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[Preprint]. 2020 Oct 27:2020.10.25.20219055.
doi: 10.1101/2020.10.25.20219055.

Saliva is a promising alternative specimen for the detection of SARS-CoV-2 in children and adults

Rebecca Yee  1 , Thao Truong  1 , Pia S Pannaraj  2   3 , Natalie Eubanks  1 , Emily Gai  1 , Jaycee Jumarang  2 , Lauren Turner  2 , Ariana Peralta  2 , Yesun Lee  2 , Jennifer Dien Bard  1   3
Affiliations

Saliva is a promising alternative specimen for the detection of SARS-CoV-2 in children and adults

Rebecca Yee et al. medRxiv. .

Update in

Abstract

Testing efforts for SARS-CoV-2 have been burdened by the scarcity of testing materials and personal protective equipment for healthcare workers. The simple and painless process of saliva collection allows for widespread testing, but enthusiasm is hampered by variable performance compared to nasopharyngeal swab (NPS) samples. We prospectively collected paired NPS and saliva samples from a total of 300 unique adult and pediatric patients. SARS-CoV-2 RNA was detected in 32.2% (97/300) of the individuals using the TaqPath COVID-19 Combo Kit (Thermo Fisher). Performance of saliva and NPS were compared against the total number of positives regardless of specimen type. The overall concordance for saliva and NPS was 91.0% (273/300) and 94.7% (284/300), respectively. The positive percent agreement (PPA) for saliva and NPS was 81.4% (79/97) and 89.7% (87/97), respectively. Saliva detected 10 positive cases that were negative by NPS. In symptomatic and asymptomatic pediatric patients not previously diagnosed with COVID-19, the performances of saliva and NPS were comparable (PPA: 82.4% vs 85.3%). The overall PPA for adults were 83.3% and 90.7% for saliva and NPS, respectively, with saliva detecting 4 cases less than NPS. However, saliva performance in symptomatic adults was identical to NPS (PPA of 93.8%). With lower cost and self-collection capabilities, saliva can be an appropriate alternative sample choice to NPS for detection of SARS-CoV-2 in children and adults.

Summary: Saliva is an acceptable alternative specimen compared to nasopharyngeal swabs for detection of SARS-CoV-2. Specifically, saliva demonstrated comparable performance to nasopharyngeal swabs in symptomatic and asymptomatic pediatric patients and in symptomatic adults.

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Conflict of interest statement

Conflict of Interest

All authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.. Concordance of Ct values from Saliva and NP swabs.
Comparison of Ct values from paired saliva and nasopharyngeal swab specimens in (A) adult and (B) pediatric patients that were positive for SARS-CoV-2. Each line represents the corresponding paired specimen. (C) Regression curve plotting Ct values from paired saliva and nasopharyngeal swab specimens that were positive for SARS-CoV-2 reveal a linear association between the Ct values obtained from the two specimen types.
Figure 2.
Figure 2.. Comparison of Ct values from asymptomatic and symptomatic populations.
The Ct values from saliva and nasopharyngeal swab specimens collected from our SARS-CoV-2 positive asymptomatic (open circle) and symptomatic (filled circle) patients in our (A) adult populations and (B) pediatric cohort.
Figure 3.
Figure 3.. Ct values of saliva and NP swab samples in relation to days between time of symptom onset to time of collection for testing.
The Ct values of (A) adult and (B) pediatric patients tested positive by both nasopharyngeal swab (black solid circle) and saliva (black open circle), nasopharyngeal swab only (blue filled circle), and saliva only (blue open circle) are depicted in reference to when they were tested since symptom onset (days).
See this image and copyright information in PMC

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