Self-Collected Oral Fluid Saliva Is Insensitive Compared With Nasal-Oropharyngeal Swabs in the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Outpatients. (30th December 2020)

• Record Type: Journal Article
• Authors: Manabe, Yukari C; Reuland, Carolyn; Yu, Tong; Azamfirei, Razvan; Hardick, Justin P; Church, Taylor; Brown, Diane M; Sewell, Thelio T; Antar, Annuka; Blair, Paul W; Heaney, Chris D; Pekosz, Andrew; Thomas, David L
• Is Part Of: Open forum infectious diseases. Volume 8:Number 2(2021)
• Publication Date: 2020-12-30
• Subjects: coronavirus -- COVID-19 -- outpatient -- saliva -- SARS-CoV-2; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa648
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic control will require widespread access to accurate diagnostics. Salivary sampling circumvents swab supply chain bottlenecks, is amenable to self-collection, and is less likely to create an aerosol during collection compared with the nasopharyngeal swab. Methods: We compared real-time reverse-transcription polymerase chain reaction Abbott m2000 results from matched salivary oral fluid (gingival crevicular fluid collected in an Oracol device) and nasal-oropharyngeal (OP) self-collected specimens in viral transport media from a nonhospitalized, ambulatory cohort of coronavirus disease 2019 (COVID-19) patients at multiple time points. These 2 sentences should be at the beginning of the results. Results: There were 171 matched specimen pairs. Compared with nasal-OP swabs, 41.6% of the oral fluid samples were positive. Adding spit to the oral fluid percent collection device increased the percent positive agreement from 37.2% (16 of 43) to 44.6% (29 of 65). The positive percent agreement was highest in the first 5 days after symptoms and decreased thereafter. All of the infectious nasal-OP samples (culture positive on VeroE6 TMPRSS2 cells) had a matched SARS-CoV-2 positive oral fluid sample. Conclusions: In this study of nonhospitalized SARS-CoV-2-infected persons, we demonstrate lower diagnostic sensitivity of self-collected oral fluid compared with nasal-OP specimens, a difference that was especially prominent more than 5 days from symptom onset. These data do not justify the routine use of oral fluid collection for diagnosis of SARS-CoV-2 despite the greater ease of collection. It also underscores the importance of considering the method of saliva specimen collection and the time from symptom onset especially in outpatient populations. Abstract : In a study of nonhospitalized COVID-19 patients, the oral fluid salivary sample type was insensitive compared to nasal-OP specimen types overall, but was improved with the addition of spit and most sensitive in the first 5 days after symptom onset.