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Comparative Study
. 2020 Nov 17;12(11):1314.
doi: 10.3390/v12111314.

Detection of SARS-CoV-2 from Saliva as Compared to Nasopharyngeal Swabs in Outpatients

Christopher Kandel  1   2 , Jennifer Zheng  2 , Janine McCready  3 , Mihaela Anca Serbanescu  4 , Hilary Racher  4   5 , Melissa Desaulnier  4 , Jeff E Powis  3 , Kyle Vojdani  3 , Laura Finlay  3 , Elena Sheldrake  6 , Christie Vermeiren  6 , Kevin Katz  5   6   7 , Allison McGeer  1   2 , Robert Kozak  5   6   8 , Lee W Goneau  4   5
Affiliations
Comparative Study

Detection of SARS-CoV-2 from Saliva as Compared to Nasopharyngeal Swabs in Outpatients

Christopher Kandel et al. Viruses. .

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.

Keywords: COVID-19; SARS-CoV-2; nasopharyngeal swab; saliva.

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Conflict of interest statement

C.K., J.Z., J.M., J.E.P., K.V., L.F., E.S., C.V., K.K., A.M., and R.M. have no conflicts of interest to declare. M.A.S., H.R., M.D., and L.W.G. are employees of Dynacare (a subsidiary of Laboratory Corporation of America), which is a private, for-profit laboratory that offers diagnostic testing services to government and non-government clients. While the individuals noted herein will not personally benefit from this submission, the company could benefit financially if the test is commercially marketed.

Figures

Figure 1
Figure 1
Cycle threshold values for the E gene target of SARS-CoV-2 RNA retrieved from individuals who were concordantly positive by nasopharyngeal swab and saliva.
See this image and copyright information in PMC

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