Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Sep;27(9):1330-1335.
doi: 10.1016/j.cmi.2021.02.009. Epub 2021 Feb 19.

Saliva for molecular detection of SARS-CoV-2 in school-age children

Hanan Al Suwaidi  1 , Abiola Senok  2 , Rupa Varghese  3 , Zulfa Deesi  3 , Hamda Khansaheb  4 , Sabeel Pokasirakath  3 , Bino Chacko  3 , Ibrahim Abufara  3 , Tom Loney  1 , Alawi Alsheikh-Ali  1
Affiliations
Observational Study

Saliva for molecular detection of SARS-CoV-2 in school-age children

Hanan Al Suwaidi et al. Clin Microbiol Infect. 2021 Sep.

Abstract

Objectives: The high diagnostic accuracy indices for saliva severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase PCR (RT-PCR) reported in adults has not been demonstrated in children, and adequately powered studies focused on the paediatric population are lacking. This study was carried out to determine the diagnostic accuracy of saliva for SARS-CoV-2 RT-PCR in ambulatory children.

Methods: During 1 to 23 October 2020, we recruited a population-based sample of children presenting for coronavirus disease 2019 (COVID-19) screening in Dubai, United Arab Emirates. Each child provided paired nasopharyngeal (NP) swab and saliva for SARS-CoV-2 RT-PCR N, E and RdRp gene detection.

Results: Paired NP swab and saliva samples were obtained from 476 children with mean ± standard deviation age of 10.8 ± 3.9 years, and 58.2% were male (277/476). Nine participants were sampled twice, so 485 pairs of NP swab/saliva were tested. Virus detection in at least one specimen type was reported in 17.9% (87/485), with similar detection in NP swab (16.7%, 81/485) and saliva (15.9%, 77/485). Sensitivity and specificity of saliva RT-PCR was 87.7% (95% confidence interval (CI) 78.5-93.9) and 98.5% (95% CI 96.8-99.5). The positive and negative predictive values were 92.2% (95% CI 84.2-96.3) and 97.6% (95% CI 95.7-98.6), with a kappa coefficient of 0.879 (95% CI 0.821-0.937). Concordance of findings between NP swab and saliva did not differ by age (p 0.67) or gender (p 0.29). Cycle threshold (Ct) values were significantly higher in NP swab/saliva pairs with discordant findings compared to those with both specimens positive.

Conclusions: In light of these findings, we recommend saliva as a diagnostic specimen for COVID-19 screening in children.

Keywords: COVID-19; Nasopharyngeal swab; RT-PCR; SARS-CoV-2; Saliva.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study flowchart. Abbreviations: NP, nasopharyngeal; RT-PCR, reverse transcriptase PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Fig. 2
Fig. 2
Cycle threshold (Ct) values of E, RdRp and N gene targets in paired saliva and nasopharyngeal (NP) swab specimens.
Fig. 3
Fig. 3
Mean cycle threshold (Ct) values for E, RdRp and N genes in nasopharyngeal (NP) swab and saliva of patients with self-reported symptoms versus those without symptoms.
See this image and copyright information in PMC

Comment in

References

    1. Pasomsub E., Watcharananan S.P., Boonyawat K., Janchompoo P., Wongtabtim G., Suksuwan W., et al. Saliva sample as a non-invasive specimen for the diagnosis of coronavirus disease-2019 (COVID-19): a cross-sectional study. Clin Microbiol Infect. 2020 doi: 10.1016/j.cmi.2020.05.001. - DOI - PMC - PubMed
    1. Senok A., Alsuwaidi H., Atrah Y., Al Ayedi O., Al Zahid J., Han A., et al. Saliva as an alternative specimen for molecular COVID-19 testing in community settings and population-based screening. Infect Drug Resist. 2020;13:3393–3399. - PMC - PubMed
    1. Wyllie A.L., Fournier J., Casanovas-Massana A., Campbell M., Tokuyama M., Vijayakumar P., et al. Saliva or nasopharyngeal swab specimens for detection of SARS-CoV-2. N Engl J Med. 2020;383:1283–1286. - PMC - PubMed
    1. Azzi L., Carcano G., Gianfagna F., Grossi P., Gasperina D.D., Genoni A., et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020;81:e45–e50. - PMC - PubMed
    1. Jamal A.J., Mozafarihashjin M., Coomes E., Powis J., Li A.X., Paterson A., et al. Sensitivity of nasopharyngeal swabs and saliva for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa848. - DOI - PMC - PubMed

Publication types