative to RT-PCR on nasopharyngeal swabs. We also retrospectively reassessed all cases of pneumonia deemed as SARS-CoV-2-related upon admission and then converted to PJP as the final diagnosis. We describe the two following cases to emphasize that clinicians should always be alert about PJP, even during the SARS-CoV-2 pandemic, and avoid focusing on COVID-19 exclusively. PJP should always be considered as a differential diagnosis in patients, particularly if immunosuppressed, with an X-ray or TC of the chest suggestive of interstitial pneumonia and a negative SARS-CoV-2 RT-PCR on nasopharyngeal swabs.
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Affiliation(s)
- Filippo Castelnuovo
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Giorgio Tiecco
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Samuele Storti
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Benedetta Fumarola
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Nigritella Brianese
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Davide Bertelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
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27
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Boutros J, Benzaquen J, Marquette CH, Ilié M, Labaky M, Benchetrit D, Lavrut T, Leroy S, Chemla R, Carles M, Tanga V, Maniel C, Bordone O, Allégra M, Lespinet V, Fayada J, Griffonnet J, Hofman V, Hofman P. Salivary detection of COVID-19: clinical performance of oral sponge sampling for SARS-CoV-2 testing. ERJ Open Res 2021; 7:00396-2021. [PMID: 34877351 PMCID: PMC8474486 DOI: 10.1183/23120541.00396-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The current diagnostic standard for coronavirus disease 2019 (COVID-19) is reverse transcriptase-polymerase chain reaction (RT-PCR) testing with nasopharyngeal (NP) swabs. The invasiveness and need for trained personnel make the NP technique unsuited for repeated community-based mass screening. We developed a technique to collect saliva in a simple and easy way with the sponges that are usually used for tamponade of epistaxis. This study was carried out to validate the clinical performance of oral sponge (OS) sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. METHODS Over a period of 22 weeks, we collected prospectively 409 paired NP and OS samples from consecutive subjects presenting to a public community-based free screening centre. Subjects were referred by their attending physician because of recent COVID-19 symptoms (n = 147) or by the contact tracing staff of the French public health insurance because they were considered as close contacts of a laboratory-confirmed COVID-19 case (n = 262). RESULTS In symptomatic subjects, RT-PCR SARS-CoV-2 testing with OS showed a 96.5% (95% CI: 89.6-94.8) concordance with NP testing, and a 93.2% (95% CI: 89.1-97.3) sensitivity when using the IdyllaTM platform and a sensitivity of 76.3% (95% CI: 69.4-83.2) on the Synlab Barla laboratory platform. In close contacts the NP-OS concordance (93.8%, 95% CI: 90.9-96.7) and OS sensitivity (71.9%, 95% CI: 66.5-77.3) were slightly lower. CONCLUSION These results strongly suggest that OS testing is a straightforward, low-cost and high-throughput sampling method that can be used for frequent RT-PCR testing of COVID-19 patients and mass screening of populations.
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Affiliation(s)
- Jacques Boutros
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
| | - Jonathan Benzaquen
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Aging, Nice, France
| | - Charles Hugo Marquette
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Aging, Nice, France
| | - Marius Ilié
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Aging, Nice, France
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | | | | | - Thibaut Lavrut
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Laboratoire de Virologie, CHU de Nice, Nice, France
| | - Sylvie Leroy
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
- CNRS UMR 7275 – Institut de Pharmacologie Moléculaire et Cellulaire, Université Côte d'Azur, Nice, France
| | | | - Michel Carles
- Dept of Infectious Diseases, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Virginie Tanga
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Charlotte Maniel
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
| | - Olivier Bordone
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Maryline Allégra
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Virginie Lespinet
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Julien Fayada
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Jennifer Griffonnet
- Dept of Pulmonary Medicine and Thoracic Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, FHU OncoAge, Nice, France
| | - Véronique Hofman
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Aging, Nice, France
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
| | - Paul Hofman
- Université Côte d'Azur, CNRS, INSERM, Institute of Research on Cancer and Aging, Nice, France
- Laboratory of Clinical and Experimental Pathology (LPCE), Université Côte d'Azur, FHU OncoAge, Centre Hospitalier Universitaire de Nice, Biobank (BB-0033-00025), Nice, France
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28
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Mendoza RP, Bi C, Cheng HT, Gabutan E, Pagapas GJ, Khan N, Hoxie H, Hanna S, Holmes K, Gao N, Lewis R, Wang H, Neumann D, Chan A, Takizawa M, Lowe J, Chen X, Kelly B, Asif A, Barnes K, Khan N, May B, Chowdhury T, Pollonini G, Gouda N, Guy C, Gordon C, Ayoluwa N, Colon E, Miller-Medzon N, Jones S, Hossain R, Dodson A, Weng M, McGaskey M, Vasileva A, Lincoln AE, Sikka R, Wyllie AL, Berke EM, Libien J, Pincus M, Premsrirut PK. Implementation of a pooled surveillance testing program for asymptomatic SARS-CoV-2 infections in K-12 schools and universities. EClinicalMedicine 2021; 38:101028. [PMID: 34308321 PMCID: PMC8286123 DOI: 10.1016/j.eclinm.2021.101028] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine COVID-19 testing that may ultimately reduce the overall viral burden in the community. METHODS We implemented a testing program using the SalivaClear࣪ pooled surveillance method that included students, faculty and staff from K-12 schools (student age range 5-18 years) and universities (student age range >18 years) across the country (Mirimus Clinical Labs, Brooklyn, NY). The data analysis was performed using descriptive statistics, kappa agreement, and outlier detection analysis. FINDINGS From August 27, 2020 until January 13, 2021, 253,406 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (Ct) values between pooled and individual samples) measures. The detection of SARS-CoV-2 in saliva was comparable to the nasopharyngeal swab. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. INTERPRETATION By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis for the presence of SARS-CoV-2 enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. We provide strong evidence that pooled testing may be a fundamental component to the reopening of schools by minimizing the risk of in-school transmission among students and faculty. FUNDING Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.
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Affiliation(s)
- Rachelle P. Mendoza
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Chongfeng Bi
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Hui-Ting Cheng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elmer Gabutan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nadia Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Helen Hoxie
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Stephen Hanna
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Kelly Holmes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nicholas Gao
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Raychel Lewis
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Huaien Wang
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Daniel Neumann
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Angela Chan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meril Takizawa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - James Lowe
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Xiao Chen
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brianna Kelly
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Aneeza Asif
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Keena Barnes
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nusrat Khan
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Brandon May
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Tasnim Chowdhury
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Nourelhoda Gouda
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Chante Guy
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Candice Gordon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Nana Ayoluwa
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Elvin Colon
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | | | - Shanique Jones
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Rauful Hossain
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Arabia Dodson
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Meimei Weng
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Miranda McGaskey
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
| | - Ana Vasileva
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Andrew E. Lincoln
- MedStar Sports Medicine Research Center, MedStar Health Research Institute, 2900 S Hanover St., Baltimore, MD 21225, USA
- Department of Rehabilitation Medicine, Georgetown University Medical Center, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - Robby Sikka
- Minnesota Timberwolves, 600 Hennepin Ave, Minneapolis, MN 55403, USA
| | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Ethan M. Berke
- OptumLabs, UnitedHealth Group, 12700 Whitewater Dr, Minnetonka, MN 55343 USA
| | - Jenny Libien
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Matthew Pincus
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
| | - Prem K. Premsrirut
- Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA
- Department of Cell Biology, SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11226, USA
- Corresponding author at: Mirimus Inc, 760 Parkside Ave. Suite 206, Brooklyn, NY 11226, USA.
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29
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Abstract
The ratio of COVID-19-attributable deaths versus “true” COVID-19 deaths depends on the synchronicity of the epidemic wave with population mortality; duration of test positivity, diagnostic time window, and testing practices close to and at death; infection prevalence; the extent of diagnosing without testing documentation; and the ratio of overall (all-cause) population mortality rate and infection fatality rate. A nomogram is offered to assess the potential extent of over- and under-counting in different situations. COVID-19 deaths were apparently under-counted early in the pandemic and continue to be under-counted in several countries, especially in Africa, while over-counting probably currently exists for several other countries, especially those with intensive testing and high sensitization and/or incentives for COVID-19 diagnoses. Death attribution in a syndemic like COVID-19 needs great caution. Finally, excess death estimates are subject to substantial annual variability and include also indirect effects of the pandemic and the effects of measures taken.
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