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Borges R, Bandeira CCS, Zerbinati RM, Palmieri M, Schwab G, Henrique Braz-Silva P, A L Lindoso J, Martinho H. Infrared spectroscopy as a predictive tool for the severity of COVID-19 using patient's saliva: A strategy to avoid hyperinflammation. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 317:124320. [PMID: 38718743 DOI: 10.1016/j.saa.2024.124320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/01/2024] [Accepted: 04/19/2024] [Indexed: 05/31/2024]
Abstract
Discriminate the severity level of COVID-19 disease is still a challenge. Here we investigate the capability of micro-infrared absorption spectroscopy (micro-FTIR) to probe COVID-19 severity level and predict hyperinflammation, correlating the assigned vibrational data to relevant biomolecules related to the immune system. Saliva of 184 patients was analysed by ELISA assay (Hepcidin) and micro-FTIR. Vibrational bands related to IgM and IgA can discriminate healthy from Severe individuals (sensitivity ≥ 0.749, specificity ≥ 0.945) and are less effective in discriminating Mild or Moderate individuals from the Severe group (sensitivity ≥ 0.628, specificity ≥ 0.867). Analysis of the second derivative of spectra probed increased levels of IL-6 in the saliva a key additional information for the degree of severity prediction. Because the model discriminates all the groups regarding the Severe group, it predicts an intense state of inflammation based on FTIR analysis. It is a powerful tool for predicting hyperinflammation conditions related to SARS-CoV-2 infection and may be an ally in implementing drugs or therapeutic approaches to manage COVID-19 in the Severe stage in healthcare facilities.
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Affiliation(s)
- Roger Borges
- Center for Natural and Human Sciences, Federal University of ABC (UFABC), Brazil; School of Biomedical Engineering, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Brazil
| | - Carla C S Bandeira
- Center for Natural and Human Sciences, Federal University of ABC (UFABC), Brazil
| | - Rodrigo M Zerbinati
- Institute of Infectious Diseases Emílio Ribas, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Michelle Palmieri
- Department of Stomatology, University of São Paulo School of Dentistry, Brazil
| | - Gabriela Schwab
- Institute of Infectious Diseases Emílio Ribas, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Henrique Braz-Silva
- Institute of Infectious Diseases Emílio Ribas, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil; Department of Stomatology, University of São Paulo School of Dentistry, Brazil
| | - José A L Lindoso
- Institute of Infectious Diseases Emílio Ribas, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Herculano Martinho
- Center for Natural and Human Sciences, Federal University of ABC (UFABC), Brazil.
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Wang Z, Liu YL, Chen Y, Siegel L, Cappelleri JC, Chu H. Double-Negative Results Matter: A Reevaluation of Sensitivities for Detecting SARS-CoV-2 Infection Using Saliva Versus Nasopharyngeal Swabs. Am J Epidemiol 2024; 193:548-560. [PMID: 37939113 DOI: 10.1093/aje/kwad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
In a recent systematic review, Bastos et al. (Ann Intern Med. 2021;174(4):501-510) compared the sensitivities of saliva sampling and nasopharyngeal swabs in the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by assuming a composite reference standard defined as positive if either test is positive and negative if both tests are negative (double negative). Even under a perfect specificity assumption, this approach ignores the double-negative results and risks overestimating the sensitivities due to residual misclassification. In this article, we first illustrate the impact of double-negative results in the estimation of the sensitivities in a single study, and then propose a 2-step latent class meta-analysis method for reevaluating both sensitivities using the same published data set as that used in Bastos et al. by properly including the observed double-negative results. We also conduct extensive simulation studies to compare the performance of the proposed method with Bastos et al.'s method for varied levels of prevalence and between-study heterogeneity. The results demonstrate that the sensitivities are overestimated noticeably using Bastos et al.'s method, and the proposed method provides a more accurate evaluation with nearly no bias and close-to-nominal coverage probability. In conclusion, double-negative results can significantly impact the estimated sensitivities when a gold standard is absent, and thus they should be properly incorporated.
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Zhang S, Luo Y, Zhuang W, Zhong G, Su L, Xu T, Zhang X. Fully Integrated Ratiometric Fluorescence Enrichment Platform for High-Sensitivity POC Testing of Salivary Cancer Biomarkers. Anal Chem 2023; 95:18739-18747. [PMID: 38079568 DOI: 10.1021/acs.analchem.3c03170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
The point-of-care (POC) testing of cancer biomarkers in saliva with both high sensitivity and accuracy remains a serious challenge in modern clinical medicine. Herein, we develop a new fully integrated ratiometric fluorescence enrichment platform that utilizes acoustic radiation forces to enrich dual-emission sandwich immune complexes for a POC visual assay. As a result, the color signals from red and green fluorescence (capture probe and report probe, respectively) are enhanced by nearly 10 times, and colorimetric sensitivity is effectively improved. When illuminated using a portable UV lamp, the fluorescence color changing from red to green can be clearly seen with the naked eye, which allows a semiqualitative assessment of the carcinoembryonic antigen (CEA) level. In combination with a homemade smartphone-based portable device, cancer biomarkers like CEA are quantified, achieving a limit of detection as low as 0.012 ng/mL. We also directly quantify CEA in human saliva samples to investigate the reliability of this fully integrated platform, thus validating the usefulness of the proposed strategy for clinical diagnosis and home monitoring of physical conditions.
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Affiliation(s)
- Shuxin Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Yong Luo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Wenxuan Zhuang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Geng Zhong
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Lei Su
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Tailin Xu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Xueji Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
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4
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Millward GG, Popelka SM, Gutierrez AG, Kowallis WJ, von Tersch RL, Yerramilli SV. A novel strategy to avoid sensitivity loss in pooled testing for SARS-CoV-2 surveillance: validation using nasopharyngeal swab and saliva samples. Front Public Health 2023; 11:1190308. [PMID: 37637813 PMCID: PMC10450028 DOI: 10.3389/fpubh.2023.1190308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
At the peak of the COVID-19 pandemic, pooled surveillance strategies were employed to alleviate the overwhelming demand for clinical testing facilities. A major drawback of most pooled-testing methods is the dilution of positive samples, which leads to a loss of detection sensitivity and the potential for false negatives. We developed a novel pooling strategy that compensates for the initial dilution with an appropriate concentration during nucleic acid extraction and real-time PCR. We demonstrated the proof of principle using laboratory-created 10-sample pools with one positive and corresponding individual positive samples by spiking a known amount of heat-inactivated SARS-CoV-2 into viral transport medium (VTM) or pooled negative saliva. No Ct difference was observed between a 10-sample pool with one positive vs. the corresponding individually analyzed positive sample by this method, suggesting that there is no detectable loss of sensitivity. We further validated this approach by using nasopharyngeal swab (NPS) specimens and showed that there is no loss of sensitivity. Serial dilutions of the virus were spiked into VTM and pooled with negative saliva in simulated 10-sample pools containing one positive to determine the LOD and process efficiency of this pooling methodology. The LOD of this approach was 10 copies/PCR, and the process efficiencies are ~95%-103% for N1 and ~87%-98% for N2 with samples in different matrices and with two different master mixes tested. Relative to TaqPath 1-step master mix, the TaqMan Fast Virus 1-Step master mix showed better sensitivity for the N2 assay, while the N1 assay showed no Ct difference. Our pooled testing strategy can facilitate large-scale, cost-effective SARS-CoV-2 surveillance screening and maintain the same level of sensitivity when analyzed individually or in a pool. This approach is highly relevant for public health surveillance efforts aimed at mitigating SARS-CoV-2 spread.
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Affiliation(s)
| | | | | | | | | | - Subrahmanyam V. Yerramilli
- Emerging Biological Threats Branch, Molecular Biology Division, Laboratory Sciences, Defense Centers for Public Health - Aberdeen “Formerly the Army Public Health Center”, Aberdeen Proving Ground, Edgewood, MD, United States
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Caixeta DC, Paranhos LR, Blumenberg C, Garcia-Júnior MA, Guevara-Vega M, Taveira EB, Nunes MAC, Cunha TM, Jardim ACG, Flores-Mir C, Sabino-Silva R. Salivary SARS-CoV-2 RNA for diagnosis of COVID-19 patients: a systematic revisew and meta-analysis of diagnostic accuracy. JAPANESE DENTAL SCIENCE REVIEW 2023:S1882-7616(23)00016-9. [PMID: 37360001 PMCID: PMC10284464 DOI: 10.1016/j.jdsr.2023.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Accurate, self-collected, and non-invasive diagnostics are critical to perform mass-screening diagnostic tests for COVID-19. This systematic review with meta-analysis evaluated the accuracy, sensitivity, and specificity of salivary diagnostics for COVID-19 based on SARS-CoV-2 RNA compared with the current reference tests using a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS). An electronic search was performed in seven databases to find COVID-19 diagnostic studies simultaneously using saliva and NPS/OPS tests to detect SARS-CoV-2 by RT-PCR. The search resulted in 10,902 records, of which 44 studies were considered eligible. The total sample consisted of 14,043 participants from 21 countries. The accuracy, specificity, and sensitivity for saliva compared with the NPS/OPS was 94.3% (95%CI= 92.1;95.9), 96.4% (95%CI= 96.1;96.7), and 89.2% (95%CI= 85.5;92.0), respectively. Besides, the sensitivity of NPS/OPS was 90.3% (95%CI= 86.4;93.2) and saliva was 86.4% (95%CI= 82.1;89.8) compared to the combination of saliva and NPS/OPS as the gold standard. These findings suggest a similarity in SARS-CoV-2 RNA detection between NPS/OPS swabs and saliva, and the association of both testing approaches as a reference standard can increase by 3.6% the SARS-CoV-2 detection compared with NPS/OPS alone. This study supports saliva as an attractive alternative for diagnostic platforms to provide a non-invasive detection of SARS-CoV-2.
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Affiliation(s)
- Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Luiz Renato Paranhos
- School of Dentistry, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marcelo Augusto Garcia-Júnior
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marco Guevara-Vega
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Elisa Borges Taveira
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Marjorie Adriane Costa Nunes
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
- School of Dentistry, CEUMA University, Sao Luiz, MA, Brazil
| | - Thúlio Marquez Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostic and Nanobiotechnology, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Minas Gerais, Brazil
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Li Y, Zhao S, Xu Z, Qiao X, Li M, Li Y, Luo X. Peptide nucleic acid and antifouling peptide based biosensor for the non-fouling detection of COVID-19 nucleic acid in saliva. Biosens Bioelectron 2023; 225:115101. [PMID: 36708624 DOI: 10.1016/j.bios.2023.115101] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/24/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
The electrochemical biosensor with outstanding sensitivity and low cost is regarded as a viable alternative to current clinical diagnostic techniques for various disease biomarkers. However, their actual analytical use in complex biological samples is severely hampered due to the biofouling, as they are also highly sensitive to nonspecific adsorption on the sensing interfaces. Herein, we have constructed a non-fouling electrochemical biosensor based on antifouling peptides and the electroneutral peptide nucleic acid (PNA), which was used as the recognizing probe for the specific binding of the viral RNA of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Different from the negatively charged DNA probes that will normally weaken the biosensors' antifouling capabilities owing to the charge attraction of positively charged biomolecules, the neutral PNA probe will generate no side-effects on the biosensor. The biosensor demonstrated remarkable sensitivity in detecting SARS-CoV-2 viral RNA, possessing a broad linear range (1.0 fM - 1.0 nM) and a detection limit down to 0.38 fM. Furthermore, the sensing performance of the constructed electrochemical biosensor in human saliva was nearly similar to that in pure buffer, indicating satisfying antifouling capability. The combination of PNA probes with antifouling peptides offered a new strategy for the development of non-fouling sensing systems capable of assaying trace disease biomarkers in complicated biological media.
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Affiliation(s)
- Yanxin Li
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Shuju Zhao
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Zhenying Xu
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Xiujuan Qiao
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Mingxuan Li
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Youke Li
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China
| | - Xiliang Luo
- Key Laboratory of Optic-electric Sensing and Analytical Chemistry for Life Science, MOE, Shandong Key Laboratory of Biochemical Analysis, College of Chemistry and Molecular Engineering, Qingdao University of Science & Technology, Qingdao, 266042, China.
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Ávila LMS, Galvis MLD, Campos MAJ, Lozano-Parra A, Villamizar LAR, Arenas MO, Martínez-Vega RA, Cala LMV, Bautista LE. Validation of RT-qPCR test for SARS-CoV-2 in saliva specimens. J Infect Public Health 2022; 15:1403-1408. [PMID: 36371937 PMCID: PMC9628233 DOI: 10.1016/j.jiph.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/19/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background Saliva samples may be an easier, faster, safer, and cost-saving alternative to NPS samples, and can be self-collected by the patient. Whether SARS-CoV-2 RT-qPCR in saliva is more accurate than in nasopharyngeal swaps (NPS) is uncertain. We evaluated the accuracy of the RT-qPCR in both types of samples, assuming both approaches were imperfect. Methods We assessed the limit of detection (LoD) of RT-qPCR in each type of sample. We collected paired NPS and saliva samples and tested them using the Berlin Protocol to detect SARS-CoV-2 envelope protein (E). We used a Bayesian latent class analysis (BLCA) to estimate the sensitivity and specificity of each test, while accounting for their conditional dependence. Results The LoD were 10 copies/mL in saliva and 100 copies/mL in NPS. Paired samples of saliva and NPS were collected in 412 participants. Out of 68 infected cases, 14 were positive only in saliva. RT-qPCR sensitivity ranged from 82.7% (95% CrI: 54.8, 94.8) in NPS to 84.5% (50.9, 96.5) in saliva. Corresponding specificities were 99.1 (95% CrI: 95.3, 99.8) and 98.4 (95% CrI: 92.8, 99.7). Conclusions SARS-CoV-2 RT-qPCR test in saliva specimens has a similar or better accuracy than RT-qPCR test in NPS. Saliva specimens may be ideal for surveillance in general population, particularly in children, and in healthcare or other personnel in need of serial testing.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Leonelo E. Bautista
- University of Wisconsin-Madison, 610 Walnut Street, WARF 703, Madison, United States,Correspondence to: Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, WARF 703, Madison, WI 53711
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Van de Casteele M, Waterschoot J, Anthierens S, DeSmet A, Galand B, Goossens H, Morbée S, Vansteenkiste M. Saliva testing among teachers during the COVID-19 pandemic: Effects on health concerns, well-being, and precautionary behavior. Soc Sci Med 2022; 311:115295. [PMID: 36067619 PMCID: PMC9394098 DOI: 10.1016/j.socscimed.2022.115295] [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: 11/22/2021] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
RATIONALE At the start of 2021, several SARS-CoV-2 cluster outbreaks in schools threatened in-person education and created a fairly chaotic and frightening environment for school personnel. To keep the schools open while preventing COVID-19 outbreaks, intensive diagnostic testing in teachers and school personnel was strongly recommended but missing at the time. OBJECTIVES A project was launched in Belgian schools to weekly analyze the morning saliva of school personnel using PCR-testing to detect and prevent COVID-19 positive cases. In this quasi-experimental study, we aimed to examine whether the implementation of this saliva testing project impacted school personnel's pandemic-related health concerns, well-being, and adherence to the health-protective measures, contrasting experimental with control schools. METHODS The data were collected during the third wave (Alpha-wave, February-March 2021) of the pandemic. The sample consisted of 435 participants from 34 different schools across Flanders (Belgium) (78.8% female; M age = 43.87 years, range = 21-67) of which 82% participated in the weekly saliva tests (i.e., experimental group) and 18% took part in the control group. RESULTS Results from a series of linear mixed regression models showed that saliva testing buffered against an increase in health concerns among tested school personnel but did not affect participants' general well-being. Slight declines in adherence to the health-protective behaviors were observed, yet this was only the case for participants who felt less supported by their school principal. High degrees of principals' support also fostered the sharpest decreases in school staff's pandemic-related health concerns. CONCLUSIONS When keeping the schools open in unstable pandemic times, weekly saliva testing is a promising strategy to prevent cluster outbreaks while simultaneously safeguarding health concerns among school personnel. School principals appear to play a critical role in the implementation of saliva testing to secure positive effects.
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Affiliation(s)
| | | | | | - Ann DeSmet
- Université Libre de Bruxelles, Belgium; University of Antwerp, Belgium
| | | | | | - Sofie Morbée
- Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Hua N, Corsten M, Bello A, Bhatt M, Milwid R, Champredon D, Turgeon P, Zemek R, Dawson L, Mitsakakis N, Webster R, Caulley L, Angel JB, Bastien N, Poliquin G, Johnson-Obaseki S. Salivary testing for SARS-CoV-2 in the pediatric population: a diagnostic accuracy study. CMAJ Open 2022; 10:E981-E987. [PMID: 36347561 PMCID: PMC9648623 DOI: 10.9778/cmajo.20210279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and timely testing for SARS-CoV-2 in the pediatric population is crucial to control the COVID-19 pandemic; saliva testing has been proposed as a less invasive alternative to nasopharyngeal swabs. We sought to compare the detection of SARS-CoV-2 using saliva versus nasopharyngeal swab in the pediatric population, and to determine the optimum time of testing for SARS-CoV-2 using saliva. METHODS We conducted a longitudinal diagnostic study in Ottawa, Canada, from Jan. 19 to Mar. 26, 2021. Children aged 3-17 years were eligible if they exhibited symptoms of COVID-19, had been identified as a high-risk or close contact to someone confirmed positive for SARS-CoV-2 or had travelled outside Canada in the previous 14 days. Participants provided both nasopharyngeal swab and saliva samples. Saliva was collected using a self-collection kit (DNA Genotek, OM-505) or a sponge-based kit (DNA Genotek, ORE-100) if they could not provide a saliva sample into a tube. RESULTS Among 1580 paired nasopharyngeal and saliva tests, 60 paired samples were positive for SARS-CoV-2. Forty-four (73.3%) were concordant-positive results and 16 (26.6%) were discordant, among which 8 were positive only on nasopharyngeal swab and 8 were positive only on saliva testing. The sensitivity of saliva was 84.6% (95% confidence interval 71.9%-93.1%). INTERPRETATION Salivary testing for SARS-CoV-2 in the pediatric population is less invasive and shows similar detection of SARS-CoV-2 to nasopharyngeal swabs. It may therefore provide a feasible alternative for diagnosis of SARS-CoV-2 infection in children.
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Affiliation(s)
- Nadia Hua
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Martin Corsten
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Alexander Bello
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Maala Bhatt
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Rachael Milwid
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - David Champredon
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Patricia Turgeon
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Roger Zemek
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Lauren Dawson
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Nicholas Mitsakakis
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Richard Webster
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Jonathan B Angel
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Nathalie Bastien
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Guillaume Poliquin
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology - Head and Neck Surgery (Hua, Caulley, Johnson-Obaseki), University of Ottawa, Ottawa, Ont.; Division of Otolaryngology - Head and Neck Surgery (Corsten), Dalhousie University, Halifax, NS; National Microbiology Laboratory (Bello, Bastien, Poliquin), Public Health Agency of Canada, Winnipeg, Man.; Department of Pediatrics and Emergency Medicine (Bhatt, Zemek), Children's Hospital of Eastern Ontario; Division of Pediatric Emergency Research (Bhatt, Zemek, Dawson, Mitsakakis, Webster), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; National Microbiology Laboratory (Milwid, Turgeon), Public Health Agency of Canada, Saint-Hyacinthe, Que.; National Microbiology Laboratory (Champredon), Public Health Agency of Canada, Guelph, Ont.; Division of Infectious Diseases (Angel), University of Ottawa, Ottawa, Ont.; Chronic Disease Program (Angel), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Pediatrics and Child Health (Poliquin), University of Manitoba, Winnipeg, Man.
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10
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McLennan K, Barton E, Lang C, Adams IR, McAllister G, Reijns MAM, Templeton K, Johannessen I, Leckie A, Gilbert N. User acceptability of saliva and gargle samples for identifying COVID-19 positive high-risk workers and household contacts. Diagn Microbiol Infect Dis 2022; 104:115732. [PMID: 35728458 PMCID: PMC9132684 DOI: 10.1016/j.diagmicrobio.2022.115732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 11/23/2022]
Abstract
Throughout the COVID-19 pandemic nasopharyngeal or nose and/or throat swabs (NTS) have been the primary approach for collecting patient samples for the subsequent detection of viral RNA. However, this procedure, if undertaken correctly, can be unpleasant and therefore deters individuals from providing high quality samples. To overcome these limitations other modes of sample collection have been explored. In a cohort of frontline health care workers we have compared saliva and gargle samples to gold-standard NTS. 93% of individuals preferred providing saliva or gargle samples, with little sex-dependent variation. Viral titers collected in samples were analyzed using standard methods and showed that gargle and saliva were similarly comparable for identifying COVID-19 positive individuals compared to NTS (92% sensitivity; 98% specificity). We suggest that gargle and saliva collection are viable alternatives to NTS swabs and may encourage testing to provide better disease diagnosis and population surveillance.
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Affiliation(s)
- Kirsty McLennan
- Occupational Health and Safety Service, Astley Ainsley Hospital, NHS Lothian, Edinburgh, UK.
| | - Ellen Barton
- Occupational Health and Safety Service, Astley Ainsley Hospital, NHS Lothian, Edinburgh, UK
| | - Christie Lang
- Occupational Health and Safety Service, Astley Ainsley Hospital, NHS Lothian, Edinburgh, UK
| | - Ian R Adams
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Gina McAllister
- Clinical Microbiology and Virology, Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Martin A M Reijns
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK
| | - Kate Templeton
- Clinical Microbiology and Virology, Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Ingólfur Johannessen
- Clinical Microbiology and Virology, Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Alastair Leckie
- Occupational Health and Safety Service, Astley Ainsley Hospital, NHS Lothian, Edinburgh, UK
| | - Nick Gilbert
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, UK.
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11
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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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12
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Jenkins HH, Lopez AAT, Tarantini FS, Tomlin H, Scales D, Lee IN, Wu S, Hyde R, Lis-Slimak K, Byaruhanga T, Thompson JL, Pijuan-Galito S, Doolan L, Kaneko K, Gwynne P, Reffin C, Park E, Dey J, Hill J, Arendt-Tranholm A, Stroud A, Petrie M, Denning C, Benest AV, Seedhouse C. Performance evaluation of a non-invasive one-step multiplex RT-qPCR assay for detection of SARS-CoV-2 direct from saliva. Sci Rep 2022; 12:11553. [PMID: 35798820 PMCID: PMC9261881 DOI: 10.1038/s41598-022-15616-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022] Open
Abstract
Polymerase chain reaction (PCR) has proven to be the gold-standard for SARS-CoV-2 detection in clinical settings. The most common approaches rely on nasopharyngeal specimens obtained from swabs, followed by RNA extraction, reverse transcription and quantitative PCR. Although swab-based PCR is sensitive, swabbing is invasive and unpleasant to administer, reducing patient compliance for regular testing and resulting in an increased risk of improper sampling. To overcome these obstacles, we developed a non-invasive one-step RT-qPCR assay performed directly on saliva specimens. The University of Nottingham Asymptomatic Testing Service protocol simplifies sample collection and bypasses the need for RNA extraction, or additives, thus helping to encourage more regular testing and reducing processing time and costs. We have evaluated the assay against the performance criteria specified by the UK regulatory bodies and attained accreditation (BS EN ISO/IEC 17,025:2017) for SARS-CoV-2 diagnostic testing by the United Kingdom Accreditation Service. We observed a sensitivity of 1 viral copy per microlitre of saliva, and demonstrated a concordance of > 99.4% between our results and those of other accredited testing facilities. We concluded that saliva is a stable medium that allows for a highly precise, repeatable, and robust testing method.
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Affiliation(s)
- Harry H Jenkins
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Ana A Tellechea Lopez
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Francesco Saverio Tarantini
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Hannah Tomlin
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Danielle Scales
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - I-Ning Lee
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Siyu Wu
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Ralph Hyde
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Katarzyna Lis-Slimak
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Timothy Byaruhanga
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Jamie L Thompson
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Sara Pijuan-Galito
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lara Doolan
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Kazuyo Kaneko
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Penny Gwynne
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Reffin
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Emily Park
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Jayasree Dey
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Jack Hill
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Asta Arendt-Tranholm
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Amy Stroud
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Moira Petrie
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Chris Denning
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Andrew V Benest
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Claire Seedhouse
- School of Medicine, Biodiscovery Institute, University of Nottingham Asymptomatic Testing Service (UoNATS), University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
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13
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Ahmadieh A, Dincer S, Navazesh M. Is saliva collected passively without forceful coughing sensitive to detect SARS-CoV-2 in ambulatory cases? A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:530-538. [PMID: 35227640 PMCID: PMC8743389 DOI: 10.1016/j.oooo.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This systematic review was conducted to assess the sensitivity rate of SARS-CoV-2 detection in the saliva of ambulatory asymptomatic and mildly symptomatic patients, with saliva being collected passively without any forceful coughing. STUDY DESIGN A literature search was performed from January 2020 to July 2021. Prospective studies excluding letters to editors were included in our review only if saliva and nasopharyngeal samples were collected simultaneously and sensitivity was reported using reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic or mildly symptomatic ambulatory cases. RESULTS A total of 436 studies were assessed; 10 (4 cohorts and 6 cross-sectional) studies met our inclusion criteria. The sensitivity rate of saliva to detect SARS-CoV-2 varied from 85.7% to 98.6% in all except for 3 studies. Lower sensitivity levels were attributed to low viral load (51.9% and 63.8%) or lack of supervision while collecting saliva (66.7%). CONCLUSIONS Passively collected saliva in the absence of coughing has a high sensitivity rate to detect SARS-CoV-2 in asymptomatic and mildly symptomatic patients compared with nasopharyngeal swabs. Limitations of previous studies, such as lack of attention to the method of saliva collection, stages, and severity of the disease at the time of sample collection, can be researched in future investigations.
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Affiliation(s)
- Azadeh Ahmadieh
- Clinical Assistant Professor of Dentistry, Division of Biomedical Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA.,Corresponding author
| | - Sibel Dincer
- Clinical Assistant Professor of Dentistry, Division of Biomedical Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
| | - Mahvash Navazesh
- Executive Associate Dean for Academic, Faculty & Student Affairs, Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Professor of Diagnostic Sciences, Herman Ostrow School of Dentistry of USC, Los Angeles, California, USA
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14
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Yasuda I, Suzuki M, Maeda H, Terada M, Sando E, Ng CFS, Otomaru H, Yoshida LM, Morimoto K. Respiratory virus detection in the upper respiratory tract of asymptomatic, community-dwelling older people. BMC Infect Dis 2022; 22:411. [PMID: 35484482 PMCID: PMC9047617 DOI: 10.1186/s12879-022-07355-w] [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: 06/10/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of virus positivity in the upper respiratory tract of asymptomatic community-dwelling older people remains elusive. Our objective was to investigate the prevalence of respiratory virus PCR positivity in asymptomatic community-dwelling older people using saliva samples and nasopharyngeal and oropharyngeal swabs. Methods We analyzed 504 community-dwelling adults aged ≥ 65 years who were ambulatory and enrolled in a cross-sectional study conducted from February to December 2018 in Nagasaki city, Japan. Fourteen respiratory viruses were identified in saliva, nasopharyngeal and oropharyngeal samples using multiplex PCR assays. Results The prevalences of PCR positivity for rhinovirus, influenza A, enterovirus and any respiratory virus were 12.9% (95% CI: 10.1–16.1%), 7.1% (95% CI: 5.1–9.8%), 6.9% (95% CI: 4.9–9.5%) and 25.2% (95% CI: 21.5–29.2%), respectively. Rhinovirus was detected in 21.5% of subjects, influenza A in 38.9% of subjects, enterovirus in 51.4% of subjects and any virus in 32.3% of subjects using only saliva sampling. Conclusions The prevalences of several respiratory viruses were higher than the percentages reported previously in pharyngeal samples from younger adults. Saliva sampling is a potentially useful method for respiratory virus detection in asymptomatic populations. Supplementary information The online version contains supplementary material available at 10.1186/s12879-022-07355-w.
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Affiliation(s)
- Ikkoh Yasuda
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan.,Department of General Internal Medicine and Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Haruka Maeda
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Mayumi Terada
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Nijigaoka Hospital, Nagasaki, Japan
| | - Eiichiro Sando
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan.,Department of General Internal Medicine and Infectious Diseases, Kita-Fukushima Medical Center, Fukushima, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hirono Otomaru
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. .,Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. .,Nijigaoka Hospital, Nagasaki, Japan.
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15
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Saliva versus Upper Respiratory Swabs: Equivalent for Severe Acute Respiratory Syndrome Coronavirus 2 University Screening while Saliva Positivity Is Prolonged After Symptom Onset in Coronavirus Disease 2019 Hospitalized Patients. J Mol Diagn 2022; 24:727-737. [PMID: 35489695 PMCID: PMC9044746 DOI: 10.1016/j.jmoldx.2022.03.012] [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: 10/13/2021] [Revised: 02/25/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Reopening of schools and workplaces during the ongoing coronavirus disease 2019 (COVID-19) pandemic requires affordable and convenient population-wide screening methods. Although upper respiratory swab is considered the preferable specimen for testing, saliva offers several advantages, such as easier collection and lower cost. In this study, we compared the performance of saliva with upper respiratory swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. Paired saliva and anterior nares specimens were collected from a largely asymptomatic cohort of students, faculty, and staff from the University of Pennsylvania. Paired saliva and combined nasopharyngeal/oropharyngeal (NP/OP) specimens were also collected from hospitalized patients with symptomatic COVID-19 following confirmatory testing. All study samples were tested by real-time PCR in the Hospital of the University of Pennsylvania. In the university cohort, positivity rates were 37 of 2500 for saliva (sensitivity, 86.1%) and 36 of 2500 for anterior nares (sensitivity, 83.7%), with an overall agreement of 99.6%. In the hospital study cohort, positivity rates were 35 of 49 for saliva (sensitivity, 89.3%) and 28 of 49 for NP/OP (sensitivity, 75.8%), with an overall agreement of 75.6%. A larger proportion of saliva than NP/OP samples tested positive after 4 days of symptom onset in hospitalized patients. Our results show that saliva has an acceptable sensitivity and is comparable to upper respiratory swab, supporting the use of saliva for SARS-CoV-2 detection in both symptomatic and asymptomatic populations.
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Jayakody H, Rowland D, Pereira C, Blackwell R, Lasota T, Laverick M, Tisi L, Leese HS, Walsham ADS. Development of a high sensitivity RT-PCR assay for detection of SARS-CoV-2 in individual and pooled nasopharyngeal samples. Sci Rep 2022; 12:5369. [PMID: 35354857 PMCID: PMC8965539 DOI: 10.1038/s41598-022-09254-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/21/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic requires sensitive detection of the SARS-CoV-2 virus from samples to ensure accurate detection of infected patients, an essential component of effective national track and trace programs. Due to the scaling challenges of large sample numbers, sample pooling is an attractive solution to reduce both extraction and amplification reagent costs, if high sensitivity can be maintained. We demonstrate that the Erba Molecular ErbaMDx SARS-CoV-2 RT-PCR Kit (EM kit) delivers high sensitivity, achieving analytical detection of 5 copies/reaction SARS-CoV-2 genomic RNA, and 200 copies/mL SARS-CoV-2 inactivated virus spiked into nasopharyngeal swab (NP) samples and extracted through workflow. Furthermore, the EM Kit demonstrates high sensitivity in both pooled (1 in 5) and non-pooled NP samples when compared to an FDA Emergency Use Authorization approved assay, following published FDA guidelines. These findings demonstrate that the EM Kit is suitable for sample pooling, with minimal impact on assay performance. As the COVID-19 pandemic progresses, high sensitivity assays such as the EM Kit will have an important role in ensuring high throughput and sensitive testing using pooled samples can be maintained, delivering the most cost-effective sample extraction and amplification option for national test and trace programs.
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Affiliation(s)
- Harindi Jayakody
- Erba Molecular, Ely, Cambridgeshire, UK
- Materials for Health Lab, Department of Chemical Engineering, University of Bath, Bath, UK
| | | | | | | | | | | | | | - Hannah S Leese
- Materials for Health Lab, Department of Chemical Engineering, University of Bath, Bath, UK
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Abstract
Coronavirus disease 2019 (COVID-19) is a mild to severe respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The diagnostic accuracy of the Centers for Disease Control and Prevention (CDC)- or World Health Organization (WHO)-recommended real-time PCR (RT-qPCR) primers in clinical practice remains unproven. We conducted a prospective study on the accuracy of RT-qPCR using an in-house-designed primer set (iNP) targeting the nucleocapsid protein as well as various recommended and commercial primers. The accuracy was assessed by culturing or seroconversion. We enrolled 12 confirmed COVID-19 patients with a total of 590 clinical samples. When a cutoff value of the cycle threshold (Ct) was set to 35, RT-qPCRs with WHO RdRp primers and CDC N1, N2, and N3 primers showed sensitivity of 42.1% to 63.2% and specificity of 90.5% to 100% in sputum, and sensitivity of 65.2% to 69.6% and specificity of 65.2% to 69.6% in nasopharyngeal samples. The sensitivity and specificity of iNP RT-qPCR in sputum and nasopharyngeal samples were 94.8%/100% and 69.6%/100%, respectively. Sputum testing had the highest sensitivity, followed by nasopharyngeal testing (P = 0.0193); self-collected saliva samples yielded better characteristics than oropharyngeal samples (P = 0.0032). Our results suggest that iNP RT-qPCR has better sensitivity and specificity than RT-PCR with WHO (P < 0.0001) or CDC (N1: P = 0.0012, N2: P = 0.0013, N3: P = 0.0012) primers. Sputum RT-qPCR analysis has the highest sensitivity, followed by nasopharyngeal, saliva, and oropharyngeal assays. Our study suggests that considerable improvement is needed for the RT-qPCR WHO and CDC primer sets for detecting SARS-CoV-2. IMPORTANCE Numerous research campaigns have addressed the vast majority of clinical and diagnostic specificity and sensitivity of various primer sets of SARS-CoV2 viral detection. Despite the impressive progress made to resolve the pandemic, there is still a need for continuous and active improvement of primers used for diagnosis in clinical practice. Our study significantly exceeds the scale of previously published research on the specificity and sensitivity of different primers comparing with different specimens and is the most comprehensive to date in terms of constant monitoring of primer sets of current usage. Henceforth, our results suggest that sputum samples sensitivity is the highest, followed by nasopharyngeal, saliva, and oropharyngeal samples. The CDC recommends the use of oropharyngeal specimens, leading to certain discrepancy between the guidelines set forth by the CDC and IDSA. We proved that the oropharyngeal samples demonstrated the lowest sensitivity for the detection of SARS-CoV-2.
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18
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Laferl H, Seitz T, Baier-Grabner S, Kelani H, Scholz E, Heger F, Götzinger F, Frischer PT, Wenisch C, Allerberger PF. Evaluation of RT-qPCR of mouthwash and buccal swabs for detection of SARS-CoV-2 in children and adults. Am J Infect Control 2022; 50:176-181. [PMID: 34718065 PMCID: PMC8552590 DOI: 10.1016/j.ajic.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
Background The use of nasopharyngeal (NP) swabs as a specimen collection method to diagnose SARS-CoV-2 infection is frequently perceived as uncomfortable by patients and requires trained personnel. In this study, detection rate of SARS-CoV-2 in mouthwash samples and buccal swabs were compared in both children and adults. Material and methods In patients admitted to hospital with confirmed COVID-19 within the previous 72 hours, NP and buccal swabs as well as mouthwash samples were collected. RT-qPCR was performed on all samples. Results In total, 170 samples were collected from 155 patients (137 adults and 18 children). Approximately 91.7% of the collected NP swabs were positive in RT-PCR compared to 63.1% of mouthwash samples and 42.4% of buccal swabs. Compared to NP swabs, the sensitivity of using mouthwash was 96.3% and 65.4% for buccal swabs in NP swab samples with a CT value <25. With increasing CT values, sensitivity decreased in both mouthwash and buccal swabs. The virus load was highest during the first week of infection, with a continuous decline observed in all three collection methods over time. Discussion Mouthwash presents an alternative collection method for detecting SARS-CoV-2 in the case of unfeasible NP swab sampling. Buccal swabs should not be used due to their low sensitivity.
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Wang Q, Li Y, Lung DC, Chan PT, Dung CH, Jia W, Miao T, Huang J, Chen W, Wang Z, Leung KM, Lin Z, Wong D, Tse H, Wong SCY, Choi GKY, Lam JYW, To KKW, Cheng VCC, Yuen KY. Aerosol transmission of SARS-CoV-2 due to the chimney effect in two high-rise housing drainage stacks. JOURNAL OF HAZARDOUS MATERIALS 2022; 421:126799. [PMID: 34396958 PMCID: PMC8327615 DOI: 10.1016/j.jhazmat.2021.126799] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 05/22/2023]
Abstract
Stack aerosols are generated within vertical building drainage stacks during the discharge of wastewater containing feces and exhaled mucus from toilets and washbasins. Fifteen stack aerosol-related outbreaks of coronavirus disease 2019 (COVID-19) in high-rise buildings have been observed in Hong Kong and Guangzhou. Currently, we investigated two such outbreaks of COVID-19 in Hong Kong, identified the probable role of chimney effect-induced airflow in a building drainage system in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We injected tracer gas (SF6) into the drainage stacks via the water closet of the index case and monitored tracer gas concentrations in the bathrooms and along the facades of infected and non-infected flats and in roof vents. The air temperature, humidity, and pressure in vertical stacks were also monitored. The measured tracer gas distribution agreed with the observed distribution of the infected cases. Phylogenetic analysis of the SARS-CoV-2 genome sequences demonstrated clonal spread from a point source in cases along the same vertical column. The stack air pressure and temperature distributions suggested that stack aerosols can spread to indoors through pipe leaks which provide direct evidence for the long-range aerosol transmission of SARS-CoV-2 through drainage pipes via the chimney effect.
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Affiliation(s)
- Qun Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China.
| | - David Christopher Lung
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China; Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
| | - Pak-To Chan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Chung-Hin Dung
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Wei Jia
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Te Miao
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Jianxiang Huang
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Wenzhao Chen
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Zixuan Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | | | - Zhang Lin
- Division of Building Science and Technology, City University of Hong Kong, Hong Kong, China
| | - Daniel Wong
- Estates Office, The University of Hong Kong, Hong Kong, China
| | - Herman Tse
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | | | | | - Jimmy Yiu-Wing Lam
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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20
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Tng DJH, Yin BCY, Cao J, Ko KKK, Goh KCM, Chua DXW, Zhang Y, Chua MLK, Low JGH, Ooi EE, Soo KC. Amplified parallel antigen rapid test for point-of-care salivary detection of SARS-CoV-2 with improved sensitivity. Mikrochim Acta 2022; 189:14. [PMID: 34870771 PMCID: PMC8646336 DOI: 10.1007/s00604-021-05113-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 01/11/2023]
Abstract
In the ongoing COVID-19 pandemic, simple, rapid, point-of-care tests not requiring trained personnel for primary care testing are essential. Saliva-based antigen rapid tests (ARTs) can fulfil this need, but these tests require overnight-fasted samples; without which independent studies have demonstrated sensitivities of only 11.7 to 23.1%. Herein, we report an Amplified Parallel ART (AP-ART) with sensitivity above 90%, even with non-fasted samples. The virus was captured multimodally, using both anti-spike protein antibodies and Angiotensin Converting Enzyme 2 (ACE2) protein. It also featured two parallel flow channels. The first contained spike protein binding gold nanoparticles which produced a visible red line upon encountering the virus. The second contained signal amplifying nanoparticles that complex with the former and amplify the signal without any linker. Compared to existing dual gold amplification techniques, a limit of detection of one order of magnitude lower was achieved (0.0064 ng·mL-1). AP-ART performance in detecting SARS-CoV-2 in saliva of COVID-19 patients was investigated using a case-control study (139 participants enrolled and 162 saliva samples tested). Unlike commercially available ARTs, the sensitivity of AP-ART was maintained even when non-fasting saliva was used. Compared to the gold standard reverse transcription-polymerase chain reaction testing on nasopharyngeal samples, non-fasting saliva tested on AP-ART showed a sensitivity of 97.0% (95% CI: 84.7-99.8); without amplification, the sensitivity was 72.7% (95% CI: 83.7-94.8). Thus, AP-ART has the potential to be developed for point-of-care testing, which may be particularly important in resource-limited settings, and for early diagnosis to initiate newly approved therapies to reduce COVID-19 severity.
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Affiliation(s)
- Danny Jian Hang Tng
- Department of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Bryan Chu Yang Yin
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Jing Cao
- Department of Biomedical Engineering, National University Singapore, 4 Engineering Drive 3, Engineering Block 4, Singapore, 117583 Singapore
- State Key Laboratory for Oncogenes and Related Genes, School of Biomedical Engineering and Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200030 People’s Republic of China
| | - Kwan Ki Karrie Ko
- Department of Microbiology, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore
| | - Kenneth Choon Meng Goh
- Department of Microbiology, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore
| | - Delia Xue Wen Chua
- Department of Biomedical Engineering, National University Singapore, 4 Engineering Drive 3, Engineering Block 4, Singapore, 117583 Singapore
| | - Yong Zhang
- Department of Biomedical Engineering, National University Singapore, 4 Engineering Drive 3, Engineering Block 4, Singapore, 117583 Singapore
| | - Melvin Lee Kiang Chua
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Oncology Academic Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Jenny Guek Hong Low
- Department of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Eng Eong Ooi
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Khee Chee Soo
- Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Oncology Academic Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
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21
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Kernéis S, Elie C, Fourgeaud J, Choupeaux L, Delarue SM, Alby ML, Quentin P, Pavie J, Brazille P, Néré ML, Minier M, Gabassi A, Gibaud A, Gauthier S, Leroy C, Voirin-Mathieu E, Poyart C, Vidaud M, Parfait B, Delaugerre C, Tréluyer JM, LeGoff J. Accuracy of saliva and nasopharyngeal sampling for detection of SARS-CoV-2 in community screening: a multicentric cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:2379-2388. [PMID: 34342768 PMCID: PMC8329409 DOI: 10.1007/s10096-021-04327-x] [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: 05/31/2021] [Accepted: 07/27/2021] [Indexed: 01/07/2023]
Abstract
Nasopharyngeal sampling for nucleic acid amplification testing (NAAT) is the standard diagnostic test of coronavirus disease 2019. Our objectives were to assess, in real-life conditions, the diagnostic accuracy of a nasopharyngeal point-of-care antigen (Ag) test and of saliva NAAT for detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in ambulatory care. This was a prospective cohort study from 19 October through 18 December 2020 in two community COVID-19 screening centers in Paris, France. Two nasopharyngeal swabs and one saliva sample were simultaneously collected. Diagnostic accuracies of nasopharyngeal Ag testing and of three saliva NAAT methods were assessed as compared to nasopharyngeal NAAT. A total of 1452 ambulatory children and adults were included. Overall, 129/1443 (9%) participants tested positive on nasopharyngeal NAAT (102/564 [18%] in symptomatic and 27/879 [3%] in asymptomatic participants). Sensitivity was 94%, 23%, 96%, and 94% for the three different protocols of saliva NAAT and for the nasopharyngeal Ag test, respectively. Estimates of specificity were above 95% for all methods. Diagnostic accuracy was similar in symptomatic and asymptomatic individuals. Diagnostic accuracy of nasopharyngeal Ag testing and of saliva NAAT is similar to that of nasopharyngeal NAAT, subject to compliance with specific protocols for saliva. Registration number: NCT04578509.
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Affiliation(s)
- Solen Kernéis
- Université de Paris, INSERM, IAME, 75018, Paris, France.
- Equipe de Prévention du Risque Infectieux, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75018, Paris, France.
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, 75015, Paris, France.
| | - Caroline Elie
- Clinical Research Unit / Clinical Investigation Center, APHP, Necker-Enfants Malades Hospital, 75015, Paris, France
- EA 7323 Pharmacologie Et Thérapeutique de L'enfant Et de La Femme Enceinte, Université de Paris, 75015, Paris, France
| | - Jacques Fourgeaud
- Virologie, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
- Equipe Hospitalo-Universitaire 7328, Prise en Charge Des Anomalies Congénitales Et de Leur Traitement, Institut Imagine, Université de Paris, 75015, Paris, France
| | - Laure Choupeaux
- Clinical Research Unit / Clinical Investigation Center, APHP, Necker-Enfants Malades Hospital, 75015, Paris, France
| | | | - Marie-Laure Alby
- Centre de Dépistage COVISAN 13 14 15, Communauté Professionnelle de Territoire de Santé, 75014, Paris, France
| | - Pierre Quentin
- Centre de Dépistage COVISAN 13 14 15, Communauté Professionnelle de Territoire de Santé, 75014, Paris, France
| | - Juliette Pavie
- Immuno-Infectiologie, AP-HP, Hôtel Dieu, 75004, Paris, France
- Centre de Dépistage COVISAN, AP-HP, Hôtel Dieu, 75004, Paris, France
| | - Patricia Brazille
- Centre de Dépistage COVISAN, AP-HP, Hôtel Dieu, 75004, Paris, France
- Espace Santé Jeunes - Unité Guy Môquet, AP-HP, Hôtel Dieu, 75004, Paris, France
| | | | - Marine Minier
- Virologie, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Audrey Gabassi
- Virologie, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | | | - Sébastien Gauthier
- Centre de Ressources Biologiques - Site Cochin, AP-HP, Fédération des CRB/PRB D'AP-HP. Centre-Université de Paris, Hôpital Cochin, 75014, Paris, France
| | | | - Etienne Voirin-Mathieu
- Plateforme SeqOIA, AP-HP, 75014, Paris, France
- Virologie, Hôpital Cochin, AP-HP, 75014, Paris, France
| | - Claire Poyart
- Université de Paris, INSERM, Institut Cochin, 1016, F-75014, Paris, France
- Bactériologie, AP-HP Centre, Hôpital Cochin, 75014, Paris, France
| | - Michel Vidaud
- Plateforme SeqOIA, AP-HP, 75014, Paris, France
- Université de Paris, INSERM, Institut Cochin, 1016, F-75014, Paris, France
| | - Béatrice Parfait
- Centre de Ressources Biologiques - Site Cochin, AP-HP, Fédération des CRB/PRB D'AP-HP. Centre-Université de Paris, Hôpital Cochin, 75014, Paris, France
| | - Constance Delaugerre
- Virologie, AP-HP, Hôpital Saint Louis, 75010, Paris, France
- Université de Paris, INSERM, U944, F-75010, Paris, France
| | - Jean-Marc Tréluyer
- Clinical Research Unit / Clinical Investigation Center, APHP, Necker-Enfants Malades Hospital, 75015, Paris, France
- EA 7323 Pharmacologie Et Thérapeutique de L'enfant Et de La Femme Enceinte, Université de Paris, 75015, Paris, France
| | - Jérôme LeGoff
- Virologie, AP-HP, Hôpital Saint Louis, 75010, Paris, France
- Equipe INSIGHT, Université de Paris, INSERM, U976, F-75010, Paris, France
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22
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De Santi C, Jacob B, Kroich P, Doyle S, Ward R, Li B, Donnelly O, Dykes A, Neelakant T, Neary D, McGuinness R, Cafferkey J, Ryan K, Quadu V, McGrogan K, Garcia Leon A, Mallon P, Fitzpatrick F, Humphreys H, De Barra E, Kerrigan SW, Cavalleri GL. Concordance between PCR-based extraction-free saliva and nasopharyngeal swabs for SARS-CoV-2 testing. HRB Open Res 2021; 4:85. [PMID: 34522839 PMCID: PMC8408542 DOI: 10.12688/hrbopenres.13353.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: Saliva represents a less invasive alternative to nasopharyngeal swab (NPS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. SalivaDirect is a nucleic acid extraction-free method for detecting SARS-CoV2 in saliva specimens. Studies evaluating the concordance of gold standard NPS and newly developed SalivaDirect protocols are limited. The aim of our study was to assess SalivaDirect as an alternative method for COVID-19 testing. Methods: Matching NPS and saliva samples were analysed from a cohort of symptomatic (n=127) and asymptomatic (n=181) participants recruited from hospital and university settings, respectively. RNA was extracted from NPS while saliva samples were subjected to the SalivaDirect protocol before RT-qPCR analysis. The presence of SARS-Cov-2 was assessed using RdRp and N1 gene targets in NPS and saliva, respectively. Results: Overall we observed 94.3% sensitivity (95% CI 87.2-97.5%), and 95.9% specificity (95% CI 92.4-97.8%) in saliva when compared to matching NPS samples. Analysis of concordance demonstrated 95.5% accuracy overall for the saliva test relative to NPS, and a very high level of agreement (κ coefficient = 0.889, 95% CI 0.833-0.946) between the two sets of specimens. Fourteen of 308 samples were discordant, all from symptomatic patients. Ct values were >30 in 13/14 and >35 in 6/14 samples. No significant difference was found in the Ct values of matching NPS and saliva sample ( p=0.860). A highly significant correlation (r = 0.475, p<0.0001) was also found between the Ct values of the concordant positive saliva and NPS specimens. Conclusions: Use of saliva processed according to the SalivaDirect protocol represents a valid method to detect SARS-CoV-2. Accurate and less invasive saliva screening is an attractive alternative to current testing methods based on NPS and would afford greater capacity to test asymptomatic populations especially in the context of frequent testing.
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Affiliation(s)
- Chiara De Santi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Benson Jacob
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patricia Kroich
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Doyle
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rebecca Ward
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Li
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Owain Donnelly
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amy Dykes
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Trisha Neelakant
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Neary
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ross McGuinness
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Kieran Ryan
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Veronica Quadu
- Mercer's Medical Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Killian McGrogan
- Mercer's Medical Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alejandro Garcia Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Patrick Mallon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan De Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Steve W. Kerrigan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gianpiero L. Cavalleri
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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23
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Mazhari R, Ruybal-Pesántez S, Angrisano F, Kiernan-Walker N, Hyslop S, Longley RJ, Bourke C, Chen C, Williamson DA, Robinson LJ, Mueller I, Eriksson EM. SARS-CoV-2 Multi-Antigen Serology Assay. Methods Protoc 2021; 4:mps4040072. [PMID: 34698238 PMCID: PMC8544427 DOI: 10.3390/mps4040072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
Serology tests are extremely useful for assessing whether a person has been infected with a pathogen. Since the onset of the COVID-19 pandemic, measurement of anti-SARS-CoV-2-specific antibodies has been considered an essential tool in identifying seropositive individuals and thereby understanding the extent of transmission in communities. The Luminex system is a bead-based technology that has the capacity to assess multiple antigens simultaneously using very low sample volumes and is ideal for high-throughput studies. We have adapted this technology to develop a COVID-19 multi-antigen serological assay. This protocol described here carefully outlines recommended steps to optimize and establish this method for COVID-19-specific antibody measurement in plasma and in saliva. However, the protocol can easily be customized and thus the assay is broadly applicable to measure antibodies to other pathogens.
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Affiliation(s)
- Ramin Mazhari
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Shazia Ruybal-Pesántez
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
- Vector-Borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, VIC 3004, Australia;
| | - Fiona Angrisano
- Vector-Borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, VIC 3004, Australia;
| | - Nicholas Kiernan-Walker
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Stephanie Hyslop
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Rhea J. Longley
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Caitlin Bourke
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Catherine Chen
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Deborah A. Williamson
- Royal Melbourne Hospital, Melbourne, VIC 3052, Australia;
- Public Health Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC 3052, Australia
| | - Leanne J. Robinson
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
- Vector-Borne Diseases and Tropical Public Health, Burnet Institute, Melbourne, VIC 3004, Australia;
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Emily M. Eriksson
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (R.M.); (S.R.-P.); (N.K.-W.); (S.H.); (R.J.L.); (C.B.); (C.C.); (L.J.R.); (I.M.)
- Department of Medical Biology, The University of Melbourne, Melbourne, VIC 3052, Australia
- Correspondence: ; Tel.: +61-3-93452870; Fax: +61-3-93470852
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24
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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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25
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Jayakody H, Kiddle G, Perera S, Tisi L, Leese HS. Molecular diagnostics in the era of COVID-19. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:3744-3763. [PMID: 34473144 DOI: 10.1039/d1ay00947h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
As the COVID-19 pandemic continues to escalate globally and acquires new mutations, accurate diagnostic technologies continue to play a vital role in controlling and understanding the epidemiology of this disease. A plethora of technologies have enabled the diagnosis of individuals, informed clinical management, aided population-wide screening to determine transmission rates and identified cases within the wider community and high-risk settings. This review explores the application of molecular diagnostics technologies in controlling the spread of COVID-19, and the key factors that affect the sensitivity and specificity of the tests used.
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Affiliation(s)
- Harindi Jayakody
- Materials for Health Lab, Department of Chemical Engineering, University of Bath, Bath, UK.
- Erba Molecular, Ely, Cambridgeshire, UK.
| | - Guy Kiddle
- Erba Molecular, Ely, Cambridgeshire, UK.
| | - Semali Perera
- Materials for Health Lab, Department of Chemical Engineering, University of Bath, Bath, UK.
| | | | - Hannah S Leese
- Materials for Health Lab, Department of Chemical Engineering, University of Bath, Bath, UK.
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26
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Bergevin MA, Freppel W, Robert G, Ambaraghassi G, Aubry D, Haeck O, Saint-Jean M, Carignan A. Validation of saliva sampling as an alternative to oro-nasopharyngeal swab for detection of SARS-CoV-2 using unextracted rRT-PCR with the Allplex 2019-nCoV assay. J Med Microbiol 2021; 70:001404. [PMID: 34369860 PMCID: PMC8513629 DOI: 10.1099/jmm.0.001404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/10/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction. The current severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) pandemic has stressed the global supply chain for specialized equipment, including flocked swabs.Hypothesis. Saliva could be a potential alternative specimen source for diagnosis of SARS-CoV-2 infection by reverse-transcriptase PCR (RT-PCR).Aim. To compare the detection efficiency of SARS-CoV-2 RNA in saliva and oro-nasopharyngeal swab (ONPS) specimens.Methodology. Patients recruited from hospital provided paired saliva and ONPS specimens. We performed manual or automated RT-PCR with prior proteinase K treatment without RNA extraction using the Seegene Allplex 2019 nCoV assay.Results. Of the 773 specimen pairs, 165 (21.3 %) had at least one positive sample. Additionally, 138 specimens tested positive by both sampling methods. Fifteen and 12 cases were detected only by nasopharyngeal swab and saliva, respectively. The sensitivity of ONPS (153/165; 92.7 %; 95 % CI: 88.8-96.7) was similar to that of saliva (150/165; 90.9 %; 95 % CI: 86.5-95.3; P=0.5). In patients with symptoms for ≤ 10 days, the sensitivity of ONPS (118/126; 93.7 %; 95 % CI: 89.4-97.9) was similar to that of saliva (122/126; 96.8 %; 95 % CI: 93.8-99.9 %; P=0.9). However, the sensitivity of ONPS (20/22; 95.2 %; 95 % CI: 86.1-100) was higher than that of saliva (16/22; 71.4 %; 95 % CI: 52.1-90.8) in patients with symptoms for more than 10 days.Conclusions. Saliva sampling is an acceptable alternative to ONPS for diagnosing SARS-CoV-2 infection in symptomatic individuals displaying symptoms for ≤ 10 days. These results reinforce the need to expand the use of saliva samples, which are self-collected and do not require swabs.
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Affiliation(s)
| | - Wesley Freppel
- Institut National de la Recherche Scientifique, Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
| | - Guylaine Robert
- Department of Medical Biology, Hôpital Cité-de-la-Santé, Laval, QC H7M 3L9, Canada
| | - Georges Ambaraghassi
- Department of Microbiology, Immunology and Infectious Diseases, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Dany Aubry
- Optilab Laval-Laurentides-Lanaudière, Quebec, Canada
| | - Olivier Haeck
- Department of Medical Biology, Hôpital Cité-de-la-Santé, Laval, QC H7M 3L9, Canada
| | - Maude Saint-Jean
- Department of Medical Biology, Hôpital Cité-de-la-Santé, Laval, QC H7M 3L9, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Quebec, Canada
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27
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De Santi C, Jacob B, Kroich P, Doyle S, Ward R, Li B, Donnelly O, Dykes A, Neelakant T, Neary D, McGuinness R, Cafferkey J, Ryan K, Quadu V, McGrogan K, Garcia Leon A, Mallon P, Fitzpatrick F, Humphreys H, De Barra E, Kerrigan SW, Cavalleri GL. Concordance between PCR-based extraction-free saliva and nasopharyngeal swabs for SARS-CoV-2 testing. HRB Open Res 2021; 4:85. [PMID: 34522839 PMCID: PMC8408542 DOI: 10.12688/hrbopenres.13353.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/04/2023] Open
Abstract
Introduction: Saliva represents a less invasive alternative to nasopharyngeal swab (NPS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. SalivaDirect is a nucleic acid extraction-free method for detecting SARS-CoV2 in saliva specimens. Studies evaluating the concordance of gold standard NPS and newly developed SalivaDirect protocols are limited. The aim of our study was to to assess SalivaDirect as an alternative method for COVID-19 testing. Methods: Matching NPS and saliva samples were analysed from a cohort of symptomatic (n=127) and asymptomatic (n=181) participants recruited from hospital and university settings, respectively. RNA was extracted from NPS while saliva samples were subjected to the SalivaDirect protocol before RT-qPCR analysis. The presence of SARS-Cov-2 was assessed using RdRP and N1 gene targets in NPS and saliva, respectively. Results: Overall we observed 94.3% sensitivity (95% CI 87.2-97.5%), and 95.9% specificity (95% CI 92.4-97.8%) in saliva when compared to matching NPS samples. Analysis of concordance demonstrated 95.5% accuracy overall for the saliva test relative to NPS, and a very high level of agreement (κ coefficient = 0.889, 95% CI 0.833-0.946) between the two sets of specimens. Fourteen of 308 samples were discordant, all from symptomatic patients. Ct values were >30 in 13/14 and >35 in 6/14 samples. No significant difference was found in the Ct values of matching NPS and saliva sample ( p=0.860). A highly significant correlation (r = 0.475, p<0.0001) was also found between the Ct values of the concordant positive saliva and NPS specimens. Conclusions: Use of saliva processed according to the SalivaDirect protocol represents a valid method to detect SARS-CoV-2. Accurate and less invasive saliva screening is an attractive alternative to current testing methods based on NPS and would afford greater capacity to test asymptomatic populations especially in the context of frequent testing.
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Affiliation(s)
- Chiara De Santi
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Benson Jacob
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patricia Kroich
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sean Doyle
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rebecca Ward
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian Li
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Owain Donnelly
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amy Dykes
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Trisha Neelakant
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Neary
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ross McGuinness
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Kieran Ryan
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Veronica Quadu
- Mercer's Medical Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Killian McGrogan
- Mercer's Medical Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alejandro Garcia Leon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Patrick Mallon
- Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hilary Humphreys
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan De Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Steve W. Kerrigan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gianpiero L. Cavalleri
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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28
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Oliver J, Tosif S, Lee LY, Costa AM, Bartel C, Last K, Clifford V, Daley A, Allard N, Orr C, Nind A, Alexander K, Meagher N, Sait M, Ballard SA, Williams E, Bond K, Williamson DA, Crawford NW, Gibney KB. Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS-CoV-2 in primary care and children. Med J Aust 2021; 215:273-278. [PMID: 34287935 PMCID: PMC8447377 DOI: 10.5694/mja2.51188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice. Design Prospective multicentre diagnostic validation study. Setting Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020. Participants 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing. Main outcome measures Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type. Results SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%). Conclusion In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.
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Affiliation(s)
- Jane Oliver
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
| | | | | | | | | | | | - Vanessa Clifford
- The Royal Children's Hospital, Melbourne, VIC.,Melbourne Medical School, University of Melbourne, Melbourne, VIC
| | - Andrew Daley
- The Royal Children's Hospital, Melbourne, VIC.,The Royal Women's Hospital, Melbourne, VIC
| | - Nicole Allard
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,cohealth, Melbourne, VIC
| | | | | | - Karyn Alexander
- Melbourne Medical School, University of Melbourne, Melbourne, VIC.,Cirqit Health, Melbourne, VIC
| | | | - Michelle Sait
- Public Health Laboratory, University of Melbourne, Melbourne, VIC
| | - Susan A Ballard
- Public Health Laboratory, University of Melbourne, Melbourne, VIC
| | | | - Katherine Bond
- Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, VIC
| | - Deborah A Williamson
- Public Health Laboratory, University of Melbourne, Melbourne, VIC.,Melbourne Health, Melbourne, VIC
| | - Nigel W Crawford
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Children's Research Institute, Melbourne, VIC
| | - Katherine B Gibney
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
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29
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Dzieciolowska S, Ravi O, Grad R. Characteristics and outcomes of family-practice patients with coronavirus disease 2019: a case series. J Med Case Rep 2021; 15:393. [PMID: 34284815 PMCID: PMC8290383 DOI: 10.1186/s13256-021-02963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The clinical history and outcomes of coronavirus disease 2019 among people not hospitalized is not yet well characterized. To better inform clinical evaluation, we set out to characterize the natural history of coronavirus disease 2019 in primary health care. METHODS Case series of all patients rostered to physicians at a university-affiliated Family Medicine clinic. Cases met the Centers for Disease Control and Prevention definition of coronavirus disease 2019 from March 1 to May 21 2020. RESULTS In total, 89 patients meeting Centers for Disease Control and Prevention criteria for coronavirus disease 2019 were documented. Their average age was 55.6 years (range 6-95 years), and all but one was symptomatic. Fifty-seven cases (64%) had a polymerase chain reaction test for coronavirus disease 2019, of whom 77.2% tested positive. Thirty cases (33.7%) reported contact with a confirmed or probable case of coronavirus disease 2019. Based on the Charlson Comorbidity Index, 28 cases (31.5%) had no comorbid conditions. The median number of days from symptom onset to first polymerase chain reaction test was 6 days (interquartile range 2.3-11 days). The median duration of fever was 3.5 days (interquartile range 1-7 days). Twenty-four cases (27%) visited the Emergency Department, and 10 were admitted to hospital. The median number of days between symptom onset and first Emergency Department visit was 8 days (interquartile range 3.5-27 days). CONCLUSIONS At the start of this pandemic, the implementation of basic measures such as diagnostic testing was delayed. If we are to improve our control over the spread of coronavirus disease 2019, we will need to substantially reduce the time from symptom onset to diagnostic testing, and subsequent contact tracing. To minimize unnecessary Emergency Department visits, we propose a testable strategy for Family Medicine to engage with coronavirus disease 2019 patients in the acute phase of their illness.
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Affiliation(s)
| | - Oumeet Ravi
- Faculty of Medicine, McGill University, Montreal, QC, H3A 0G4, Canada
- Herzl Family Practice Centre, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Roland Grad
- Herzl Family Practice Centre, 3755 Cote Ste Catherine Road, Montreal, QC, H3T 1E2, Canada
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30
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SARS-CoV-2 saliva testing is a useful tool for Covid-19 diagnosis. J Virol Methods 2021; 296:114241. [PMID: 34273438 PMCID: PMC8279922 DOI: 10.1016/j.jviromet.2021.114241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 01/01/2023]
Abstract
SARS-CoV-2 is the etiologic agent of coronavirus disease 2019 (COVID-19) and is mainly detected by RT-PCR methods from upper respiratory specimens, as recommended by the World Health Organization. Oro/nasopharyngeal swabbing can be discomfortable to the patients, requires trained healthcare personnel and may generate aerosol, increasing the risk of nosocomial infections. In this study, we describe two SARS-CoV-2 RNA extraction-free single RT-PCR protocols on saliva samples and compared the results with the paired oro/nasopharyngeal swab specimens from 400 patients. The two saliva protocols demonstrated a substantial agreement when compared to the oro/nasopharyngeal swab protocol. Moreover, the positivity rate of saliva protocols increased according to the disease period. The 95 % limit of detection of one of the therefore implemented saliva protocol was determined as 9441 copies/mL. Our results support the conclusion that RNA extraction-free RT-PCR using self-collected saliva specimens is an alternative to nasopharyngeal swabs, especially in the early phase of symptom onset.
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Abstract
Although nasopharyngeal samples have been considered the gold standard for COVID-19 testing, variability in viral load across different anatomical sites could cause nasopharyngeal samples to be less sensitive than saliva or nasal samples in certain cases. Self-collected samples have logistical advantages over nasopharyngeal samples, making them amenable to population-scale screening. To evaluate sampling alternatives for population screening, we collected nasopharyngeal, saliva, and nasal samples from two cohorts with varied levels and types of symptoms. In a mixed cohort of 60 symptomatic and asymptomatic participants, we found that saliva had 88% concordance with nasopharyngeal samples when tested in the same testing lab (n = 41) and 68% concordance when tested in different testing labs (n = 19). In a second cohort of 20 participants hospitalized for COVID-19, saliva had 74% concordance with nasopharyngeal samples tested in the same testing lab but detected virus in two participants that tested negative with nasopharyngeal samples on the same day. Medical record review showed that the saliva-based testing sensitivity was related to the timing of symptom onset and disease stage. We find that no sample site will be perfectly sensitive for COVID-19 testing in all situations, and the significance of negative results will always need to be determined in the context of clinical signs and symptoms. Saliva retained high clinical sensitivity for early-stage and presymptomatic COVID-19 while allowing easier collection, minimizing the exposure of health care workers, and need for personal protective equipment and making it a viable option for population-scale testing. IMPORTANCE Methods for COVID-19 detection are necessary for public health efforts to monitor the spread of disease. Nasopharyngeal samples have been considered the best approach for COVID-19 testing. However, alternative samples like self-collected saliva offer advantages for population-scale screening. Meta-analyses of recent studies suggest that saliva is useful for detecting SARS-CoV-2; however, differences in disease prevalence, sample collection, and analysis methods still confound strong conclusions on the utility of saliva compared to nasopharyngeal samples. Here, we find that the sensitivity of saliva testing is related to both the timing of the sample collection relative to symptom onset and the disease stage. Importantly, several clinical vignettes in our cohorts highlight the challenges of medical decision making with limited knowledge of the associations between laboratory test data and the natural biology of infection.
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Borghi E, Massa V, Zuccotti G, Wyllie AL. Testing Saliva to Reveal the Submerged Cases of the COVID-19 Iceberg. Front Microbiol 2021; 12:721635. [PMID: 34322114 PMCID: PMC8312273 DOI: 10.3389/fmicb.2021.721635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Elisa Borghi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valentina Massa
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Anne L. Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Logistic advantage of two-step screening strategy for SARS-CoV-2 at airport quarantine. Travel Med Infect Dis 2021; 43:102127. [PMID: 34174408 PMCID: PMC8220861 DOI: 10.1016/j.tmaid.2021.102127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
Background Airport quarantine is required to reduce the risk of entry of travelers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is challenging for both high accuracy and rapid turn-around time to coexist in testing; polymerase chain reaction (PCR) is time-consuming with high accuracy, while antigen testing is rapid with less accuracy. However, there are few data on the concordance between PCR and antigen testing. Methods Arrivals at three international airports in Japan between July 29 and September 30, 2020 were tested for SARS-CoV-2 using self-collected saliva by a screening strategy with initial chemiluminescent enzyme immunoassay (CLEIA) followed by confirmatory nucleic acid amplification tests (NAAT) only for intermediate range antigen concentrations. Results Among the 95,457 persons entering Japan during the period, 88,924 (93.2%) were tested by CLEIA, and 0.29% (254/88,924) were found to be SARS-CoV-2 antigen positive (≥4.0 pg/mL). NAAT was required for confirmatory testing in 0.58% (513/88,924) with intermediate antigen concentrations (0.67–4.0 pg/mL) whereby the virus was detected in 6.6% (34/513). This two-step strategy reduced the utilization of NAAT to one out of every 173 test subjects. The estimated performance of this strategy did not show significant increase in false negatives as compared to performing NAAT in all subjects. Conclusions Point of care testing by quantitative CLEIA using self-collected saliva is less labor-intensive and yields results rapidly, thus suitable as an initial screening test. Reserving NAAT for CLEIA indeterminate cases may prevent compromising accuracy while significantly improving the logistics of administering mass-screening at large venues.
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Ibrahimi N, Delaunay-Moisan A, Hill C, Le Teuff G, Rupprecht JF, Thuret JY, Chaltiel D, Potier MC. Screening for SARS-CoV-2 by RT-PCR: Saliva or nasopharyngeal swab? Rapid review and meta-analysis. PLoS One 2021; 16:e0253007. [PMID: 34111196 PMCID: PMC8191978 DOI: 10.1371/journal.pone.0253007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diagnosis of COVID-19 in symptomatic patients and screening of populations for SARS-CoV-2 infection require access to straightforward, low-cost and high-throughput testing. The recommended nasopharyngeal swab tests are limited by the need of trained professionals and specific consumables and this procedure is poorly accepted as a screening method In contrast, saliva sampling can be self-administered. METHODS In order to compare saliva and nasopharyngeal/oropharyngeal samples for the detection of SARS-CoV-2, we designed a meta-analysis searching in PubMed up to December 29th, 2020 with the key words "(SARS-CoV-2 OR COVID-19 OR COVID19) AND (salivary OR saliva OR oral fluid)) NOT (review[Publication Type]) NOT (PrePrint[Publication Type])" applying the following criteria: records published in peer reviewed scientific journals, in English, with at least 15 nasopharyngeal/orapharyngeal swabs and saliva paired samples tested by RT-PCR, studies with available raw data including numbers of positive and negative tests with the two sampling methods. For all studies, concordance and sensitivity were calculated and then pooled in a random-effects model. FINDINGS A total of 377 studies were retrieved, of which 50 were eligible, reporting on 16,473 pairs of nasopharyngeal/oropharyngeal and saliva samples. Meta-analysis showed high concordance, 92.5% (95%CI: 89.5-94.7), across studies and pooled sensitivities of 86.5% (95%CI: 83.4-89.1) and 92.0% (95%CI: 89.1-94.2) from saliva and nasopharyngeal/oropharyngeal swabs respectively. Heterogeneity across studies was 72.0% for saliva and 85.0% for nasopharyngeal/oropharyngeal swabs. INTERPRETATION Our meta-analysis strongly suggests that saliva could be used for frequent testing of COVID-19 patients and "en masse" screening of populations.
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Affiliation(s)
- Nusaïbah Ibrahimi
- Service de Biostatistique et d’Épidémiologie, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Agnès Delaunay-Moisan
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette Cedex, France
| | - Catherine Hill
- Service de Biostatistique et d’Épidémiologie, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Gwénaël Le Teuff
- Service de Biostatistique et d’Épidémiologie, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-François Rupprecht
- Aix Marseille Univ, Université de Toulon, CNRS, Centre de Physique Théorique, Turing Center for Living Systems, Marseille, France
| | - Jean-Yves Thuret
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette Cedex, France
| | - Dan Chaltiel
- Service de Biostatistique et d’Épidémiologie, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Marie-Claude Potier
- Institut du Cerveau (ICM), CNRS UMR 7225 – Inserm U1127, Sorbonne Université, Paris, France
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Alkhateeb KJ, Cahill MN, Ross AS, Arnold FW, Snyder JW. The reliability of saliva for the detection of SARS-CoV-2 in symptomatic and asymptomatic patients: Insights on the diagnostic performance and utility for COVID-19 screening. Diagn Microbiol Infect Dis 2021; 101:115450. [PMID: 34284319 PMCID: PMC8180088 DOI: 10.1016/j.diagmicrobio.2021.115450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022]
Abstract
Current literature has focused on testing saliva in symptomatic patients, and little information is available regarding saliva performance in asymptomatic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We compared paired saliva and nasopharyngeal swabs (NPS) collected from 33 symptomatic and 12 asymptomatic known SARS-CoV-2-positive patients. Saliva had an overall sensitivity of 59%, a specificity of 95%, and a negative predictive value of 98%. Saliva demonstrated higher sensitivity in symptomatic (80%) vs. asymptomatic individuals (36%) (P = 0.006), and in high-risk (symptomatic, febrile and/or with comorbidities) (82%) vs. low-risk (asymptomatic, afebrile, and no comorbidities) (22%) patients (P = 0.0002). Cycle threshold (Ct) values in NPS specimens were higher in saliva-negative vs. saliva-positive cases (P = 0.02 and <0.001). Overall, these findings show that despite saliva's low sensitivity in asymptomatic SARS-CoV-2 infections, it can detect infections with lower Ct values and a potentially higher chance of viral transmission. Additional studies are warranted to fully evaluate saliva as a screening test for coronavirus disease-2019.
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Affiliation(s)
- Khaled J Alkhateeb
- Department of Pathology and Laboratory Medicine, The University of Louisville, Louisville, KY, USA.
| | - Meredith N Cahill
- Department of Medicine, Division of Infectious Diseases, The University of Louisville, Louisville, KY, USA; Center of Excellence for Research in Infectious Diseases, Louisville, KY, USA
| | - Adam S Ross
- Department of Emergency Medicine, The University of Louisville, Louisville, KY, USA
| | - Forest W Arnold
- Department of Medicine, Division of Infectious Diseases, The University of Louisville, Louisville, KY, USA; Center of Excellence for Research in Infectious Diseases, Louisville, KY, USA
| | - James W Snyder
- Department of Pathology and Laboratory Medicine, The University of Louisville, Louisville, KY, USA.
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Caixeta DC, Oliveira SW, Cardoso-Sousa L, Cunha TM, Goulart LR, Martins MM, Marin LM, Jardim ACG, Siqueira WL, Sabino-Silva R. One-Year Update on Salivary Diagnostic of COVID-19. Front Public Health 2021; 9:589564. [PMID: 34150692 PMCID: PMC8210583 DOI: 10.3389/fpubh.2021.589564] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a global health problem, which is challenging healthcare worldwide. In this critical review, we discussed the advantages and limitations in the implementation of salivary diagnostic platforms of COVID-19. The diagnostic test of COVID-19 by invasive nasopharyngeal collection is uncomfortable for patients and requires specialized training of healthcare professionals in order to obtain an appropriate collection of samples. Additionally, these professionals are in close contact with infected patients or suspected cases of COVID-19, leading to an increased contamination risk for frontline healthcare workers. Although there is a colossal demand for novel diagnostic platforms with non-invasive and self-collection samples of COVID-19, the implementation of the salivary platforms has not been implemented for extensive scale testing. Up to date, several cross-section and clinical trial studies published in the last 12 months support the potential of detecting SARS-CoV-2 RNA in saliva as a biomarker for COVID-19, providing a self-collection, non-invasive, safe, and comfortable procedure. Therefore, the salivary diagnosis is suitable to protect healthcare professionals and other frontline workers and may encourage patients to get tested due to its advantages over the current invasive methods. The detection of SARS-CoV-2 in saliva was substantial also in patients with a negative nasopharyngeal swab, indicating the presence of false negative results. Furthermore, we expect that salivary diagnostic devices for COVID-19 will continue to be used with austerity without excluding traditional gold standard specimens to detect SARS-CoV-2.
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Affiliation(s)
- Douglas Carvalho Caixeta
- Innovation Center in Salivary Diagnostic and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | - Stephanie Wutke Oliveira
- Innovation Center in Salivary Diagnostic and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
- School of Dentistry, Federal University of Uberlandia, Uberlandia, Brazil
| | - Leia Cardoso-Sousa
- Innovation Center in Salivary Diagnostic and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
| | | | - Luiz Ricardo Goulart
- Institute of Genetics and Biochemistry, Federal University of Uberlandia, Uberlandia, Brazil
| | - Mario Machado Martins
- Institute of Genetics and Biochemistry, Federal University of Uberlandia, Uberlandia, Brazil
| | - Lina Maria Marin
- College of Dentistry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ana Carolina Gomes Jardim
- Laboratory of Virology, Institute of Biomedical Science, Federal University of Uberlandia, Uberlandia, Brazil
- São Paulo State University, Institute of Biosciences, Humanities and Exact Sciences, São José Do Rio Preto, Brazil
| | | | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostic and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, Brazil
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Yokota I, Shane PY, Okada K, Unoki Y, Yang Y, Iwasaki S, Fujisawa S, Nishida M, Teshima T. A novel strategy for SARS-CoV-2 mass screening with quantitative antigen testing of saliva: a diagnostic accuracy study. LANCET MICROBE 2021; 2:e397-e404. [PMID: 34031649 PMCID: PMC8133768 DOI: 10.1016/s2666-5247(21)00092-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Quantitative RT-PCR (RT-qPCR) of nasopharyngeal swab (NPS) samples for SARS-CoV-2 detection requires medical personnel and is time consuming, and thus is poorly suited to mass screening. In June, 2020, a chemiluminescent enzyme immunoassay (CLEIA; Lumipulse G SARS-CoV-2 Ag kit, Fujirebio, Tokyo, Japan) was developed that can detect SARS-CoV-2 nucleoproteins in NPS or saliva samples within 35 min. In this study, we assessed the utility of CLEIA in mass SARS-CoV-2 screening. Methods We did a diagnostic accuracy study to develop a mass-screening strategy for salivary detection of SARS-CoV-2 by CLEIA, enrolling hospitalised patients with clinically confirmed COVID-19, close contacts identified at community health centres, and asymptomatic international arrivals at two airports, all based in Japan. All test participants were enrolled consecutively. We assessed the diagnostic accuracy of CLEIA compared with RT-qPCR, estimated according to concordance (Kendall's coefficient of concordance, W), and sensitivity (probability of CLEIA positivity given RT-qPCR positivity) and specificity (probability of CLEIA negativity given RT-qPCR negativity) for different antigen concentration cutoffs (0·19 pg/mL, 0·67 pg/mL, and 4·00 pg/mL; with samples considered positive if the antigen concentration was equal to or more than the cutoff and negative if it was less than the cutoff). We also assessed a two-step testing strategy post hoc with CLEIA as an initial test, using separate antigen cutoff values for test negativity and positivity from the predefined cutoff values. The proportion of intermediate results requiring secondary RT-qPCR was then quantified assuming prevalence values of RT-qPCR positivity in the overall tested population of 10%, 30%, and 50%. Findings Self-collected saliva was obtained from 2056 participants between June 12 and Aug 6, 2020. Results of CLEIA and RT-qPCR were concordant in 2020 (98·2%) samples (Kendall's W=0·99). Test sensitivity was 85·4% (76 of 89 positive samples; 90% credible interval [CrI] 78·0-90·3) at the cutoff of 0·19 pg/mL; 76·4% (68 of 89; 68·2-82·8) at the cutoff of 0·67 pg/mL; and 52·8% (47 of 89; 44·1-61·3) at the cutoff of 4·0 pg/mL. Test specificity was 91·3% (1796 of 1967 negative samples; 90% CrI 90·2-92·3) at the cutoff of 0·19 pg/mL, 99·2% (1952 of 1967; 98·8-99·5) at the cutoff of 0·67 pg/mL, and 100·0% (1967 of 1967; 99·8-100·0) at the cutoff of 4·00 pg/mL. Using a two-step testing strategy with a CLEIA negativity cutoff of 0·19 pg/mL (to maximise sensitivity) and a CLEIA positivity cutoff of 4·00 pg/mL (to maximise specificity), the proportions of indeterminate results (ie, samples requiring secondary RT-qPCR) would be approximately 11% assuming a prevalence of RT-qPCR positivity of 10%, 16% assuming a prevalence of RT-qPCR positivity of 30%, and 21% assuming a prevalence of RT-qPCR positivity of 50%. Interpretation CLEIA testing of self-collected saliva is simple and provides results quickly, and is thus suitable for mass testing. To improve accuracy, we propose a two-step screening strategy with an initial CLEIA test followed by confirmatory RT-qPCR for intermediate concentrations, varying positive and negative thresholds depending on local prevalence. Implementation of this strategy has expedited sample processing at Japanese airports since July, 2020, and might apply to other large-scale mass screening initiatives. Funding Ministry of Health, Labour and Welfare, Japan.
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Affiliation(s)
- Isao Yokota
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Peter Y Shane
- International Medical Department, Hokkaido University Hospital, Sapporo, Japan
| | - Kazufumi Okada
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoko Unoki
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yichi Yang
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sumio Iwasaki
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinichi Fujisawa
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takanori Teshima
- International Medical Department, Hokkaido University Hospital, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.,Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
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Caulley L, Shaw J, Corsten M, Hua N, Angel JB, Poliquin G, Whelan J, Antonation K, Johnson-Obaseki S. Salivary testing of COVID-19: evaluation of serological testing following positive salivary results. BMC Infect Dis 2021; 21:410. [PMID: 33947347 PMCID: PMC8093594 DOI: 10.1186/s12879-021-06108-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Salivary detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proposed as an alternative to nasopharyngeal or oropharyngeal swab testing. Our group previously published a study demonstrating that both testing methods identified SARS-CoV-2 using polymerase chain reaction (PCR)-based detection methodology. We therefore conducted a follow-up study using antibody testing to evaluate the accuracy of saliva versus swabs for COVID-19 detection and the durability of antibody response. Methods Venous blood samples were collected from consenting participants and the presence of serum antibodies for SARS-CoV-2 was evaluated on a large, automated immunoassay platform by the Roche anti-SARS-CoV-2 qualitative assay (Roche Diagnostics, Laval Quebec). Individuals with a serum antibody cut-off index (COI) ≥ 1.0 were considered positive. Results In asymptomatic and mildly symptomatic patients with a previously positive standard swab and/or saliva SARS-CoV-2 PCR-test, 42 demonstrated antibodies with 13 patients positive by swab alone, and 8 patients positive by saliva alone. Conclusions Despite their status as ‘current standard’ for COVID-19 testing, these findings highlight limitations of PCR-based tests.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, 501 Smyth Rd, Ottawa, K1H8L1, Canada
| | - Julie Shaw
- Department of Pathology and Laboratory Medicine, University of Ottawa, 451 Smyth Road, Ottawa, K1H8L1, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 6299 South St, Halifax, B3F4R2, Canada
| | - Nadia Hua
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, 501 Smyth Rd, Ottawa, K1H8L1, Canada
| | - Jonathan B Angel
- Division of Infectious Diseases, University of Ottawa, 451 Smyth Road, Ottawa, K1H8L1, Canada.,Chronic Disease Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, K1H8L1, Canada
| | - Guillaume Poliquin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St, Winnipeg, R3E3M4, Canada.,Department of Pediatrics & Child Health, University of Manitoba, 66 Chancellors Cir, Winnipeg, R3T2N2, Canada
| | - Jonathan Whelan
- Department of Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, K1H8L1, Canada
| | - Kym Antonation
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St, Winnipeg, R3E3M4, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, 501 Smyth Rd, Ottawa, K1H8L1, Canada.
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Butler-Laporte G, Lawandi A, Schiller I, Yao M, Dendukuri N, McDonald EG, Lee TC. Comparison of Saliva and Nasopharyngeal Swab Nucleic Acid Amplification Testing for Detection of SARS-CoV-2: A Systematic Review and Meta-analysis. JAMA Intern Med 2021; 181:353-360. [PMID: 33449069 PMCID: PMC7811189 DOI: 10.1001/jamainternmed.2020.8876] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/05/2020] [Indexed: 01/09/2023]
Abstract
Importance Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the noninvasive criterion standard for diagnosis of coronavirus disease 2019 (COVID-19). However, it requires trained personnel, limiting its availability. Saliva NAAT represents an attractive alternative, but its diagnostic performance is unclear. Objective To assess the diagnostic accuracy of saliva NAAT for COVID-19. Data Sources In this systematic review, a search of the MEDLINE and medRxiv databases was conducted on August 29, 2020, to find studies of diagnostic test accuracy. The final meta-analysis was performed on November 17, 2020. Study Selection Studies needed to provide enough data to measure salivary NAAT sensitivity and specificity compared with imperfect nasopharyngeal swab NAAT as a reference test. An imperfect reference test does not perfectly reflect the truth (ie, it can give false results). Studies were excluded if the sample contained fewer than 20 participants or was neither random nor consecutive. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed for the systematic review, with multiple authors involved at each stage of the review. To account for the imperfect reference test sensitivity, we used a bayesian latent class bivariate model for the meta-analysis. Main Outcomes and Measures The primary outcome was pooled sensitivity and specificity. Two secondary analyses were performed: one restricted to peer-reviewed studies, and a post hoc analysis limited to ambulatory settings. Results The search strategy yielded 385 references, and 16 unique studies were identified for quantitative synthesis. Eight peer-reviewed studies and 8 preprints were included in the meta-analyses (5922 unique patients). There was significant variability in patient selection, study design, and stage of illness at which patients were enrolled. Fifteen studies included ambulatory patients, and 9 exclusively enrolled from an outpatient population with mild or no symptoms. In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses. Conclusions and Relevance These results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.
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Affiliation(s)
- Guillaume Butler-Laporte
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
| | - Alexander Lawandi
- Department of Critical Care Medicine, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Ian Schiller
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Mandy Yao
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Nandini Dendukuri
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
| | - Emily G. McDonald
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Todd C. Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montréal, Québec, Canada
- Centre for Outcomes Research, McGill University Health Centre, Montréal, Québec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
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40
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Azzi L, Maurino V, Baj A, Dani M, d’Aiuto A, Fasano M, Lualdi M, Sessa F, Alberio T. Diagnostic Salivary Tests for SARS-CoV-2. J Dent Res 2021; 100:115-123. [PMID: 33131360 PMCID: PMC7604673 DOI: 10.1177/0022034520969670] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.
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Affiliation(s)
- L. Azzi
- Unit of Oral Medicine and
Pathology, ASST dei Sette Laghi–Ospedale di Circolo e Fondazione Macchi,
Department of Medicine and Surgery, University of Insubria, Varese,
Italy
| | - V. Maurino
- Unit of Oral Medicine and
Pathology, ASST dei Sette Laghi–Ospedale di Circolo e Fondazione Macchi,
Department of Medicine and Surgery, University of Insubria, Varese,
Italy
| | - A. Baj
- Laboratory of Clinical
Microbiology, ASST dei Sette Laghi–Ospedale di Circolo e Fondazione Macchi,
Department of Medicine and Surgery, University of Insubria, Varese,
Italy
| | - M. Dani
- Unit of Oral Medicine and
Pathology, ASST dei Sette Laghi–Ospedale di Circolo e Fondazione Macchi,
Department of Medicine and Surgery, University of Insubria, Varese,
Italy
| | - A. d’Aiuto
- Unit of Oral Medicine and
Pathology, ASST dei Sette Laghi–Ospedale di Circolo e Fondazione Macchi,
Department of Medicine and Surgery, University of Insubria, Varese,
Italy
| | - M. Fasano
- Laboratory of Biochemistry and
Functional Proteomics, Department of Science and High Technology, Busto
Arsizio (VA), Italy
| | - M. Lualdi
- Laboratory of Biochemistry and
Functional Proteomics, Department of Science and High Technology, Busto
Arsizio (VA), Italy
| | - F. Sessa
- Unit of Pathology, ASST dei Sette
Laghi–Ospedale di Circolo e Fondazione Macchi, Department of Medicine and
Surgery, University of Insubria, Varese, Italy
| | - T. Alberio
- Laboratory of Biochemistry and
Functional Proteomics, Department of Science and High Technology, Busto
Arsizio (VA), Italy
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41
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Manabe YC, Reuland C, Yu T, Azamfirei R, Hardick JP, Church T, Brown DM, Sewell TT, Antar A, Blair PW, Heaney CD, Pekosz A, Thomas DL. Self-Collected Oral Fluid Saliva Is Insensitive Compared With Nasal-Oropharyngeal Swabs in the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Outpatients. Open Forum Infect Dis 2021; 8:ofaa648. [PMID: 33604399 PMCID: PMC7798743 DOI: 10.1093/ofid/ofaa648] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic control will require widespread access to accurate diagnostics. Salivary sampling circumvents swab supply chain bottlenecks, is amenable to self-collection, and is less likely to create an aerosol during collection compared with the nasopharyngeal swab. METHODS We compared real-time reverse-transcription polymerase chain reaction Abbott m2000 results from matched salivary oral fluid (gingival crevicular fluid collected in an Oracol device) and nasal-oropharyngeal (OP) self-collected specimens in viral transport media from a nonhospitalized, ambulatory cohort of coronavirus disease 2019 (COVID-19) patients at multiple time points. These 2 sentences should be at the beginning of the results. RESULTS There were 171 matched specimen pairs. Compared with nasal-OP swabs, 41.6% of the oral fluid samples were positive. Adding spit to the oral fluid percent collection device increased the percent positive agreement from 37.2% (16 of 43) to 44.6% (29 of 65). The positive percent agreement was highest in the first 5 days after symptoms and decreased thereafter. All of the infectious nasal-OP samples (culture positive on VeroE6 TMPRSS2 cells) had a matched SARS-CoV-2 positive oral fluid sample. CONCLUSIONS In this study of nonhospitalized SARS-CoV-2-infected persons, we demonstrate lower diagnostic sensitivity of self-collected oral fluid compared with nasal-OP specimens, a difference that was especially prominent more than 5 days from symptom onset. These data do not justify the routine use of oral fluid collection for diagnosis of SARS-CoV-2 despite the greater ease of collection. It also underscores the importance of considering the method of saliva specimen collection and the time from symptom onset especially in outpatient populations.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Reuland
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Tong Yu
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Razvan Azamfirei
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Justin P Hardick
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Taylor Church
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Diane M Brown
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Thelio T Sewell
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Annuka Antar
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Paul W Blair
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Henry M. Jackson Foundation, Bethesda, Maryland, USA
| | - Chris D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David L Thomas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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42
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Laboratory testing for the diagnosis of COVID-19. Biochem Biophys Res Commun 2021; 538:226-230. [PMID: 33139015 PMCID: PMC7598306 DOI: 10.1016/j.bbrc.2020.10.069] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
Rapid and accurate laboratory diagnosis of active COVID-19 infection is one of the cornerstones of pandemic control. With the myriad of tests available in the market, the use of correct specimen type and laboratory-testing technique in the right clinical scenario could be challenging for non-specialists. In this mini-review, we will discuss the difference in diagnostic performance for different upper and lower respiratory tract specimens, and the role of blood and fecal specimens. We will analyze the performance characteristics of laboratory testing techniques of nucleic acid amplification tests, antigen detection tests, antibody detection tests, and point-of-care tests. Finally, the dynamics of viral replication and antibody production, and laboratory results interpretation in conjunction with clinical scenarios will be discussed.
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43
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Ana Laura GO, Abraham Josué NR, Briceida LM, Israel PO, Tania AF, Nancy MR, Lourdes JB, Daniela DLRZ, Fernando OR, Carlos Mauricio JE, Sergio René BP, Irineo RT, Horacio MG, Oscar MC, Héctor Q. Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions. Front Pediatr 2021; 9:642781. [PMID: 33912522 PMCID: PMC8071854 DOI: 10.3389/fped.2021.642781] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/17/2021] [Indexed: 01/27/2023] Open
Abstract
Background: The reference standard for the molecular diagnostic testing for COVID-19 is the use of nasopharyngeal or combined nasopharyngeal and oropharyngeal (NP/OP) swabs. Saliva has been proposed as a minimally invasive specimen whose collection reduces the risks for health care personnel. Objective: To assess the suitability of saliva for COVID-19 diagnosis as a replacement of the reference standard NP/OP swab in the setting of a tertiary care pediatric unit. Study design: A paired study based in the prospective cohort design in patients suspected of having COVID-19. Methods: RT-PCR was used to detect SARS-CoV-2 in paired samples of saliva and NP/OP swab collected from May through August 2020 from 156 pediatric participants, of whom 128 has at least one comorbidity and 91 showed clinical symptoms related to SARS-CoV-2 infection. Additionally, we studied a group of 326 members of the hospital staff, of whom 271 had symptoms related to SARS-CoV-2 infection. Results: In the group of pediatric participants the sensitivity of the diagnostic test in saliva was 82.3% (95% CI 56.6-96.2) and the specificity 95.6% (95% CI 90.8-98.4). The prevalence of COVID-19 was 10.9% (17/156). In 6 of the 23 participants who tested positive for SARS-CoV-2 in at least one specimen type, the virus was detected in saliva but not in NP/OP swab, while in 3 participants the NP/OP swab was positive and saliva negative. In the group of adults, the sensitivity of the test in saliva was 77.8% (95% CI 67.2-86.3) and prevalence 24.8% (81/326). Discordant results between the two types of specimens showed a significant association with low viral load in the pharynx of adults but not of pediatric participants. Interpretation: In the context of a pediatric tertiary care hospital, the sensibility of the test in saliva is not high enough to replace the use of NP/OP swab for COVID-19 diagnosis. Neither NP/OP swab nor saliva could detect all the participants infected with SARS-CoV-2.
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Affiliation(s)
- Guzmán-Ortiz Ana Laura
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nevárez-Ramírez Abraham Josué
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Parra-Ortega Israel
- Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Martínez-Rodríguez Nancy
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - De la Rosa-Zamboni Daniela
- Departamento de Epidemiología Hospitalaria, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | | | - Reyna-Trinidad Irineo
- Departamento de Enfermería, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Márquez-González Horacio
- Departamento de Investigación Clínica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Medina-Contreras Oscar
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Quezada Héctor
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Towards an accurate and systematic characterisation of persistently asymptomatic infection with SARS-CoV-2. THE LANCET. INFECTIOUS DISEASES 2020; 21:e163-e169. [PMID: 33301725 PMCID: PMC7834404 DOI: 10.1016/s1473-3099(20)30837-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/08/2023]
Abstract
People with persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience no symptoms throughout the course of infection, and pre-symptomatic individuals become infectious days before they report symptoms. Transmission of SARS-CoV-2 from individuals without symptoms contributes to pandemic spread, but the extent of transmission from persistently asymptomatic individuals remains unknown. We describe three methodological issues that hinder attempts to estimate this proportion. First, incomplete symptom assessment probably overestimates the asymptomatic fraction. Second, studies with inadequate follow-up misclassify pre-symptomatic individuals. Third, serological studies might identify people with previously unrecognised infection, but reliance on poorly defined antibody responses and retrospective symptom assessment might result in misclassification. We provide recommendations regarding definitions, detection, documentation, and follow-up to improve the identification and evaluation of people with persistently asymptomatic SARS-CoV-2 infection and their contacts. Accurate characterisation of the persistently asymptomatic fraction of infected individuals might shed light on COVID-19 pathogenesis and transmission dynamics, and inform public health responses.
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45
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Aisenberg G, Hwang KO. Clinical Prediction of Coronavirus Disease-2019: How Accurate Can One Be? Cureus 2020; 12:e11936. [PMID: 33425516 PMCID: PMC7785508 DOI: 10.7759/cureus.11936] [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] [Indexed: 11/05/2022] Open
Abstract
Background Some models based on clinical information have been reported to predict which patients have Coronavirus Disease-2019 (COVID-19) pneumonia but have failed so far to yield reliable results. We aimed to determine if physicians were able to accurately predict which patients, as described in clinical vignettes, had, or did not have this infection using their clinical acumen and epidemiological data. Methods Of 1177 patients under investigation for COVID-19 admitted, we selected 20 and presented them in a vignette form. We surveyed physicians from different levels of training (<5, and five or more years after graduation from medical school) and included non-medical participants as a control group. We asked all participants to predict the result of the PCR test for COVID-19. We measured the accuracy of responses as a whole, and at three stages of the pandemic associated with a growing incidence of COVID-19 in the community. We calculated the inter-rater reliability, sensitivity, and specificity of the clinical prediction as a whole and by pandemic stage. Results Between June 8 and August 28, 2020, 82 doctors and 20 non-medical participants completed the survey. The accuracy was 58% (59% for doctors and 52% for non-medical, p=0.002). The lowest accuracy was noted for cases in the pandemic middle stage; years of post-graduate training represented no difference. Of the 2040 total answers, 1176 were accurate and 864 inaccurate (349 false positives and 515 false negatives). Conclusion The influence of symptomatic positivity, confirmation bias, and rapid expertise acquisition on accuracy is discussed, as the disease is new, time after graduation made no difference in the response accuracy. The limited clinical diagnostic capacity emphasizes the need for a reliable diagnostic test.
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Affiliation(s)
- Gabriel Aisenberg
- Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at University of Texas, Houston, USA
| | - Kevin O Hwang
- Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at University of Texas, Houston, USA
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46
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Detection of SARS-CoV-2 from Saliva as Compared to Nasopharyngeal Swabs in Outpatients. Viruses 2020; 12:v12111314. [PMID: 33212817 PMCID: PMC7697440 DOI: 10.3390/v12111314] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/31/2022] Open
Abstract
Widely available and easily accessible testing for COVID-19 is a cornerstone of pandemic containment strategies. Nasopharyngeal swabs (NPS) are the currently accepted standard for sample collection but are limited by their need for collection devices and sampling by trained healthcare professionals. The aim of this study was to compare the performance of saliva to NPS in an outpatient setting. This was a prospective study conducted at three centers, which compared the performance of saliva and NPS samples collected at the time of assessment center visit. Samples were tested by real-time reverse transcription polymerase chain reaction and sensitivity and overall agreement determined between saliva and NPS. Clinical data was abstracted by chart review for select study participants. Of the 432 paired samples, 46 were positive for SARS-CoV-2, with seven discordant observed between the two sample types (four individuals testing positive only by NPS and three by saliva only). The observed agreement was 98.4% (kappa coefficient 0.91) and a composite reference standard demonstrated sensitivity of 0.91 and 0.93 for saliva and NPS samples, respectively. On average, the Ct values obtained from saliva as compared to NPS were higher by 2.76. This study demonstrates that saliva performs comparably to NPS for the detection of SARS-CoV-2. Saliva was simple to collect, did not require transport media, and could be tested with equipment readily available at most laboratories. The use of saliva as an acceptable alternative to NPS could support the use of widespread surveillance testing for SARS-CoV-2.
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