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. 2022 Jul;69(4):e194-e203.
doi: 10.1111/tbed.14280. Epub 2021 Aug 17.

Repetitive saliva-based mass screening as a tool for controlling SARS-CoV-2 transmission in nursing homes

Claude Saegerman  1   2 , Anne-Françoise Donneau  2   3 , Niko Speybroeck  4 , Anh Nguyet Diep  3 , Alexandria Williams  5 , Lambert Stamatakis  6 , Wouter Coppieters  7 , Fabienne Michel  2   8 , Christophe Breuer  9 , Margaux Dandoy  10 , Olivier Ek  10 , Claire Gourzones  10 , Joey Schyns  10 , Emeline Goffin  10 , Frédéric Minner  10 , Véronique Renault  1 , Laurent Gillet  1   10   11 , Fabrice Bureau  10   12
Affiliations

Repetitive saliva-based mass screening as a tool for controlling SARS-CoV-2 transmission in nursing homes

Claude Saegerman et al. Transbound Emerg Dis. 2022 Jul.

Abstract

Nursing home (NH) residents and staff have been severely affected by the COVID-19 pandemic. The aim of this study was to examine the use of weekly saliva RT-qPCR testing for SARS-CoV-2 detection among NH workers as a strategy to control disease transmission within NHs in Belgium. From 16 November to 27 December 2020, a voluntary and anonymous weekly screening was implemented in a cohort of 50,000 workers across 572 NHs in the Walloon region of Belgium to detect asymptomatic cases of SARS-CoV-2 via saliva RT-qPCR testing and using the Diagenode saliva sample collection device. Positive workers were isolated to avoid subsequent infections in residents and other staff. RT-qPCR testing was based on pooled saliva sampling techniques from three workers, followed by individual testing of each positive or inconclusive pool. The majority of NHs (85%) and 55% of their workers participated. Pooling did not affect sensitivity as it only induced a very decrease in sensitivity estimated as 0.33%. Significant decreases in the prevalence (34.4-13.4%) and incidence of NHs with either single (13.8-2%) or multiple positive workers (3.7-0%) were observed over time. In addition, deaths among NH residents and NH worker absences decreased significantly over time. Weekly saliva RT-qPCR testing for SARS-CoV-2 demonstrated large-scale feasibility and efficacy in disrupting the chain of transmission. Implementation of this testing strategy in NHs could also be extended to other settings with the aim to control viral transmission for maintaining essential activities.

Keywords: Belgium; COVID-19; RT-qPCR; SARS-CoV-2; nursing home; saliva test; worker.

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Conflict of interest statement

The two last authors are the inventors of the device used in the saliva collection kit. This device was patented (EP20186086.3) and produced by Diagenode (Seraing, Belgium) under a commercial agreement with the University of Liège. This does not alter the adherence to all journal policies on sharing data and materials, as detailed online in the Author Guide.

Figures

FIGURE 1
FIGURE 1
Participating (N = 530) and non‐participating (N = 42) NHs in the study; map of Belgium, with Wallonia located in the south
FIGURE 2
FIGURE 2
Map of Wallonia; cumulative odds of positive RT‐qPCR results by nursing home and quartile. Legend: Q1, Q2, Q3 and Q4 are the quartiles
FIGURE 3
FIGURE 3
Regional trends during second wave in (a) the number of possible or confirmed COVID‐19 cases per 1000 absent NH workers, and (b) number of COVID‐19 deaths per 1000 NH residents (derived from Sciensano, 2021b). NH, Nursing home; (a) black line represents Wallonia; grey dash represents Flanders; (b) black bars represent Wallonia, grey bars represent Flanders
FIGURE 4
FIGURE 4
During the first wave, (a) regional trends in the number of deaths due to COVID‐19 per 1000 NH residents, and (b) the ratio between deaths in Wallonia/Flanders over time (Derived from Sciensano, 2021b). NH, Nursing home; (a) bars in black represent Wallonia, while bars in grey represent Flanders
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