Short communication
Challenges in use of saliva for detection of SARS CoV-2 RNA in symptomatic outpatients

https://doi.org/10.1016/j.jcv.2020.104567Get rights and content

Highlights

  • Saliva has been recommended as an alternative sample for detection of SARS CoV-2 infection, but data are limited.

  • In this study, SARS CoV-2 was detected by RT-PCR in 35 of 124 patients, 30 (85.7 %) by saliva and 33 (94.3 %) by NP swab.

  • The median cycle threshold value was significantly lower for NPS than for saliva.

  • A third of pure saliva samples were difficult to pipet, which slowed processing.

Abstract

Background

A major expansion in SARS CoV-2 testing is urgently needed. Saliva is an attractive option as an alternative for nasopharyngeal swabs (NPS), since saliva can be self-collected, is non-invasive, and sample quality is not dependent on the expertise of the collector.

Objective

To compare SARS CoV-2 positivity on paired NPS and saliva samples.

Study design

NPS and paired saliva samples were prospectively collected from symptomatic outpatients suspected of having COVID-19 and were tested by real-time RT-PCR.

Results

In total, 35/124 (26.6 %) samples were RT-PCR positive, with 33/35 positive by NPS (sensitivity = 94.3 % (95 % CI 81.4%–99.0%)) and 30/35 by pure saliva (sensitivity = 85.7 % (95 % CI 70.6%–93.7%)), for an overall agreement of 117/124 (94.4 %). The median cycle threshold value was significantly lower for NPS than for saliva (p = 0.0331). A third or more of pure saliva samples from symptomatic patients were thick, stringy, and difficult to pipet.

Conclusions

Real-time RT-PCR of pure saliva had an overall sensitivity for SARS CoV-2 RNA detection of 85.7 % when compared to simultaneously collected NPS. Our study highlighted the need to optimize collection and processing before saliva can be used for high volume testing.

Keywords

SARS CoV-2
COVID-19
Saliva
Nasopharyngeal swab
Real-time RT-PCR

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