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Akeel S, Almazrooa S, Jazzar A, Mohammed Sindi A, Farsi NJ, Binmadi N, Badkok R, Aljohani M, AlFarabi S. Detection of Specific Immunoglobulins in the Saliva of Patients With Mild COVID-19. Cureus 2024; 16:e52113. [PMID: 38213933 PMCID: PMC10783611 DOI: 10.7759/cureus.52113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Abstract
Saliva has many advantages over blood as a biofluid, so using it for measuring and monitoring antibody responses in COVID-19 would be highly valuable. To assess the value of saliva-based IgG and IgM/IgA antibody testing in COVID-19, this cross-sectional pilot study evaluated the accuracy of salivary and serum IgG and IgM/IgA for detecting mild COVID-19 and their correlation. Fifty-one patients with mild COVID-19 (14-28 days post-symptom onset) were included in the study. Enzyme-linked immunosorbent assays (ELISA) were used to measure IgG and IgM/IgA responses to SARS-CoV-2 spike protein in both serum and saliva samples using a slightly modified protocol for saliva samples. Saliva-based IgG testing had 30% sensitivity and 100% specificity, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 50%. Saliva-based IgM/IgA testing had 13.2% sensitivity and 100% specificity, with a PPV of 100% and an NPV of 28.3%. Blood and saliva IgG values were positively correlated. Saliva currently has limited diagnostic value for COVID-19 testing, at least for mild disease. Nevertheless, the significant positive correlation between blood and saliva IgG titers indicates that saliva might be a complementary biofluid for assessing systemic antibody responses to the virus, especially if the assay is further optimized across the full disease spectrum.
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Affiliation(s)
- Sara Akeel
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Soulafa Almazrooa
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Ahoud Jazzar
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Amal Mohammed Sindi
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Nada J Farsi
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Nada Binmadi
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Reem Badkok
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Modi Aljohani
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Sarah AlFarabi
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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Baron S, Cuervo I, Shah D, Gonzalez A, Harari H, Flores D. COVID-19 Infections, Pandemic-Related Social and Economic Impacts, and Changes to Mental and Self-Rated Health Among Latinx Immigrant Housecleaners in New York City: The Safe and Just Cleaners Study. Am J Public Health 2023; 113:893-903. [PMID: 37406262 PMCID: PMC10323835 DOI: 10.2105/ajph.2023.307324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 07/07/2023]
Abstract
Objectives. To estimate impacts of COVID-19 infections and social and economic sequelae on mental and self-rated health among Latinx immigrant housecleaners in New York City. Methods. From March to June 2021, we conducted a follow-up study with 74% retention of 402 housecleaners initially surveyed before the pandemic between August 2019 and February 2020. We measured rates of self-reported COVID-19 infections, COVID-19 antibodies, and pandemic-related social and economic sequelae and examined predictors of mental and self-rated health changes using logistic regression models. Results. Fifty-three percent reported COVID-19 infections, consistent with the rate demonstrating COVID-19 antibodies. During shutdown of nonessential services, from March 22 to June 8, 2020, 29% worked as housecleaners, although this was not associated with higher COVID-19 infection rates. COVID-19-related stigma at work, lost earnings owing to COVID-19 infections, housing insecurity, food insecurity, and unsafe homes, including experiencing intimate partner verbal abuse, were statistically associated with changes in mental or self-rated health compared with prepandemic measures. Conclusions. The disproportionate impact and virtually nonexistent safety net housecleaners experienced during the first year of the pandemic highlight the importance of inclusive stopgap measures to mitigate economic insecurity and its sequelae. (Am J Public Health. 2023;113(8):893-903. https://doi.org/10.2105/AJPH.2023.307324).
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Affiliation(s)
- Sherry Baron
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Isabel Cuervo
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dhwanil Shah
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana Gonzalez
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Homero Harari
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deysi Flores
- Sherry Baron, Isabel Cuervo, and Dhwanil Shah are with the Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens. Ana Gonzalez, and Deysi Flores are with Make the Road New York, Brooklyn, NY. Homero Harari is with the Selikoff Centers for Occupational Health and Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY
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3
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Sohaei D, Ulndreaj A, Mathew A, Campbell C, Stengelin M, Sigal G, Joe J, Romero D, Padmanabhan N, Ren A, Ghorbani A, Soosaipillai A, Kulasingam V, Prassas I, Diamandis EP. Sensitive Serology Measurements in the Saliva of Individuals with COVID-19 Symptoms Using a Multiplexed Immunoassay. J Appl Lab Med 2022; 7:1354-1365. [PMID: 36179121 PMCID: PMC9619505 DOI: 10.1093/jalm/jfac073] [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: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Background There are numerous benefits to performing salivary serology measurements for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen for coronavirus disease 2019 (COVID-19). Here, we used a sensitive multiplex serology assay to quantitate salivary IgG against 4 SARS-CoV-2 antigens: nucleocapsid, receptor-binding domain, spike, and N-terminal domain. Methods We used single samples from 90 individuals with COVID-19 diagnosis collected at 0 to 42 days postsymptom onset (PSO) and from 15 uninfected control subjects. The infected individuals were segmented in 4 groups (0–7 days, 8–14 days, 15–21 days, and >21 days) based on days PSO, and values were compared to controls. Results Compared to controls, infected individuals showed higher levels of antibodies against all antigens starting from 8 days PSO. When applying cut-offs with at least 93.3% specificity at every time interval segment, nucleocapsid protein serology had the best sensitivity at 0 to 7 days PSO (60% sensitivity [35.75% to 80.18%], ROC area under the curve [AUC] = 0.73, P = 0.034). Receptor-binding domain serology had the best sensitivity at 8 to 14 days PSO (83.33% sensitivity [66.44%–92.66%], ROC AUC = 0.90, P < 0.0001), and all assays except for N-terminal domain had 92% sensitivity (75.03%–98.58%) at >14 days PSO. Conclusions This study shows that our multiplexed immunoassay can distinguish infected from uninfected individuals and reliably (93.3% specificity) detect seroconversion (in 60% of infected individuals) as early as the first week PSO, using easy-to-collect saliva samples.
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Affiliation(s)
- Dorsa Sohaei
- Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, ON , Canada
- Department of Clinical Biochemistry, University Health Network , Toronto, ON , Canada
| | - Antigona Ulndreaj
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, ON , Canada
| | - Anu Mathew
- Meso Scale Diagnostics, LLC , Rockville, MD , USA
| | | | | | - George Sigal
- Meso Scale Diagnostics, LLC , Rockville, MD , USA
| | - Jessica Joe
- Meso Scale Diagnostics, LLC , Rockville, MD , USA
| | | | | | - Annie Ren
- Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, ON , Canada
| | - Atefeh Ghorbani
- Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, ON , Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, ON , Canada
| | - Antoninus Soosaipillai
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, ON , Canada
| | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, ON , Canada
- Department of Clinical Biochemistry, University Health Network , Toronto, ON , Canada
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, ON , Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, ON , Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, ON , Canada
- Department of Clinical Biochemistry, University Health Network , Toronto, ON , Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital , Toronto, ON , Canada
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Jacobson TA, Kler JS, Bae Y, Chen J, Ladror DT, Iyer R, Nunes DA, Montgomery ND, Pleil JD, Funk WE. A state-of-the-science review and guide for measuring environmental exposure biomarkers in dried blood spots. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022:10.1038/s41370-022-00460-7. [PMID: 35963945 PMCID: PMC9375076 DOI: 10.1038/s41370-022-00460-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Dried blood spot (DBS) sampling is a simple, cost-effective, and minimally invasive alternative to venipuncture for measuring exposure biomarkers in public health and epidemiological research. DBS sampling provides advantages in field-based studies conducted in low-resource settings and in studies involving infants and children. In addition, DBS samples are routinely collected from newborns after birth (i.e., newborn dried blood spots, NDBS), with many states in the United States permitting access to archived NDBS samples for research purposes. OBJECTIVES We review the state of the science for analyzing exposure biomarkers in DBS samples, both archived and newly collected, and provide guidance on sample collection, storage, and blood volume requirements associated with individual DBS assays. We discuss recent progress regarding analytical methods, analytical sensitivity, and specificity, sample volume requirements, contamination considerations, estimating extracted blood volumes, assessing stability and analyte recovery, and hematocrit effects. METHODS A systematic search of PubMed (MEDLINE), Embase (Elsevier), and CINAHL (EBSCO) was conducted in March 2022. DBS method development and application studies were divided into three main chemical classes: environmental tobacco smoke, trace elements (including lead, mercury, cadmium, and arsenic), and industrial chemicals (including endocrine-disrupting chemicals and persistent organic pollutants). DBS method development and validation studies were scored on key quality-control and performance parameters by two members of the review team. RESULTS Our search identified 47 published reports related to measuring environmental exposure biomarkers in human DBS samples. A total of 28 reports (37 total studies) were on methods development and validation and 19 reports were primarily the application of previously developed DBS assays. High-performing DBS methods have been developed, validated, and applied for detecting environmental exposures to tobacco smoke, trace elements, and several important endocrine-disrupting chemicals and persistent organic pollutants. Additional work is needed for measuring cadmium, arsenic, inorganic mercury, and bisphenol A in DBS and NDBS samples. SIGNIFICANCE We present an inventory and critical review of available assays for measuring environmental exposure biomarkers in DBS and NDBS samples to help facilitate this sampling medium as an emerging tool for public health (e.g., screening programs, temporal biomonitoring) and environmental epidemiology (e.g., field-based studies).
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Affiliation(s)
- Tyler A Jacobson
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jasdeep S Kler
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yeunook Bae
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiexi Chen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel T Ladror
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ramsunder Iyer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise A Nunes
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan D Montgomery
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joachim D Pleil
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - William E Funk
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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McPhillips L, MacSharry J. Saliva as an alternative specimen to nasopharyngeal swabs for COVID-19 diagnosis: Review. Access Microbiol 2022; 4:acmi000366. [PMID: 36003360 PMCID: PMC9394527 DOI: 10.1099/acmi.0.000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/25/2022] [Indexed: 12/12/2022] Open
Abstract
Almost 2 years ago, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered to be the causative agent of the disease COVID-19. Subsequently, SARS-CoV-2 has spread across the world infecting millions of people, resulting in the ongoing COVID-19 pandemic. The current 'gold standard' for COVID-19 diagnosis involves obtaining a nasopharyngeal swab (NPS) from the patient and testing for the presence of SARS-CoV-2 RNA in the specimen using real-time reverse transcription PCR (RT-qPCR). However, obtaining a NPS specimen is an uncomfortable and invasive procedure for the patient and is limited in its applicability to mass testing. Interest in saliva as an alternative diagnostic specimen is of increasing global research interest due to its malleability to mass testing, greater patient acceptability and overall ease of specimen collection. However, the current literature surrounding the sensitivity of saliva compared to NPS is conflicting. The aim of this review was to analyse the recent literature to assess the viability of saliva in COVID-19 diagnosis. We hypothesize that the discrepancies in the current literature are likely due to the variations in the saliva collection and processing protocols used between studies. The universal adaptation of an optimised protocol could alleviate these discrepancies and see saliva specimens be as sensitive, if not more, than NPS for COVID-19 diagnosis. Whilst saliva specimens are more complimentary to mass-testing, with the possibility of samples being collected from home, the RT-qPCR diagnostic process remains to be the rate-limiting step and therefore interest in salivary rapid antigen tests, which negate the wait-times of RT-qPCR with results available within 15-30 min, may be an answer to this.
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Affiliation(s)
- Leah McPhillips
- School of Microbiology, University College Cork, Cork, Ireland
- Present address: Department of Molecular Microbiology, The John Innes Centre, Norwich, UK
| | - John MacSharry
- School of Microbiology, University College Cork, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
- The APC Microbiome Ireland, University College Cork, Cork, Ireland
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6
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Abraha I, Eusebi P, Germani A, Pasquarelli E, Pascolini S, Antonietti R, Argenti S, Fioravanti A, Martini E, Aristei L, Mancinelli P, Ottaviani ML, Roselli M, Barzacca M, Belardinelli E, Micheli M. Temporal trends and differences of SARS-CoV-2-specific antibody responses in symptomatic and asymptomatic subjects: a longitudinal study from Umbria in Italy. BMJ Open 2022; 12:e056370. [PMID: 35851013 PMCID: PMC9296997 DOI: 10.1136/bmjopen-2021-056370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Dynamics of antibody responses following SARS-CoV-2 infection are controversial in terms of immunity and persistence. We aimed to assess longitudinally the trend of antibody serological titres, their correlation with clinical severity as well as clinical reinfection during a follow-up. DESIGN Longitudinal cohort, 12 months follow-up study. SETTING USL Umbria 2. PARTICIPANTS Consecutive subjects aged 15-75 who were discharged with the diagnosis of Sars-Cov-2 from the hospitals of the AUSL Umbria 2, or resulted positive to a PCR test for SARS-CoV-2 infection with or without symptoms were recruited. SARS-CoV-2 serological testing for antibodies targeting the Nucleocapside and Spike proteins were determined. RESULTS Of 184 eligible subjects, 149 were available for evaluation: 17 were classified as oligo/asymptomatic, 107 as symptomatic, 25 as hospital admitted. Participants differed in terms of signs and symptoms as well as treatment. Overall there was a significant difference in terms of antibody titres between groups (anti-S: p<0.00; anti-N: p=0.019). Median anti-S titres in the symptomatic and hospital admitted participants were significantly higher compared with the oligo/asymptomatic participants. During follow-up, the median titre of anti-S antibodies did not show significant variations (p=0.500) and the difference within groups remained constant overtime. Subjects that showed an anti-S titre above the threshold of 12 U/mL were 88.7% at first visit and 88.2% at last follow-up. Anti-N values were higher in the hospital admitted participants compared with the other two groups. Anti-N titre reduced constantly overtime (p<0.001) and across the three groups of participants. The percentage of the subjects with serological titre above threshold (<1.4 U/mL) decreased from 74.5%% to 29.2% (p<0.001). None of the participants developed clinically evident reinfection. CONCLUSION Anti-N and anti-S correlate well with clinical severity. While anti-N declines overtime, anti-S antibodies persist for at least 1 year.
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Affiliation(s)
- Iosief Abraha
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Paolo Eusebi
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonella Germani
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Erica Pasquarelli
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Sofia Pascolini
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Rossana Antonietti
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Sandro Argenti
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Alessandra Fioravanti
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Elisa Martini
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Luana Aristei
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Paola Mancinelli
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | | | - Martina Roselli
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Milena Barzacca
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Erika Belardinelli
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Marta Micheli
- Servizio Immunotrasfusionale, Azienda Unità Sanitaria Locale Umbria 2, Foligno (PG), Italy
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Nelson KN, Siegler AJ, Sullivan PS, Bradley H, Hall E, Luisi N, Hipp-Ramsey P, Sanchez T, Shioda K, Lopman BA. Nationally representative social contact patterns among U.S. adults, August 2020-April 2021. Epidemics 2022; 40:100605. [PMID: 35810698 PMCID: PMC9242729 DOI: 10.1016/j.epidem.2022.100605] [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: 09/17/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
The response to the COVID-19 pandemic in the U.S prompted abrupt and dramatic changes to social contact patterns. Monitoring changing social behavior is essential to provide reliable input data for mechanistic models of infectious disease, which have been increasingly used to support public health policy to mitigate the impacts of the pandemic. While some studies have reported on changing contact patterns throughout the pandemic, few have reported differences in contact patterns among key demographic groups and none have reported nationally representative estimates. We conducted a national probability survey of US households and collected information on social contact patterns during two time periods: August-December 2020 (before widespread vaccine availability) and March-April 2021 (during national vaccine rollout). Overall, contact rates in Spring 2021 were similar to those in Fall 2020, with most contacts reported at work. Persons identifying as non-White, non-Black, non-Asian, and non-Hispanic reported high numbers of contacts relative to other racial and ethnic groups. Contact rates were highest in those reporting occupations in retail, hospitality and food service, and transportation. Those testing positive for SARS-CoV-2 antibodies reported a higher number of daily contacts than those who were seronegative. Our findings provide evidence for differences in social behavior among demographic groups, highlighting the profound disparities that have become the hallmark of the COVID-19 pandemic.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA.
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, USA
| | - Eric Hall
- School of Public Health, Oregon Health & Science University, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Palmer Hipp-Ramsey
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, USA
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8
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Zhao Z, Li R, Ma Y, Islam I, Rajper AMA, Song W, Ren H, Tse ZTH. Supporting Technologies for COVID-19 Prevention: Systemized Review. JMIRX MED 2022; 3:e30344. [PMID: 35695850 PMCID: PMC9168838 DOI: 10.2196/30344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022]
Abstract
Background
During COVID-19, clinical and health care demands have been on the rapid rise. Major challenges that have arisen during the pandemic have included a lack of testing kits, shortages of ventilators to treat severe cases of COVID-19, and insufficient accessibility to personal protective equipment for both hospitals and the public. New technologies have been developed by scientists, researchers, and companies in response to these demands.
Objective
The primary objective of this review is to compare different supporting technologies in the subjugation of the COVID-19 spread.
Methods
In this paper, 150 news articles and scientific reports on COVID-19–related innovations during 2020-2021 were checked, screened, and shortlisted to yield a total of 23 articles for review. The keywords “COVID-19 technology,” “COVID-19 invention,” and “COVID-19 equipment” were used in a Google search to generate related news articles and scientific reports. The search was performed on February 1, 2021. These were then categorized into three sections, which are personal protective equipment (PPE), testing methods, and medical treatments. Each study was analyzed for its engineering characteristics and potential social impact on the COVID-19 pandemic.
Results
A total of 9 articles were selected for review concerning PPE. In general, the design and fabrication of PPE were moving toward the direction of additive manufacturing and intelligent information feedback while being eco-friendly. Moreover, 8 articles were selected for reviewing testing methods within the two main categories of molecular and antigen tests. All the inventions endeavored to increase sensitivity while reducing the turnaround time. However, the inventions reported in this review paper were not sufficiently tested for their safety and efficiency. Most of the inventions are temporary solutions intended to be used only during shortages of medical resources. Finally, 6 articles were selected for the review of COVID-19 medical treatment. The major challenge identified was the uncertainty in applying novel ideas to speed up the production of ventilators.
Conclusions
The technologies developed during the COVID-19 pandemic were considered for review. In order to better respond to future pandemics, national reserves of critical medical supplies should be increased to improve preparation. This pandemic has also highlighted the need for the automation and optimization of medical manufacturing.
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Affiliation(s)
- Zhuo Zhao
- School of Electrical and Computer Engineering University of Georgia Athens, GA United States
| | - Rui Li
- Tandon School of Engineering New York University Brooklyn, NY United States
| | - Yangmyung Ma
- Hull York Medical School University of York Heslington York United Kingdom
| | - Iman Islam
- Hull York Medical School University of York Heslington York United Kingdom
| | | | - WenZhan Song
- Department of Computer Science University of Georgia Athens, GA United States
| | - Hongliang Ren
- Department of Biomedical Engineering National University of Singapore Singapore Singapore
| | - Zion Tsz Ho Tse
- Department of Electronic Engineering University of York York United Kingdom
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9
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Sullivan PS, Siegler AJ, Shioda K, Hall EW, Bradley H, Sanchez T, Luisi N, Valentine-Graves M, Nelson KN, Fahimi M, Kamali A, Sailey C, Lopman BA. Severe Acute Respiratory Syndrome Coronavirus 2 Cumulative Incidence, United States, August 2020-December 2020. Clin Infect Dis 2022. [PMID: 34245245 DOI: 10.1093/cid/ciab626.pmid:34245245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a national probability survey of US households to estimate cumulative incidence adjusted for antibody waning. METHODS From August-December 2020 a random sample of US addresses were mailed a survey and self-collected nasal swabs and dried blood spot cards. One adult household member completed the survey and mail specimens for viral detection and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a commercial, emergency use authorization-approved antigen capture assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning antibodies and calculated reported fraction (RF) and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored. RESULTS Among 39 500 sampled households, 4654 respondents provided responses. Cumulative incidence adjusted for waning was 11.9% (95% credible interval [CrI], 10.5%-13.5%) as of 30 October 2020. We estimated 30 332 842 (CrI, 26 703 753-34 335 338) total infections in the US adult population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults. Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were more likely than White non-Hispanics to be seropositive. CONCLUSIONS One in 8 US adults had been infected with SARS-CoV-2 by October 2020; however, few had been accounted for in public health reporting. The COVID-19 pandemic is likely substantially underestimated by reported cases. Disparities in COVID-19 by race observed among reported cases cannot be attributed to differential diagnosis or reporting of infections in population subgroups.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kamali
- California Department of Public Health, Sacramento, California, USA
| | | | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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10
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Nelson KN, Siegler AJ, Sullivan PS, Bradley H, Hall E, Luisi N, Hipp-Ramsey P, Sanchez T, Shioda K, Lopman BA. Nationally Representative Social Contact Patterns among U.S. adults, August 2020-April 2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.09.22.21263904. [PMID: 35378746 PMCID: PMC8978954 DOI: 10.1101/2021.09.22.21263904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The response to the COVID-19 pandemic in the U.S prompted abrupt and dramatic changes to social contact patterns. Monitoring changing social behavior is essential to provide reliable input data for mechanistic models of infectious disease, which have been increasingly used to support public health policy to mitigate the impacts of the pandemic. While some studies have reported on changing contact patterns throughout the pandemic., few have reported on differences in contact patterns among key demographic groups and none have reported nationally representative estimates. We conducted a national probability survey of US households and collected information on social contact patterns during two time periods: August-December 2020 (before widespread vaccine availability) and March-April 2021 (during national vaccine rollout). Overall, contact rates in Spring 2021 were similar to those in Fall 2020, with most contacts reported at work. Persons identifying as non-White, non-Black, non-Asian, and non-Hispanic reported high numbers of contacts relative to other racial and ethnic groups. Contact rates were highest in those reporting occupations in retail, hospitality and food service, and transportation. Those testing positive for SARS-CoV-2 antibodies reported a higher number of daily contacts than those who were seronegative. Our findings provide evidence for differences in social behavior among demographic groups, highlighting the profound disparities that have become the hallmark of the COVID-19 pandemic.
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Affiliation(s)
- Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health
| | - Eric Hall
- School of Public Health, Oregon Health & Science University
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | | | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University
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11
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Kraay ANM, Nelson KN, Zhao CY, Demory D, Weitz JS, Lopman BA. Modeling serological testing to inform relaxation of social distancing for COVID-19 control. Nat Commun 2021; 12:7063. [PMID: 34862373 PMCID: PMC8642547 DOI: 10.1038/s41467-021-26774-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 10/19/2021] [Indexed: 01/24/2023] Open
Abstract
Serological testing remains a passive component of the public health response to the COVID-19 pandemic. Using a transmission model, we examine how serological testing could have enabled seropositive individuals to increase their relative levels of social interaction while offsetting transmission risks. We simulate widespread serological testing in New York City, South Florida, and Washington Puget Sound and assume seropositive individuals partially restore their social contacts. Compared to no intervention, our model suggests that widespread serological testing starting in late 2020 would have averted approximately 3300 deaths in New York City, 1400 deaths in South Florida and 11,000 deaths in Washington State by June 2021. In all sites, serological testing blunted subsequent waves of transmission. Findings demonstrate the potential benefit of widespread serological testing, had it been implemented in the pre-vaccine era, and remain relevant now amid the potential for emergence of new variants.
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Affiliation(s)
- Alicia N M Kraay
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Kristin N Nelson
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Conan Y Zhao
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
- Interdisciplinary Graduate Program in Quantitative Biosciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - David Demory
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joshua S Weitz
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
- School of Physics, Georgia Institute of Technology, Atlanta, GA, USA
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12
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Heaney CD, Pisanic N, Randad PR, Kruczynski K, Howard T, Zhu X, Littlefield K, Patel EU, Shrestha R, Laeyendecker O, Shoham S, Sullivan D, Gebo K, Hanley D, Redd AD, Quinn TC, Casadevall A, Zenilman JM, Pekosz A, Bloch EM, Tobian AAR. Comparative performance of multiplex salivary and commercially available serologic assays to detect SARS-CoV-2 IgG and neutralization titers. J Clin Virol 2021; 145:104997. [PMID: 34695724 PMCID: PMC8502080 DOI: 10.1016/j.jcv.2021.104997] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 10/03/2021] [Indexed: 02/01/2023]
Abstract
Oral fluid (hereafter saliva) offers a non-invasive sampling method for detection of SARS-CoV-2 antibodies. However, data comparing performance of salivary tests against commercially-available serologic and neutralizing antibody (nAb) assays are lacking. This study compared the performance of a laboratory-developed multiplex salivary SARS-CoV-2 IgG assay targeting antibodies to nucleocapsid (N), receptor binding domain (RBD) and spike (S) antigens to three commercially-available SARS-CoV-2 serologic enzyme immunoassays (EIAs) (Ortho Vitros, Euroimmun, and BioRad) and nAb. Paired saliva and plasma samples were collected from 101 eligible COVID-19 convalescent plasma (CCP) donors >14 days since PCR+ confirmed diagnosis. Concordance was evaluated using positive (PPA) and negative (NPA) percent agreement, and Cohen's kappa coefficient. The range between salivary and plasma EIAs for SARS-CoV-2-specific N was PPA: 54.4-92.1% and NPA: 69.2-91.7%, for RBD was PPA: 89.9-100% and NPA: 50.0-84.6%, and for S was PPA: 50.6-96.6% and NPA: 50.0-100%. Compared to a plasma nAb assay, the multiplex salivary assay PPA ranged from 62.3% (N) and 98.6% (RBD) and NPA ranged from 18.8% (RBD) to 96.9% (S). Combinations of N, RBD, and S and a summary algorithmic index of all three (N/RBD/S) in saliva produced ranges of PPA: 87.6-98.9% and NPA: 50-91.7% with the three EIAs and ranges of PPA: 88.4-98.6% and NPA: 21.9-34.4% with the nAb assay. A multiplex salivary SARS-CoV-2 IgG assay demonstrated variable, but comparable performance to three commercially-available plasma EIAs and a nAb assay, and may be a viable alternative to assist in monitoring population-based seroprevalence and vaccine antibody response.
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Affiliation(s)
- Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Pranay R Randad
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Tyrone Howard
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kirsten Littlefield
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Zenilman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA; Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Chamberlain AT, Toomey KE, Bradley H, Hall EW, Fahimi M, Lopman BA, Luisi N, Sanchez T, Drenzek C, Shioda K, Siegler AJ, Sullivan PS. Cumulative incidence of SARS-CoV-2 infections among adults in Georgia, USA, August-December 2020. J Infect Dis 2021; 225:396-403. [PMID: 34662409 PMCID: PMC8807152 DOI: 10.1093/infdis/jiab522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reported COVID-19 cases underestimate true SARS-CoV-2 infections. Data on all infections, including asymptomatic infections, are needed to guide programs. To minimize biases in estimates from reported cases and seroprevalence surveys, we conducted a household-based probability survey in Georgia and estimated cumulative incidence of SARS-CoV-2 infections adjusted for antibody waning. METHODS From August to December 2020, we mailed specimen collection kits (nasal swabs and blood spots) to a random sample of Georgia addresses. One household adult completed a survey and returned specimens for virus and antibody testing. We estimated cumulative incidence of SARS-CoV-2 infections adjusted for waning antibodies, reported fraction, and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic and clinical subgroups were explored with weighted prevalence ratios (PR). RESULTS Among 1,370 participants, adjusted cumulative incidence of SARS-CoV-2 was 16.1% (95% credible interval (CrI): 13.5-19.2%) as of November 16, 2020. The reported fraction was 26.6% and IFR was 0.78%. Non-Hispanic Black (PR: 2.03, CI 1.0, 4.1) and Hispanic adults (PR: 1.98, CI 0.74, 5.31) were more likely than non-Hispanic White adults to be seropositive. CONCLUSIONS As of mid-November 2020, one in 6 adults in Georgia had been infected with SARS-CoV-2. The COVID-19 epidemic in Georgia is likely substantially underestimated by reported cases.
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Affiliation(s)
- Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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14
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Pinilla YT, Friessinger E, Griesbaum JM, Berner L, Heinzel C, Elsner K, Fendel R, Held J, Kreidenweiss A. Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy). JMIR Res Protoc 2021; 10:e27739. [PMID: 34533472 PMCID: PMC8510152 DOI: 10.2196/27739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. OBJECTIVE This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. METHODS SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2-antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). RESULTS The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. CONCLUSIONS Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2-antibody measurement allows for a unique, representative, population-based sample collection process. TRIAL REGISTRATION ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27739.
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Affiliation(s)
- Yudi T Pinilla
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Evelyn Friessinger
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Lilith Berner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Constanze Heinzel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Käthe Elsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Rolf Fendel
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jana Held
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, partner site Tübingen, Tübingen, Germany
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15
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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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16
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Duś-Ilnicka I, Krala E, Cholewińska P, Radwan-Oczko M. The Use of Saliva as a Biosample in the Light of COVID-19. Diagnostics (Basel) 2021; 11:1769. [PMID: 34679467 PMCID: PMC8534561 DOI: 10.3390/diagnostics11101769] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Saliva is easy to collect and a biofluid that is readily available without the need for special equipment for its collection. The collection process, which is non-invasive and inexpensive, leads to obtaining a biomaterial that can serve as a source of information for molecular diagnostics of diseases in general medicine, genetics and dentistry. Unfortunately, many of the salivary methodologies are lacking important parameters to provide for not only the safety of the operator, but also the quality and reproducibility of the research. Since the COVID-19 pandemic, salivary diagnostics demonstrate a great potential for research of SARS-CoV 2. In this review, good practice for unstimulated saliva collection and patient preparation was provided, based on the latest literature and available guidelines. Schemes for saliva collection procedures were presented following an extended literature search. Descriptions of salivary probes/cups, techniques of saliva collection, and the use of specific buffering solutions for the stability of collected samples for SARS-CoV-2 detection were also evaluated.
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Affiliation(s)
- Irena Duś-Ilnicka
- Oral Pathology Department, Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 50-425 Wroclaw, Poland; (E.K.); (M.R.-O.)
| | - Elżbieta Krala
- Oral Pathology Department, Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 50-425 Wroclaw, Poland; (E.K.); (M.R.-O.)
| | - Paulina Cholewińska
- Institute of Animal Breeding, Faculty of Biology and Animal Breeding, Wroclaw University of Enviromental and Life Sciences, ul. Chełmońskiego 38C, 51-630 Wroclaw, Poland;
| | - Małgorzata Radwan-Oczko
- Oral Pathology Department, Faculty of Dentistry, Wroclaw Medical University, ul. Krakowska 26, 50-425 Wroclaw, Poland; (E.K.); (M.R.-O.)
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Khiabani K, Amirzade-Iranaq MH. Are saliva and deep throat sputum as reliable as common respiratory specimens for SARS-CoV-2 detection? A systematic review and meta-analysis. Am J Infect Control 2021; 49:1165-1176. [PMID: 33774101 PMCID: PMC7987587 DOI: 10.1016/j.ajic.2021.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The COVID-19 pandemic raises an urgent need for large-scale control through easier, cheaper, and safer diagnostic specimens, including saliva and sputum. We aimed to conduct a systemic review and meta-analysis on the reliability and sensitivity of SARS-CoV-2 detection in saliva and deep throat sputum (DTS) compared to nasopharyngeal, combined naso/oropharyngeal, and oropharyngeal swabs. METHODS This systematic review and meta-analysis was performed according to the PRISMA statement. The inclusion criteria were studies that specifically assessed a sample of saliva or DTS with at least one other respiratory specimen in patients with COVID-19 infection, based on RT-PCR tests. The DerSimonian-Laird bivariate random-effects model analysis performed using STATA software with the "metaprop" package. RESULTS From 1598 studies, we retrieved 33 records, of which 26 studies were included for quantitative analysis. We found an overall sensitivity of 97% (95% confidence interval [CI], 86-100) for bronchoalveolar lavage fluid, 92% (95% CI, 80-99) for double naso/oropharyngeal swabs, 87% (95% CI, 77-95) for nasopharyngeal swabs, 83% (95% CI, 77-89) for saliva, 82% (95% CI, 76-88) for DTS, and 44% (95% CI, 35-52) for oropharyngeal swabs among symptomatic patients, respectively. Regardless of the type of specimens, the viral load and sensitivity in the severe patients were higher than mild and in the symptomatic patients higher than asymptomatic cases. CONCLUSIONS The present review provides evidence for the diagnostic value of different respiratory specimens and supports saliva and DTS as promising diagnostic tools for first-line screening of SARS-CoV-2 infection. However, the methods of sampling, storing, and laboratory assay need to be optimized and validated before introducing as a definitive diagnosis tool. Saliva, DTS, and nasopharyngeal swab showed approximately similar results, and sensitivity was directly related to the disease severity. This review revealed a relationship between viral load, disease severity, and test sensitivity. None of the specimens showed appropriate diagnostic sensitivity for asymptomatic patients.
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18
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Maritz L, Woudberg NJ, Bennett AC, Soares A, Lapierre F, Devine J, Kimberg M, Bouic PJ. Validation of high-throughput, semiquantitative solid-phase SARS coronavirus-2 serology assays in serum and dried blood spot matrices. Bioanalysis 2021; 13:1183-1193. [PMID: 34114884 PMCID: PMC8202508 DOI: 10.4155/bio-2021-0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 12/12/2022] Open
Abstract
Aim: Serological assays for the detection of anti-SARS coronavirus-2 (SARS-CoV-2) antibodies are essential to the response to the global pandemic. A ligand binding-based serological assay was validated for the semiquantitative detection of IgG, IgM, IgA and neutralizing antibodies (nAb) against SARS-CoV-2 in serum. Results: The assay demonstrated high levels of diagnostic specificity and sensitivity (85-99% for all analytes). Serum IgG, IgM, IgA and nAb correlated positively (R2 = 0.937, R2 = 0.839, R2 = 0.939 and R2 = 0.501, p < 0.001, respectively) with those measured in dried blood spot samples collected using the hemaPEN® microsampling device (Trajan Scientific and Medical, Victoria, Australia). In vitro SARS-CoV-2 pseudotype neutralization correlated positively with the solid phase nAb signals in convalescent donors (R2 = 0.458, p < 0.05). Conclusion: The assay is applicable in efficacy studies, infection monitoring and postmarketing surveillance following vaccine rollout.
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Affiliation(s)
- Leo Maritz
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Nicholas J Woudberg
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Amber C Bennett
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Andreia Soares
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Florian Lapierre
- Trajan Scientific & Medical, 7 Argent Place, Ringwood, Victoria, 3134, Australia
| | - Justin Devine
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Matti Kimberg
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
| | - Patrick J Bouic
- Synexa Life Sciences, 4 Kunene Circle, Montague Gardens, Cape Town, 7441, South Africa
- Division of Medical Microbiology, Faculty of Medicine & Health Sciences, University of Stellenbosch, Cape Town, 7505, South Africa
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19
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Lamba K, Bradley H, Shioda K, Sullivan PS, Luisi N, Hall EW, Mehrotra ML, Lim E, Jain S, Kamali A, Sanchez T, Lopman BA, Fahimi M, Siegler AJ. SARS-CoV-2 Cumulative Incidence and Period Seroprevalence: Results From a Statewide Population-Based Serosurvey in California. Open Forum Infect Dis 2021; 8:ofab379. [PMID: 34377733 PMCID: PMC8339610 DOI: 10.1093/ofid/ofab379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background California has reported the largest number of coronavirus disease 2019 (COVID-19) cases of any US state, with more than 3.5 million confirmed as of March 2021. However, the full breadth of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in California is unknown as reported cases only represent a fraction of all infections. Methods We conducted a population-based serosurvey, utilizing mailed, home-based SARS-CoV-2 antibody testing along with a demographic and behavioral survey. We weighted data from a random sample to represent the adult California population and estimated period seroprevalence overall and by participant characteristics. Seroprevalence estimates were adjusted for waning antibodies to produce statewide estimates of cumulative incidence, the infection fatality ratio (IFR), and the reported fraction. Results California's SARS-CoV-2 weighted seroprevalence during August-December 2020 was 4.6% (95% CI, 2.8%-7.4%). Estimated cumulative incidence as of November 2, 2020, was 8.7% (95% CrI, 6.4%-11.5%), indicating that 2 660 441 adults (95% CrI, 1 959 218-3 532 380) had been infected. The estimated IFR was 0.8% (95% CrI, 0.6%-1.0%), and the estimated percentage of infections reported to the California Department of Public Health was 31%. Disparately high risk for infection was observed among persons of Hispanic/Latinx ethnicity and people with no health insurance and who reported working outside the home. Conclusions We present the first statewide SARS-CoV-2 cumulative incidence estimate among adults in California. As of November 2020, ~1 in 3 SARS-CoV-2 infections in California adults had been identified by public health surveillance. When accounting for unreported SARS-CoV-2 infections, disparities by race/ethnicity seen in case-based surveillance persist.
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Affiliation(s)
- Katherine Lamba
- California Department of Public Health, Richmond, California, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Megha L Mehrotra
- California Department of Public Health, Richmond, California, USA
| | - Esther Lim
- California Department of Public Health, Richmond, California, USA
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA
| | - Amanda Kamali
- California Department of Public Health, Richmond, California, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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20
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Role of Laboratory Medicine in SARS-CoV-2 Diagnostics. Lessons Learned from a Pandemic. Healthcare (Basel) 2021; 9:healthcare9070915. [PMID: 34356292 PMCID: PMC8303636 DOI: 10.3390/healthcare9070915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022] Open
Abstract
Since the 2019 novel coronavirus outbreak began in Wuhan, China, diagnostic methods in the field of molecular biology have been developing faster than ever under the vigilant eye of world's research community. Unfortunately, the medical community was not prepared for testing such large volumes or ranges of biological materials, whether blood samples for antibody immunological testing, or salivary/swab samples for real-time PCR. For this reason, many medical diagnostic laboratories have made the switch to working in the field of molecular biology, and research undertaken to speed up the flow of samples through laboratory. The aim of this narrative review is to evaluate the current literature on laboratory techniques for the diagnosis of SARS-CoV-2 infection available on pubmed.gov, Google Scholar, and according to the writers' knowledge and experience of the laboratory medicine. It assesses the available information in the field of molecular biology by comparing real-time PCR, LAMP technique, RNA sequencing, and immunological diagnostics, and examines the newest techniques along with their limitations for use in SARS-CoV-2 diagnostics.
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21
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Sullivan PS, Siegler AJ, Shioda K, Hall EW, Bradley H, Sanchez T, Luisi N, Valentine-Graves M, Nelson KN, Fahimi M, Kamali A, Sailey C, Lopman BA. SARS-CoV-2 cumulative incidence, United States, August-December 2020. Clin Infect Dis 2021; 74:1141-1150. [PMID: 34245245 PMCID: PMC8406864 DOI: 10.1093/cid/ciab626] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a
national probability survey of US households to estimate cumulative
incidence adjusted for antibody waning. Methods From August–December 2020 a random sample of US addresses were mailed a
survey and self-collected nasal swabs and dried blood spot cards. One adult
household member completed the survey and mail specimens for viral detection
and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a
commercial, emergency use authorization–approved antigen capture
assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning
antibodies and calculated reported fraction (RF) and infection fatality
ratio (IFR). Differences in seropositivity among demographic, geographic,
and clinical subgroups were explored. Results Among 39 500 sampled households, 4654 respondents provided responses.
Cumulative incidence adjusted for waning was 11.9% (95% credible interval
[CrI], 10.5%–13.5%) as of 30 October 2020. We estimated 30 332 842
(CrI, 26 703 753–34 335 338) total infections in the US adult
population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults.
Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were
more likely than White non-Hispanics to be seropositive. Conclusions One in 8 US adults had been infected with SARS-CoV-2 by October 2020;
however, few had been accounted for in public health reporting. The COVID-19
pandemic is likely substantially underestimated by reported cases.
Disparities in COVID-19 by race observed among reported cases cannot be
attributed to differential diagnosis or reporting of infections in
population subgroups.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kayoko Shioda
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Eric W Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin N Nelson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kamali
- California Department of Public Health, Sacramento, California, USA (Kamali)
| | - Charles Sailey
- Molecular Testing Labs, Vancouver, Washington, USA (Sailey)
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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22
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Hemida MG. The next-generation coronavirus diagnostic techniques with particular emphasis on the SARS-CoV-2. J Med Virol 2021; 93:4219-4241. [PMID: 33751621 PMCID: PMC8207115 DOI: 10.1002/jmv.26926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022]
Abstract
The potential zoonotic coronaviruses (SARS-CoV, MERS-CoV, and SARS-CoV-2) are of global health concerns. Early diagnosis is the milestone in their mitigation, control, and eradication. Many diagnostic techniques are showing great success and have many advantages, such as the rapid turnover of the results, high accuracy, and high specificity and sensitivity. However, some of these techniques have several pitfalls if samples were not collected, processed, and transported in the standard ways and if these techniques were not practiced with extreme caution and precision. This may lead to false-negative/positive results. This may affect the downstream management of the affected cases. These techniques require regular fine-tuning, upgrading, and optimization. The continuous evolution of new strains and viruses belong to the coronaviruses is hampering the success of many classical techniques. There are urgent needs for next generations of coronaviruses diagnostic assays that overcome these pitfalls. This new generation of diagnostic tests should be able to do simultaneous, multiplex, and high-throughput detection of various coronavirus in one reaction. Furthermore, the development of novel assays and techniques that enable the in situ detection of the virus on the environmental samples, especially air, water, and surfaces, should be given considerable attention in the future. These approaches will have a substantial positive impact on the mitigation and eradication of coronaviruses, including the current SARS-CoV-2 pandemic.
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Affiliation(s)
- Maged G. Hemida
- Department of Microbiology, College of Veterinary MedicineKing Faisal UniversityAl AhsaSaudi Arabia
- Department of Virology, Faculty of Veterinary MedicineKafrelsheikh UniversityKafr ElsheikhEgypt
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23
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Sagredo-Olivares K, Morales-Gómez C, Aitken-Saavedra J. Evaluation of saliva as a complementary technique to the diagnosis of COVID-19: a systematic review. Med Oral Patol Oral Cir Bucal 2021; 26:e526-e532. [PMID: 33609022 PMCID: PMC8254882 DOI: 10.4317/medoral.24424] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/01/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Infectious disease coronavirus 2019 (COVID-19) is caused by the SARS-CoV-2 virus, and it mainly affects the upper respiratory tract. The gold standard for its diagnosis is real-time reverse transcription polymerase chain reaction (RT-qPCR) performed on a nasopharyngeal swab. In contrast, testing saliva has significant advantages as a diagnostic method. MATERIAL AND METHODS We searched for articles evaluating saliva as a diagnostic method for COVID-19 on the PUBMED/MEDLINE, WEB OF SCIENCE, COCHRANE, and SCIELO platforms. We initially found 233 articles and 20 were selected for inclusion following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol: 18 cross-sectional studies and 2 case reports, including 8 from America, 8 from Asia, and 4 from Europe. The studies evaluated the presence of viral RNA, IgG, IgM, and IgA in samples of unstimulated saliva from adults with confirmed or suspected COVID-19. The vast majority of the studies performed RT-qPCR on the saliva samples and compared the results with the gold standard (a nasopharyngeal swab of the same patient). RESULTS Saliva samples analyzed by RT-qPCR, reverse transcription isothermal amplification (RT-LAMP), spectroscopy, and enzyme-linked immunosorbent assay (ELISA) offer high sensitivity to detect SARS-CoV-2 in the early stages of the disease and among asymptomatic patients as compared to nasopharyngeal swab RT-qPCR. In addition, the self-collection of saliva offers the possibility of receiving telemedicine instructions to carry out the test, reducing the risk of contagion. CONCLUSIONS The diagnosis of COVID-19 through saliva is sensitive, non-invasive, and is of low risk for the healthcare professionals. However, further studies are recommended to validate its clinical use.
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24
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Rajadhyaksha M, Londhe V. Microsampling: A role to play in Covid-19 diagnosis, surveillance, treatment and clinical trials. Drug Test Anal 2021; 13:1238-1248. [PMID: 34089576 DOI: 10.1002/dta.3107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
The outbreak of the new coronavirus disease changed the world upside down. Every day, millions of people were subjected to diagnostic testing for Covid-19, all over the world. Molecular tests helped in the diagnosis of current infection by detecting the presence of viral genome whereas serological tests helped in detecting the presence of antibody in blood as well as contributed to vaccine development. This testing helped in understanding the immunogenicity, community prevalence, geographical spread and conditions post-infection. However, with the contagious nature of the virus, biological specimen sampling involved the risk of transmission and spread of infection. Clinic or pathology visit was the most concerning part. Trained personnel and resources was another barrier. In this scenario, microsampling played an important role due to its most important advantage of remote, contactless, small volume and self-sampling. Minimum requirements for sample storage and ease of shipment added value in this situation. The highly sensitive instruments and validated assay formats assured the accuracy of results and stability of samples. Microsampling techniques are contributing effectively to the Covid-19 pandemic by reducing the demand for clinical staff in population-level testing. The validated and established applications supported the use of microsampling in diagnosis, therapeutic drug monitoring, development of treatment or vaccines and clinical trials for Covid-19.
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Affiliation(s)
- Madhura Rajadhyaksha
- SPPSPTM, SVKM's Narsee Monjee Institute of Management Studies, Mumbai, India.,Sitec Labs. Ltd., Navi Mumbai, India
| | - Vaishali Londhe
- SPPSPTM, SVKM's Narsee Monjee Institute of Management Studies, Mumbai, India
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25
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Atieh MA, Guirguis M, Alsabeeha NHM, Cannon RD. The diagnostic accuracy of saliva testing for SARS-CoV-2: A systematic review and meta-analysis. Oral Dis 2021; 28 Suppl 2:2347-2361. [PMID: 34080272 PMCID: PMC8242702 DOI: 10.1111/odi.13934] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Early detection of coronavirus disease 2019 (COVID-19) is paramount for controlling the progression and spread of the disease. Currently, nasopharyngeal swabbing (NPS) is the standard method for collecting specimens. Saliva was recently proposed as an easy and safe option with many authorities adopting the methodology despite the limited evidence of efficacy. OBJECTIVES The aim of this review was to systematically evaluate the current literature on the use of saliva test for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and carry out a meta-analysis to determine its diagnostic accuracy. MATERIALS AND METHODS Prospective studies were searched for in electronic databases, complemented by hand-searching relevant journals. The risk of bias and applicability were assessed using the revised Quality Assessment of Studies of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analyses and meta-regression modeling were performed to calculate the diagnostic accuracy and examine sources of heterogeneity. RESULTS A total of 16 studies were included with 2928 paired samples. The overall meta-analysis showed a high sensitivity and specificity for saliva test at 0.88 (95% CI 0.82-0.92) and 0.92 (95% CI 0.75-0.98), respectively. The diagnostic odds ratio was calculated at 87 (95% CI 19-395) and area under the curve was calculated as 0.92 (95% CI 0.90-0.94) suggesting very good performance of the saliva tests in detecting SARS-CoV-2. CONCLUSION Saliva testing has a very good discriminative and diagnostic ability to detect of SARS-CoV-2. Additional large and well-designed prospective studies are needed to further validate the diagnostic accuracy and determine a safe sample collection method prior to its recommendation for mass application. CLINICAL RELEVANCE Saliva demonstrated high sensitivity and specificity. The use of saliva will allow for self-collection of specimens and specimen collection in outpatient and community clinics.
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Affiliation(s)
- Momen A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates.,Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Marina Guirguis
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Nabeel H M Alsabeeha
- Prosthetic Section, Ras Al-Khaimah Dental Center, Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Richard D Cannon
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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26
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Brinc D, Biondi MJ, Li D, Sun H, Capraru C, Smookler D, Zahoor MA, Casey J, Kulasingam V, Feld JJ. Evaluation of Dried Blood Spot Testing for SARS-CoV-2 Serology Using a Quantitative Commercial Assay. Viruses 2021; 13:962. [PMID: 34067361 PMCID: PMC8224688 DOI: 10.3390/v13060962] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/10/2021] [Accepted: 05/19/2021] [Indexed: 12/22/2022] Open
Abstract
Dried blood spots (DBS) are commonly used for serologic testing for viruses and provide an alternative collection method when phlebotomy and/or conventional laboratory testing are not readily available. DBS collection could be used to facilitate widespread testing for SARS-CoV-2 antibodies to document past infection, vaccination, and potentially immunity. We investigated the characteristics of Roche's Anti-SARS-CoV-2 (S) assay, a quantitative commercial assay for antibodies against the spike glycoprotein. Antibody levels were reduced relative to plasma following elution from DBS. Quantitative results from DBS samples were highly correlated with values from plasma (r2 = 0.98), allowing for extrapolation using DBS results to accurately estimate plasma antibody levels. High concordance between plasma and fingerpick DBS was observed in PCR-confirmed COVID-19 patients tested 90 days or more after the diagnosis (45/46 matched; 1/46 mismatched plasma vs. DBS). The assessment of antibody responses to SARS-CoV-2 using DBS may be feasible using a quantitative anti-S assay, although false negatives may rarely occur in those with very low antibody levels.
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Affiliation(s)
- Davor Brinc
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.B.); (V.K.)
- Department of Clinical Biochemistry, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Mia J. Biondi
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
| | - Daniel Li
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Heng Sun
- Department of Clinical Biochemistry, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Camelia Capraru
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
| | - David Smookler
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
| | - Muhammad Atif Zahoor
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
| | - Julia Casey
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
| | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.B.); (V.K.)
- Department of Clinical Biochemistry, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Jordan J. Feld
- Viral Hepatitis Care Network (VIRCAN) Study Group, Toronto Centre for Liver Disease, Toronto, ON M5G 2C, Canada; (M.J.B.); (C.C.); (D.S.); (M.A.Z.); (J.C.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada;
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Warsi I, Khurshid Z, Shazam H, Umer MF, Imran E, Khan MO, Slowey PD, Goodson JM. Saliva Exhibits High Sensitivity and Specificity for the Detection of SARS-COV-2. Diseases 2021; 9:38. [PMID: 34065171 PMCID: PMC8161819 DOI: 10.3390/diseases9020038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
In the wake of the COVID-19 pandemic, it is crucial to assess the application of a multitude of effective diagnostic specimens for conducting mass testing, for accurate diagnosis and to formulate strategies for its prevention and control. As one of the most versatile and amenable specimen options, saliva offers great advantages for widespread screening strategies due to its non-invasive properties, cost-effectiveness, excellent stability and minimal risk of cross-infection. This review attempts to outline the scientific rationale for detection of SARS-COV-2 in saliva specimens. By combining the data obtained from ten chosen published clinical studies, we calculated the pooled sensitivity and specificity using an online calculator. Through evidence, we established that SARS-COV-2 is detectable in saliva with a high degree of diagnostic sensitivity (87%) and specificity (98%). We also presented a review of emerging technologies approved by the FDA for detection of SARS-COV-2 in oral fluids (saliva and sputum) using polymerase chain reaction methods. Given the challenges involved in obtaining invasive specimens from the naso- and oropharynx, saliva can serve as an easy to collect diagnostic specimen for screening in the work environment, schools and for home testing. Furthermore, saliva offers the opportunity to screen early cases that can be missed by invasive sampling.
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Affiliation(s)
- Ibrahim Warsi
- Medical Sciences in Clinical Investigation, Harvard Medical School, Boston, MA 02115, USA;
- The Forsyth Institute, Cambridge, MA 02142, USA;
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Hamda Shazam
- Department of Oral Pathology, College of Dentistry, Ziauddin University, Karachi 74700, Pakistan;
| | - Muhammad Farooq Umer
- Al-Shifa School of Public Health, Al-Shifa Trust, Jhelum Road, Rawalpindi, Punjab 46000, Pakistan;
| | - Eisha Imran
- Department of Dental Materials, Institute of Medical Sciences, HITEC Dental College, Taxilla 751010, Pakistan;
| | - Muhammad Owais Khan
- Dow International Dental College (DIDC), Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Paul Desmond Slowey
- Health Science Center, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China;
- Oasis Diagnostics® Corporation, Vancouver, WA 98686, USA
| | - J. Max Goodson
- The Forsyth Institute, Cambridge, MA 02142, USA;
- Department of Oral Medicine, Infection, and Immunology, Harvard School of Dental Medicine, Boston, MA 02115, USA
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28
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Evaluation of Specimen Types and Saliva Stabilization Solutions for SARS-CoV-2 Testing. J Clin Microbiol 2021; 59:JCM.01418-20. [PMID: 33674284 PMCID: PMC8091857 DOI: 10.1128/jcm.01418-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Therefore, alternative specimen types have been investigated that provide similar detection sensitivity with reduced health care exposure and the potential for self-collection. In this study, the detection sensitivity of SARS-CoV-2 in nasal swabs (NS) and saliva was compared to that of NPS using matched specimens from two outpatient cohorts in New York State (total n = 463). The first cohort showed only a 5.4% positivity, but the second cohort (n = 227) had a positivity rate of 41%, with sensitivity in NPS, NS, and saliva of 97.9%, 87.1%, and 87.1%, respectively. Whether the reduced sensitivity of NS or saliva is acceptable must be assessed in the settings where they are used. However, we sought to improve on it by validating a method to mix the two sample types, as the combination of nasal swab and saliva resulted in 94.6% SARS-CoV-2 detection sensitivity. Spiking experiments showed that combining them did not adversely affect the detection sensitivity in either. Virus stability in saliva was also investigated, with and without the addition of commercially available stabilizing solutions. The virus was stable in saliva at both 4°C and room temperature for up to 7 days. The addition of stabilizing solutions did not enhance stability and, in some situations, reduced detectable virus levels.
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29
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Griesemer SB, Van Slyke G, Ehrbar D, Strle K, Yildirim T, Centurioni DA, Walsh AC, Chang AK, Waxman MJ, St George K. Evaluation of Specimen Types and Saliva Stabilization Solutions for SARS-CoV-2 Testing. J Clin Microbiol 2021; 59:JCM.01418-20. [PMID: 33674284 DOI: 10.1101/2020.06.16.20133041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/24/2021] [Indexed: 05/23/2023] Open
Abstract
Identifying SARS-CoV-2 infections through aggressive diagnostic testing remains critical to tracking and curbing the spread of the COVID-19 pandemic. Collection of nasopharyngeal swabs (NPS), the preferred sample type for SARS-CoV-2 detection, has become difficult due to the dramatic increase in testing and consequent supply strain. Therefore, alternative specimen types have been investigated that provide similar detection sensitivity with reduced health care exposure and the potential for self-collection. In this study, the detection sensitivity of SARS-CoV-2 in nasal swabs (NS) and saliva was compared to that of NPS using matched specimens from two outpatient cohorts in New York State (total n = 463). The first cohort showed only a 5.4% positivity, but the second cohort (n = 227) had a positivity rate of 41%, with sensitivity in NPS, NS, and saliva of 97.9%, 87.1%, and 87.1%, respectively. Whether the reduced sensitivity of NS or saliva is acceptable must be assessed in the settings where they are used. However, we sought to improve on it by validating a method to mix the two sample types, as the combination of nasal swab and saliva resulted in 94.6% SARS-CoV-2 detection sensitivity. Spiking experiments showed that combining them did not adversely affect the detection sensitivity in either. Virus stability in saliva was also investigated, with and without the addition of commercially available stabilizing solutions. The virus was stable in saliva at both 4°C and room temperature for up to 7 days. The addition of stabilizing solutions did not enhance stability and, in some situations, reduced detectable virus levels.
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Affiliation(s)
- Sara B Griesemer
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Greta Van Slyke
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Dylan Ehrbar
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Klemen Strle
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Tugba Yildirim
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Dominick A Centurioni
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Anne C Walsh
- Directors Office, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Andrew K Chang
- Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Michael J Waxman
- Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Kirsten St George
- Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, SUNY, Albany, New York, USA
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Casillas Santana MA, Dipp Velázquez FA, Sámano Valencia C, Martínez Zumarán A, Zavala Alonso NV, Martínez Rider R, Salas Orozco MF. Saliva: What Dental Practitioners Should Know about the Role of This Biofluid in the Transmission and Diagnostic of SARS-CoV-2. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:349. [PMID: 33917276 PMCID: PMC8067428 DOI: 10.3390/medicina57040349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has become a global ongoing pandemic. This pandemic represents a great work risk for all health professionals, it includes dental professionals who are in constant contact with saliva, which represents one of the main routes of transmission of the disease. This is due to the fact that a wide variety of oral tissues and cells are susceptible to infection by SARS-CoV-2 and that they express the ACE2 receptor, which is the main route of entry of the virus into cells, as well as the proteins TMPRSS and furin that contributes to the binding of the virus to the host cells. According to recent studies, some of the oral cells most susceptible to infection by SARS-CoV-2 are the epithelial cells of the salivary glands. This explains the presence of the virus in the saliva of infected patients and provides scientific evidence that supports the use of saliva as a biofluid that offers the opportunity to develop new detection and diagnostic techniques. This is because saliva is much easier to collect compared to nasopharyngeal swab. However, the presence of the virus in saliva, also represents a great source of transmission, since the main form of infection is through microscopic drops that are generated when infected people cough or sneeze. Likewise, health professionals, such as dentists are exposed to contagion through saliva. The objective of this review article is to provide a perspective on the main cells and tissues that can be affected by the virus, the risk of contagion that the presence of the virus in saliva represents for dentists; and the new techniques developed from saliva samples for the diagnosis and surveillance of SARS-CoV-2 infection. This review is expected to contribute to the knowledge of oral health professionals about the risk of saliva in the spread of SARS-CoV-2, but also its advantages as a diagnostic tool for pandemic control. In conclusion, the authors can mention that information that provides more scientific evidence of the mechanisms of infection of the coronavirus in oral cells and tissues is being published continually. This also explains the presence of the virus in the saliva of infected people and the risk of contagion that this means. It also provides scientific evidence of the use of saliva as a biofluid for the detection, diagnosis, monitoring, and control of the spread of the virus.
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Affiliation(s)
- Miguel Angel Casillas Santana
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Farid Alonso Dipp Velázquez
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Carolina Sámano Valencia
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Alan Martínez Zumarán
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Norma Verónica Zavala Alonso
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Ricardo Martínez Rider
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Marco Felipe Salas Orozco
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
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31
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Iankov I, Viker K, Turgeon C, Matern D, Galanis E. Parameters of immunoglobulin extraction from dried blood spot cards and immunoassays for detection of antibody response to pathogens including the novel SARS-CoV-2. J Immunol Methods 2021; 492:112996. [PMID: 33582147 PMCID: PMC7877893 DOI: 10.1016/j.jim.2021.112996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
Dried blood spots (DBS) are routinely used in screening newborns for treatable disorders. Immunoglobulin extraction from DBS, serum or other biological fluids loaded on filter paper cards could represent a valuable method of specimen preservation in monitoring immune response against pathogens as well as vaccination efficiency. In this study using different sources including serum, and monoclonal antibodies we established parameters for antibody extraction from the filter cards to assess antibody reactivity against Helicobacter pylori, measles virus (MV) and the novel coronavirus SARS-CoV-2 antigens. We demonstrated that DBS and dried undiluted serum result in completely preserved antibody activity for immunoassays, including in virus neutralization assays against MV. Extraction efficiency was determined by IgG concentration measurements. The plaque-reduction neutralization titer 50% of dried human serum spots remained stable after more than 10-day storage – 1:359 vs. 1:345 for the corresponding frozen sample. DBSs could be used to monitor immune response to bacterial and viral antigens following natural exposure or immunization. Mice immunized with recombinant spike protein receptor-binding domain of SARS-CoV-2 developed a strong antibody response by day 14 and reached titers above 1:64,000 on day 21 following the secondary boost immunization as measured on DBS samples in antigen-mediated ELISA. Variability in IgG concentration of eluted DBS could be influenced by factors involved in sample application, extraction process and sample characteristics. Adjustment of antibody specific activity to the eluted IgG concentration can increase accuracy of the result interpretation, including in SARS-CoV-2 serological diagnostics.
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Affiliation(s)
- Ianko Iankov
- Department of Molecular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Kimberly Viker
- Department of Molecular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Coleman Turgeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Dietrich Matern
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Evanthia Galanis
- Department of Molecular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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32
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Cañete MG, Valenzuela IM, Garcés PC, Massó IC, González MJ, Providell SG. Saliva sample for the massive screening of SARS-CoV-2 infection: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:540-548. [PMID: 33637473 PMCID: PMC7849433 DOI: 10.1016/j.oooo.2021.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/11/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Objective This systematic review aims to describe the value of saliva as a noninvasive sample for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in comparison with the current method for sample collection, the nasopharyngeal swab. Study Design We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. We searched in 5 databases (PubMed, Cochrane, EBSCO, Elsevier, and MEDLINE) and included articles published between December 2019 and July 2020. Results This review included 22 publications that met inclusion criteria, 17 of which were case series, 2 of which were case reports, and 3 of which were massive screenings. All articles compared saliva with nasopharyngeal swabs. The detection rate of SARS-CoV-2 in saliva was similar to that for nasopharyngeal swabs. The sensitivity ranged between 20% and 97%, and specificity ranged between 66% and 100%. Conclusions This systematic review found that saliva might be an appropriate, fast, painless, simple, and noninvasive sample for SARS-CoV-2 detection, making it ideal for massive screening of SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Patricia Carvajal Garcés
- Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Isabel Castro Massó
- Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - María Julieta González
- Institute of Biomedical Sciences (ICBM), Faculty of Medicine, Universidad de Chile, Santiago, Chile
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33
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Heaney CD, Pisanic N, Randad PR, Kruczynski K, Howard T, Zhu X, Littlefield K, Patel EU, Shrestha R, Laeyendecker O, Shoham S, Sullivan D, Gebo K, Hanley D, Redd AD, Quinn TC, Casadevall A, Zenilman JM, Pekosz A, Bloch EM, Tobian AAR. Comparative performance of multiplex salivary and commercially available serologic assays to detect SARS-CoV-2 IgG and neutralization titers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.28.21250717. [PMID: 33532806 PMCID: PMC7852272 DOI: 10.1101/2021.01.28.21250717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral fluid (hereafter saliva) offers a non-invasive sampling method for the detection of SARS-CoV-2 antibodies. However, data comparing performance of salivary tests against commercially-available serologic and neutralizing antibody (nAb) assays are lacking. This study compared the performance of a multiplex salivary SARS-CoV-2 IgG assay targeting antibodies to nucleocapsid (N), receptor binding domain (RBD) and spike (S) antigens to three commercially-available SARS-CoV-2 serology enzyme immunoassays (EIAs) (Ortho Vitros, Euroimmun, and BioRad) and nAb. Paired saliva and plasma samples were collected from 101 eligible COVID-19 convalescent plasma (CCP) donors >14 days since PCR+ confirmed diagnosis. Concordance was evaluated using positive (PPA) and negative (NPA) percent agreement, overall percent agreement (PA), and Cohen kappa coefficient. The range between salivary and plasma EIAs for SARS-CoV-2-specific N was PPA: 54.4-92.1% and NPA: 69.2-91.7%, for RBD was PPA: 89.9-100% and NPA: 50.0-84.6%, and for S was PPA: 50.6-96.6% and NPA: 50.0-100%. Compared to a plasma nAb assay, the multiplex salivary assay PPA ranged from 62.3% (N) and 98.6% (RBD) and NPA ranged from 18.8% (RBD) to 96.9% (S). Combinations of N, RBD, and S and a summary algorithmic index of all three (N/RBD/S) in saliva produced ranges of PPA: 87.6-98.9% and NPA: 50-91.7% with the three EIAs and ranges of PPA: 88.4-98.6% and NPA: 21.9-34.4% with the nAb assay. A multiplex salivary SARS-CoV-2 IgG assay demonstrated comparable performance to three commercially-available plasma EIAs and a nAb assay, and may be a viable alternative to assist in screening CCP donors and monitoring population-based seroprevalence and vaccine antibody response.
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Affiliation(s)
- Christopher D. Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Pranay R. Randad
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tyrone Howard
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kirsten Littlefield
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U. Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M. Zenilman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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34
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Patton LL. Viral pandemics and oral health: Lessons learned from HIV to SARS-CoV-2. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:149-153. [PMID: 33309265 PMCID: PMC7642737 DOI: 10.1016/j.oooo.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023]
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35
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Kanji JN, Zelyas N, MacDonald C, Pabbaraju K, Khan MN, Prasad A, Hu J, Diggle M, Berenger BM, Tipples G. False negative rate of COVID-19 PCR testing: a discordant testing analysis. Virol J 2021; 18:13. [PMID: 33422083 PMCID: PMC7794619 DOI: 10.1186/s12985-021-01489-0] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/02/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND COVID-19 is diagnosed via detection of SARS-CoV-2 RNA using real time reverse-transcriptase polymerase chain reaction (rtRT-PCR). Performance of many SARS-CoV-2 rtRT-PCR assays is not entirely known due to the lack of a gold standard. We sought to evaluate the false negative rate (FNR) and sensitivity of our laboratory-developed SARS-CoV-2 rtRT-PCR targeting the envelope (E) and RNA-dependent RNA-polymerase (RdRp) genes. METHODS SARS-CoV-2 rtRT-PCR results at the Public Health Laboratory (Alberta, Canada) from January 21 to April 18, 2020 were reviewed to identify patients with an initial negative rtRT-PCR followed by a positive result on repeat testing within 14 days (defined as discordant results). Negative samples from these discordant specimens were re-tested using three alternate rtRT-PCR assays (targeting the E gene and N1/N2 regions of the nucleocapsid genes) to assess for false negative (FN) results. RESULTS During the time period specified, 95,919 patients (100,001 samples) were tested for SARS-CoV-2. Of these, 49 patients were found to have discordant results including 49 positive and 52 negative swabs. Repeat testing of 52 negative swabs found five FNs (from five separate patients). Assuming 100% specificity of the diagnostic assay, the FNR and sensitivity in this group of patients with discordant testing was 9.3% (95% CI 1.5-17.0%) and 90.7% (95% CI 82.6-98.9%) respectively. CONCLUSIONS Studies to understand the FNR of routinely used assays are important to confirm adequate clinical performance. In this study, most FN results were due to low amounts of SARS-CoV-2 virus concentrations in patients with multiple specimens collected during different stages of infection. Post-test clinical evaluation of each patient is advised to ensure that rtRT-PCR results are not the only factor in excluding COVID-19.
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Affiliation(s)
- Jamil N Kanji
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada.
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Room 1NW-29, 16940 - 87 Avenue NW, Edmonton, AB, T5R 4H5, Canada.
| | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Clayton MacDonald
- Division of Medical Microbiology and Infection Control, Vancouver Coastal Health Vancouver General Hospital, 899 W 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Kanti Pabbaraju
- Public Health Laboratory, Alberta Precision Laboratories, Foothills Hospital, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Muhammad Naeem Khan
- Health Protection and Communicable Disease Control, Public Health, Alberta Health Services, Coronation Plaza, 14310 - 111 Avenue NW, Edmonton, AB, T5M 3Z7, Canada
| | - Abhaya Prasad
- Health Protection and Communicable Disease Control, Public Health, Alberta Health Services, Coronation Plaza, 14310 - 111 Avenue NW, Edmonton, AB, T5M 3Z7, Canada
| | - Jia Hu
- Medical Officer of Health (MOH), Public Health, Alberta Health Services, 1213 - 4 Street SW, Calgary, AB, T2R 0X7, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Mathew Diggle
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Byron M Berenger
- Public Health Laboratory, Alberta Precision Laboratories, Foothills Hospital, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, 3535 Research Road NW, Calgary, AB, T2L 2K8, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
- Li Ka Shing Institute of Virology, University of Alberta, 6-010 Katz Group Centre for Pharmacy and Research, Edmonton, AB, T6G 2E1, Canada
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Munhoz L, Haddad D, Arita E. Saliva as a Potential SARS-CoV-2 Reservoir: What is Already Known? A Systematic Review. JOURNAL OF OROFACIAL SCIENCES 2021. [DOI: 10.4103/jofs.jofs_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Cassoni A, Pucci R, Mangini N, Fadda MT, Battisti A, Giovannetti F, Terenzi V, Della Monaca M, Priore P, Raponi I, Valentini V. Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control. Cancers (Basel) 2020; 13:E33. [PMID: 33374237 PMCID: PMC7795055 DOI: 10.3390/cancers13010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has significantly affected the surgical units, especially those operating on the airways. This study evaluates the series of patients with tumors of the head and neck treated by our unit during Phase-1 of the pandemic and the efficacy of the preventive measures implemented for protecting both the patients and staff. A screening program was administered to all the patients who had to undergo surgery. None of the patients tested and operated during Phase 1, between 10 March and 18 May 2020, were positive for COVID-19. A significant portion of the patients was suffering from tumors in advanced stages (T3 and T4). Two patients developed respiratory symptoms during their stay at the unit, so they were put in precautionary isolation and tested, but resulted negative for COVID-19. All the surgical department staff followed the Italian Ministry of Health's prevention protocol and underwent serological testing. IgG and IgM were negative in everyone, thus confirming that nobody had been exposed to the virus. This study highlights the commitment to efficiently treating patients suffering from tumors of the head and neck region and confirms the effectiveness of the safety measures used to protect our patients and staff's health.
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Affiliation(s)
- Andrea Cassoni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Resi Pucci
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Nicolò Mangini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Maria Teresa Fadda
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Andrea Battisti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Filippo Giovannetti
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Valentina Terenzi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Marco Della Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Paolo Priore
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
| | - Ingrid Raponi
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
| | - Valentino Valentini
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.C.); (N.M.); (M.T.F.); (V.T.); (M.D.M.); (I.R.); (V.V.)
- Oncological and Reconstructive Maxillofacial Surgery Unit, Policlinico Umberto I of Rome, D.A.I. testa e collo. Viale del Policlinico 155, 00161 Rome, Italy; (A.B.); (F.G.); (P.P.)
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Medeiros da Silva RC, Nogueira Marinho LC, de Araújo Silva DN, Costa de Lima K, Pirih FQ, Luz de Aquino Martins AR. Saliva as a possible tool for the SARS-CoV-2 detection: A review. Travel Med Infect Dis 2020; 38:101920. [PMID: 33220456 PMCID: PMC7674016 DOI: 10.1016/j.tmaid.2020.101920] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Salivary tests for the new coronavirus (SARS-CoV-2) diagnosis have been suggested as alternative methods for the nasopharyngeal and oropharyngeal tests. METHOD Two reviewers independently performed a search in the following electronic databases: PubMed, Medline, Cochrane Library, Web of Science, Embase and Scopus to identify cross-sectional and cohort studies that used saliva samples for SARS-CoV-2 detection. The search strategy was: ("saliva") and ("SARS-CoV-2" or "coronavirus" or "COVID-1"). RESULTS A total of 363 studies were identified and 39 were selected for review. Salivary samples for SARS-CoV-2 detection was as consistent and sensitive as the nasopharyngeal swabs in most studies, having been effective in detecting asymptomatic infections previously tested negative in nasopharyngeal samples. Viral nucleic acids found in saliva obtained from the duct of the salivary gland may indicate infection in that gland. Live viruses could be detected in saliva by viral culture. CONCLUSIONS Salivary samples show great potential in SARS-CoV-2 detection and may be recommended as a simple and non-invasive alternative.
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Affiliation(s)
| | | | | | - Kenio Costa de Lima
- Dentistry Department, Rio Grande Do Norte Federal University, Natal, RN, Brazil.
| | - Flavia Queiroz Pirih
- Dentistry Department, Rio Grande Do Norte Federal University, Natal, RN, Brazil.
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Abstract
The SARS-CoV-2 virus caused a globally growing pandemic called coronavirus disease 2019 (COVID-19) that has disrupted social, political, and medical environments around the world. Nations are assessing ways to reopen businesses while trying to balance health care risks and economic fallouts. Strategies involving antibody testing have been proposed before phased reopening of the economy. Therefore, assessing the sensitivity and specificity of antibody tests for symptomatic and asymptomatic COVID-19 patients remains paramount to prevent COVID-19 outbreaks. The antibody tests for SARS-CoV-2 detect the presence of IgA, IgM, or IgG antibodies produced by B cells. There are four major types of antibody tests: rapid diagnostic tests, enzyme-linked immunosorbent assays, neutralization assays, and chemiluminescent immunoassays. Currently, there is no standard antibody test for detecting SARS-CoV-2 antibodies during or after exposure or infection. The antibody tests for SARS-CoV-2 have a low specificity within the first week of exposure and increase in the second and third weeks. The current data on antibody tests have several limitations in quality and the presence of bias. Specifically, many antibody tests have a high false-negative rate and a high risk of bias for participant selection, application of index tests, reference standard used, and flow and timing for antibody tests that may incorrectly report the accuracy of COVID-19 antibody tests. In this review, we summarize the current methods, sensitivity/specificity, and gaps in knowledge concerning COVID-19 antibody testing.
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Affiliation(s)
- Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Bohn MK, Mancini N, Loh TP, Wang CB, Grimmler M, Gramegna M, Yuen KY, Mueller R, Koch D, Sethi S, Rawlinson WD, Clementi M, Erasmus R, Leportier M, Kwon GC, Menezes ME, Patru MM, Singh K, Ferrari M, Najjar O, Horvath AR, Adeli K, Lippi G. IFCC Interim Guidelines on Molecular Testing of SARS-CoV-2 Infection. Clin Chem Lab Med 2020; 58:1993-2000. [PMID: 33027042 DOI: 10.1515/cclm-2020-1412] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/12/2022]
Abstract
The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection globally has relied extensively on molecular testing, contributing vitally to case identification, isolation, contact tracing, and rationalization of infection control measures during the coronavirus disease 2019 (COVID-19) pandemic. Clinical laboratories have thus needed to verify newly developed molecular tests and increase testing capacity at an unprecedented rate. As the COVID-19 pandemic continues to pose a global health threat, laboratories continue to encounter challenges in the selection, verification, and interpretation of these tests. This document by the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 provides interim guidance on: (A) clinical indications and target populations, (B) assay selection, (C) assay verification, and (D) test interpretation and limitations for molecular testing of SARS-CoV-2 infection. These evidence-based recommendations will provide practical guidance to clinical laboratories worldwide and highlight the continued importance of laboratory medicine in our collective pandemic response.
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Affiliation(s)
- Mary Kathryn Bohn
- Paediatric Laboratory Medicine, The Hospital for Sick Children, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Tze Ping Loh
- National University Health System, Singapore, Singapore
| | | | | | | | | | | | - David Koch
- Emory University School of Medicine, Atlanta, GA, USA
| | - Sunil Sethi
- National University Health System, Singapore, Singapore
| | - William D Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, NSW, Randwick, Australia
| | | | - Rajiv Erasmus
- University of Stellenbosch, Cape Town, Western Cape, Republic of South Africa
| | | | - Gye Cheol Kwon
- Chungnam National University Hospital, Daejeon, Republic of South Korea
| | | | | | | | | | - Osama Najjar
- Allied Health Professions Ministry of Health, Palestine, Palestine
| | - Andrea R Horvath
- Department of Clinical Chemistry, New South Wales Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Khosrow Adeli
- Paediatric Laboratory Medicine, The Hospital for Sick Children, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Giuseppe Lippi
- University Hospital of Verona, Verona, Italy.,Taskforce on COVID-19, International Federation of Clinical Chemistry (IFCC), Milan, Italy
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SARS-CoV-2 identification and IgA antibodies in saliva: One sample two tests approach for diagnosis. Clin Chim Acta 2020; 510:717-722. [PMID: 32946791 PMCID: PMC7492139 DOI: 10.1016/j.cca.2020.09.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
Saliva is an eligible matrix for SARS-CoV-2 molecular detection and IgA measurement. Saliva collection offers several advantages: safe, non-invasive and self-collection. Positive molecular testing results were associated with disease duration. The presence of salivary IgA was associated with pneumonia and CRP values.
Aim This study aims to verify whether standardized saliva collection is suitable for SARS-CoV-2 molecular detection and IgA measurement. Methods 43 COVID-19 inpatients and 326 screening subjects underwent naso-pharyngeal (NP)-swab and saliva collection (Salivette). Inpatients also underwent repeated blood collections to evaluate inflammation and organs involvement. In all patients and subjects, SARS-CoV-2 (gene E) rRT-PCR was undertaken in saliva and NP-swabs. Salivary IgA and serum IgA, IgG, IgM were measured on inpatients’ samples. Results NP-swabs and saliva were both SARS-CoV-2 positive in 7 (16%) or both negative in 35 (82%) out of 43 patients successfully included in the study. NP-swabs and saliva results did not perfectly match in one patient (saliva positive, NP-swab negative). Positive molecular results were significantly associated with disease duration (p = 0.0049). 326/326 screening subjects were SARS-CoV-2 negative on both NP-swabs and saliva. Among the 27 saliva samples tested for IgA, 18 were IgA positive. Salivary IgA positivity was associated with pneumonia (p = 0.002) and CRP values (p = 0.0183), not with other clinical and molecular data, or with serum immunoglubulins. Conclusions A standardized saliva collection can be adopted to detect SARS-CoV-2 infection in alternative to NP-swabs. Preliminary data on salivary IgA support the use of saliva also for patient monitoring.
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Abstract
Given the global nature of the coronavirus disease 2019 (COVID-19) pandemic, the need for disease detection and expanding testing capacity remains critical priorities. This review discusses the technological advances in testing capability and methodology that are currently used or in development for detecting the novel coronavirus. We describe the current clinical diagnostics and technology, including molecular and serological testing approaches, for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) testing as well as address their advantages and limitations. Nucleic acid amplification technology for molecular diagnostics remains the gold standard for virus detection. We highlight alternative molecular detection techniques used for developing novel COVID-19 diagnostics on the horizon. Antibody response against SARS-CoV-2 remains poorly understood and proper validation of serology tests is necessary to demonstrate their accuracy and clinical utility. In order to bring the pandemic under control, we must speed up the development of rapid and widespread testing through improvements in clinical diagnostics and testing technology as well as access to these tools.
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Affiliation(s)
- Cindy H Chau
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan D Strope
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Siegler AJ, Sullivan PS, Sanchez T, Lopman B, Fahimi M, Sailey C, Frankel M, Rothenberg R, Kelley CF, Bradley H. Protocol for a national probability survey using home specimen collection methods to assess prevalence and incidence of SARS-CoV-2 infection and antibody response. Ann Epidemiol 2020; 49:50-60. [PMID: 32791199 PMCID: PMC7417272 DOI: 10.1016/j.annepidem.2020.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The U.S. response to the SARS-CoV-2 epidemic has been hampered by early and ongoing delays in testing for infection; without data on where infections were occurring and the magnitude of the epidemic, early public health responses were not data-driven. Understanding the prevalence of SARS-CoV-2 infections and immune response is critical to developing and implementing effective public health responses. Most serological surveys have been limited to localities that opted to conduct them and/or were based on convenience samples. Moreover, results of antibody testing might be subject to high false positive rates in the setting of low prevalence of immune response and imperfect test specificity. METHODS We will conduct a national serosurvey for SARS-CoV-2 PCR positivity and immune experience. A probability sample of U.S. addresses will be mailed invitations and kits for the self-collection of anterior nares swab and finger prick dried blood spot specimens. Within each sampled household, one adult 18 years or older will be randomly selected and asked to complete a questionnaire and to collect and return biological specimens to a central laboratory. Nasal swab specimens will be tested for SARS-CoV-2 RNA by RNA PCR; dried blood spot specimens will be tested for antibodies to SARS-CoV-2 (i.e., immune experience) by enzyme-linked immunoassays. Positive screening tests for antibodies will be confirmed by a second antibody test with different antigenic basis to improve predictive value of positive (PPV) antibody test results. All persons returning specimens in the baseline phase will be enrolled into a follow-up cohort and mailed additional specimen collection kits 3 months after baseline. A subset of 10% of selected households will be invited to participate in full household testing, with tests offered for all household members aged ≥3 years. The main study outcomes will be period prevalence of infection with SARS-CoV-2 and immune experience, and incidence of SARS-CoV-2 infection and antibody responses. RESULTS Power calculations indicate that a national sample of 4000 households will facilitate estimation of national SARS-CoV-2 infection and antibody prevalence with acceptably narrow 95% confidence intervals across several possible scenarios of prevalence levels. Oversampling in up to seven populous states will allow for prevalence estimation among subpopulations. Our 2-stage algorithm for antibody testing produces acceptable PPV at prevalence levels ≥1.0%. Including oversamples in states, we expect to receive data from as many as 9156 participants in 7495 U.S. households. CONCLUSIONS In addition to providing robust estimates of prevalence of SARS-CoV-2 infection and immune experience, we anticipate this study will establish a replicable methodology for home-based SARS-CoV-2 testing surveys, address concerns about selection bias, and improve positive predictive value of serology results. Prevalence estimates of SARS-CoV-2 infection and immune experience produced by this study will greatly improve our understanding of the spectrum of COVID-19 disease, its current penetration in various demographic, geographic, and occupational groups, and inform the range of symptoms associated with infection. These data will inform resource needs for control of the ongoing epidemic and facilitate data-driven decisions for epidemic mitigation strategies.
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Affiliation(s)
- Aaron J Siegler
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA.
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA
| | - Travis Sanchez
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA
| | - Ben Lopman
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA
| | | | | | - Martin Frankel
- Zicklin School of Business, Baruch College, New York City, NY
| | - Richard Rothenberg
- Department of Epidemiology and Biostatistics, Georgia State University, Atlanta
| | - Colleen F Kelley
- Department of Epidemiology, Emory University School of Public Health, Atlanta, GA; Emory University School of Medicine, Atlanta, GA
| | - Heather Bradley
- Department of Epidemiology and Biostatistics, Georgia State University, Atlanta
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Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men. J Clin Microbiol 2020; 58:JCM.01215-20. [PMID: 32611792 DOI: 10.1128/jcm.01215-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/23/2020] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was used primarily for genital and anorectal infections, with only limited studies on the performance of self-collection of oropharyngeal swabs for oropharyngeal STI detection. The Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhea and chlamydia screening on 16 March 2020 in order to reduce health care worker risk during the COVID-19 pandemic. We compared the proportions of valid and positive samples for gonorrhea and chlamydia among men who have sex with men (MSM) in two time periods; the clinician collection period, between 20 January and 15 March 2020, and the self-collection period, between 16 March and 8 May 2020. A total of 4,097 oropharyngeal swabs were included. The proportion of oropharyngeal swabs with equivocal or invalid results for Neisseria gonorrhoeae was higher in the self-collection period (1.6% [24/1,497]) than in the clinician collection period (0.9% [23/2,600]) (P = 0.038), but the proportions did not differ for the detection of Chlamydia trachomatis The positivity rates of oropharyngeal N. gonorrhoeae (adjusted prevalence ratio [PR], 1.07 [95% confidence interval {CI}, 0.85 to 1.34]) (P = 0.583) and oropharyngeal C. trachomatis (adjusted PR, 0.84 [95% CI, 0.51 to 1.39]) (P = 0.504) specimens did not differ between the two periods. Self-collected oropharyngeal swabs for the detection of N. gonorrhoeae and C. trachomatis have acceptable performance characteristics and, importantly, reduce health care worker exposure to respiratory infections.
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Varadhachary A, Chatterjee D, Garza J, Garr RP, Foley C, Letkeman A, Dean J, Haug D, Breeze J, Traylor R, Malek A, Nath R, Linbeck L. Salivary anti-SARS-CoV-2 IgA as an accessible biomarker of mucosal immunity against COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.08.07.20170258. [PMID: 32817976 PMCID: PMC7430621 DOI: 10.1101/2020.08.07.20170258] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Mucosal immunity, including secretory IgA (sIgA), plays an important role in early defenses against respiratory pathogens. Salivary testing, the most convenient way to measure sIgA, has been used to characterize mucosal immune responses to many viral infections including SARS, MERS, influenza, HIV, and RSV. However, its role has not yet been characterized in the COVID-19 pandemic. Here, we report development and validation of a rapid immunoassay for measuring salivary IgA against the SARS-CoV-2 virus, and report quantitative results in both pre-COVID-19 and muco-converted subjects. Methods We developed and refined a specific test for salivary IgA against SARS-CoV-2 on the Brevitest platform, a rapid immunoassay system designed for point-of-care use. A qualitative test was validated as per FDA guidelines with saliva obtained from subjects prior to the emergence of COVID-19, and from PCR-confirmed COVID-19 patients. We also generated a quantitative measure of anti-SARS-CoV-2 salivary IgA. Time taken for saliva self-collection was measured and its ease-of-use assessed. Results We successfully validated a qualitative salivary assay for SARS-CoV-2 IgA antibodies, with positive and negative predictive values of 92% and 97%, respectively, and no observable cross-reactivity with any of seven potential confounders. Pre-COVID-19 saliva samples showed an 8-fold range of IgA concentrations, suggesting a broad continuum of natural antibody resistance against the novel virus, though at levels lower than that observed in COVID-19 PCR-confirmed subjects. Samples from muco-positive subjects also shown a ~9-fold variation in salivary IgA levels, with elevated salivary IgA observed beyond three months after onset of symptoms. We observed a correlation (r=0.4405) between salivary IgA levels and COVID-19 disease severity. In anecdotal observations, we observed individuals who exhibited antibodies early in the course of their disease, contemporaneously with a positive PCR test, as well as individuals who muco-converted despite no known direct exposure to a COVID-19 patient, no symptoms, and negative molecular and/or serum antibody tests. Salivary collection took 5-10 minutes, and was reported as being easy (mean of 1.1 on a scale of 1 to 10). Implications Mucosal immunity, including secretory IgA, plays an important role in host defense against respiratory pathogens, and our early data suggest it may do so in COVID-19. Salivary IgA, an accessible marker of mucosal immunity, may be a useful indicator of several key parameters including individual and community immune response, disease severity, clinical risk, and herd immunity. The non-invasive nature and ease of saliva collection facilitates its potential use as a biomarker for ongoing patient assessment and management, as well as a community surveillance tool. By measuring mucosal immune responses directly and systemic immune responses indirectly, salivary IgA could be useful in developing and deploying a vaccine(s) against COVID-19. Quantitative IgA assessment could also potentially serve as a tool to segment the population into different risk categories and inform individual and collective decisions relating to appropriate activities and vaccine prioritization/delivery. These data reinforce the importance of further investigation into the role of mucosal immunity and IgA in host responses against COVID-19.
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Affiliation(s)
- Atul Varadhachary
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - Dev Chatterjee
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - Javier Garza
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - R. Patrick Garr
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - Christopher Foley
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - Andrea Letkeman
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | - John Dean
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
| | | | | | | | | | | | - Leo Linbeck
- BreviTest Technologies, LLC and Fannin Innovation Studio, Houston, TX
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Sapkota D, Søland TM, Galtung HK, Sand LP, Giannecchini S, To KKW, Mendes-Correa MC, Giglio D, Hasséus B, Braz-Silva PH. COVID-19 salivary signature: diagnostic and research opportunities. J Clin Pathol 2020; 74:jclinpath-2020-206834. [PMID: 32769214 DOI: 10.1136/jclinpath-2020-206834] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 01/05/2023]
Abstract
The COVID-19 (caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) epidemic started in Wuhan (Hubei Province, China) in mid-December 2019 and quickly spread across the world as a pandemic. As a key to tracing the disease and to implement strategies aimed at breaking the chain of disease transmission, extensive testing for SARS-CoV-2 was suggested. Although nasopharyngeal/oropharyngeal swabs are the most commonly used biological samples for SARS-CoV-2 diagnosis, they have a number of limitations related to sample collection and healthcare personnel safety. In this context, saliva is emerging as a promising alternative to nasopharyngeal/oropharyngeal swabs for COVID-19 diagnosis and monitoring. Saliva collection, being a non-invasive approach with possibility for self-collection, circumvents to a great extent the limitations associated with the use of nasopharyngeal/oropharyngeal swabs. In addition, various salivary biomarkers including the salivary metabolomics offer a high promise to be useful for better understanding of COVID-19 and possibly in the identification of patients with various degrees of severity, including asymptomatic carriers. This review summarises the clinical and scientific basis for the potential use of saliva for COVID-19 diagnosis and disease monitoring. Additionally, we discuss saliva-based biomarkers and their potential clinical and research applications related to COVID-19.
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Affiliation(s)
- Dipak Sapkota
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tine Merete Søland
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Pathology, Rikshospitalet University Hospital, Oslo, Norway
| | - Hilde Kanli Galtung
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lars Peter Sand
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Simone Giannecchini
- Department of Experimental and Clinical Medicine, Universita degli Studi di Firenze, Firenze, Toscana, Italy
| | - Kelvin K W To
- State Key Laboratory for Emerging Infectious Diseases, Department of Microbiology, Li KaShing Faculty of Medicine of the University of Hong Kong, Hong Kong, China
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Maria Cassia Mendes-Correa
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Giglio
- Department of Clinical Oncology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Oral Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Paulo Henrique Braz-Silva
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Valentine-Graves M, Hall E, Guest JL, Adam E, Valencia R, Shinn K, Hardee I, Sanchez T, Siegler AJ, Sullivan PS. At-home self-collection of saliva, oropharyngeal swabs and dried blood spots for SARS-CoV-2 diagnosis and serology: Post-collection acceptability of specimen collection process and patient confidence in specimens. PLoS One 2020; 15:e0236775. [PMID: 32756585 PMCID: PMC7406082 DOI: 10.1371/journal.pone.0236775] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Options to increase the ease of testing for SARS-CoV-2 infection and immune response are needed. Self-collection of diagnostic specimens at home offers an avenue to allow people to test for SARS-CoV-2 infection or immune response without traveling to a clinic or laboratory. Before this study, survey respondents indicated willingness to self-collect specimens for COVID-related tests, but hypothetical willingness can differ from post-collection acceptability after participants collect specimens. Methods 153 US adults were enrolled in a study of the willingness and feasibility of patients to self-collect three diagnostic specimens (saliva, oropharyngeal swab (OPS) and dried blood spot (DBS) card) while observed by a clinician through a telehealth session. After the specimens were collected, 148 participants participated in a survey about the acceptability of the collection, packing and shipping process, and their confidence in the samples collected for COVID-related laboratory testing. Results A large majority of participants (>84%) reported that collecting, packing and shipping of saliva, OPS, and DBS specimens were acceptable. Nearly nine in 10 (87%) reported being confident or very confident that the specimens they collected were sufficient for laboratory analysis.There were no differences in acceptability for any specimen type, packing and shipping, or confidence in samples, by gender, age, race/ethnicity, or educational level. Conclusions Self-collection of specimens for SARS-CoV-2 testing, and preparing and shipping specimens for analysis, were acceptable in a diverse group of US adults. Further refinement of materials and instructions to support self-collection of saliva, OPS and DBS specimens for COVID-related testing is needed.
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Affiliation(s)
- Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Eric Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jodie Lynn Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Elizabeth Adam
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rachel Valencia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kaitlin Shinn
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Isabel Hardee
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Aaron J. Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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48
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Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi A, Nagy Á, Lohinai Z, Szakács Z, Hegyi P, Steward MC, Varga G. Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis. Front Med (Lausanne) 2020; 7:465. [PMID: 32903849 PMCID: PMC7438940 DOI: 10.3389/fmed.2020.00465] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background: COVID-19 is a serious and potentially deadly disease. Early diagnosis of infected individuals will play an important role in stopping its further escalation. The present gold standard for sampling is the nasopharyngeal swab method. However, several recent papers suggested that saliva-based testing is a promising alternative that could simplify and accelerate COVID-19 diagnosis. Objectives: Our aim was to conduct a meta-analysis on the reliability and consistency of SARS-CoV-2 viral RNA detection in saliva specimens. Methods: We have reported our meta-analysis according to the Cochrane Handbook. We searched the Cochrane Library, Embase, Pubmed, Scopus, Web of Science and clinical trial registries for eligible studies published between 1 January and 25 April 2020. The number of positive tests and the total number of tests conducted were collected as raw data. The proportion of positive tests in the pooled data were calculated by score confidence-interval estimation with the Freeman-Tukey transformation. Heterogeneity was assessed using the I 2 measure and the χ2-test. Results: The systematic search revealed 96 records after removal of duplicates. Twenty-six records were included for qualitative analysis and 5 records for quantitative synthesis. We found 91% (CI 80-99%) sensitivity for saliva tests and 98% (CI 89-100%) sensitivity for nasopharyngeal swab (NPS) tests in previously confirmed COVID-19 patients, with moderate heterogeneity among the studies. Additionally, we identified 18 registered, ongoing clinical trials of saliva-based tests for detection of the virus. Conclusion: Saliva tests offer a promising alternative to NPS for COVID-19 diagnosis. However, further diagnostic accuracy studies are needed to improve their specificity and sensitivity.
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Affiliation(s)
- László Márk Czumbel
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Iván Mandel
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Anita Hegyi
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Ákos Nagy
- Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Lohinai
- Department of Conservative Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Martin C. Steward
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Gábor Varga
- Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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49
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Carpenter CR, Mudd PA, West CP, Wilber E, Wilber ST. Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases. Acad Emerg Med 2020; 27:653-670. [PMID: 32542934 PMCID: PMC7323136 DOI: 10.1111/acem.14048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.
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Affiliation(s)
- Christopher R. Carpenter
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Philip A. Mudd
- From the Department of Emergency Medicine Washington University in St. Louis School of MedicineEmergency Care Research Core St. Louis MO USA
| | - Colin P. West
- the Division of General Internal Medicine Department of Medicine Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA
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50
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Anoushiravani AA, Barnes CL, Bosco JA, Bozic KJ, Huddleston JI, Kang JD, Ready JE, Tornetta P, Iorio R. Reemergence of Multispecialty Inpatient Elective Orthopaedic Surgery During the COVID-19 Pandemic: Guidelines for a New Normal. J Bone Joint Surg Am 2020; 102:e79. [PMID: 32675667 DOI: 10.2106/jbjs.20.00829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Joseph A Bosco
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Healthcare, Stanford, California
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham Health, Boston, Massachusetts
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham Health, Boston, Massachusetts
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts
| | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham Health, Boston, Massachusetts
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