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Observational Study
. 2021 Sep 20;215(6):273-278.
doi: 10.5694/mja2.51188. Epub 2021 Jul 20.

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS-CoV-2 in primary care and children

Jane Oliver  1 , Shidan Tosif  2 , Lai-Yang Lee  2 , Anna-Maria Costa  2 , Chelsea Bartel  2 , Katherine Last  2 , Vanessa Clifford  2   3 , Andrew Daley  2   4 , Nicole Allard  1   5 , Catherine Orr  5 , Ashley Nind  5 , Karyn Alexander  3   6 , Niamh Meagher  7 , Michelle Sait  8 , Susan A Ballard  8 , Eloise Williams  9 , Katherine Bond  10 , Deborah A Williamson  8   11 , Nigel W Crawford  12 , Katherine B Gibney  1   9
Affiliations
Observational Study

Adding saliva testing to oropharyngeal and deep nasal swab testing increases PCR detection of SARS-CoV-2 in primary care and children

Jane Oliver et al. Med J Aust. .

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.

Keywords: COVID-19; Child health; Diagnosis; General practice; Infectious diseases; Public health; Respiratory tract infections.

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Conflict of interest statement

No relevant disclosures.

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References

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