Practical challenges to the clinical implementation of saliva for SARS-CoV-2 detection
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BRIEF REPORT
Practical challenges to the clinical implementation of saliva for SARS-CoV-2 detection Nancy Matic 1,2 & Aleksandra Stefanovic 1,2 & Victor Leung 1,2 & Tanya Lawson 1 & Gordon Ritchie 1,2 & Lynne Li 2 & Sylvie Champagne 1,2 & Marc G. Romney 1,2 & Christopher F. Lowe 1,2 Received: 1 July 2020 / Accepted: 28 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Due to global shortages of flocked nasopharyngeal swabs and appropriate viral transport media during the COVID-19 pandemic, alternate diagnostic specimens for SARS-CoV-2 detection are sought. The accuracy and feasibility of saliva samples collected and transported without specialized collection devices or media were evaluated. Saliva demonstrated good concordance with paired nasopharyngeal swabs for SARS-CoV-2 detection in 67/74 cases (90.5%), though barriers to saliva collection were observed in long-term care residents and outbreak settings. SARS-CoV-2 RNA was stable in human saliva at room temperature for up to 48 h after initial specimen collection, informing appropriate transport time and conditions. Keywords COVID-19 . SARS-CoV-2 . Saliva . Nasopharyngeal . Transport
Introduction Diagnostic testing is a cornerstone of the COVID-19 pandemic response strategy [1], yet the establishment of laboratory testing which is accurate, practical, and scalable to meet the demand for public health surveillance measures has been a considerable challenge. Nasopharyngeal swabs are the preferred specimen type over throat swabs due to superior sensitivity [2, 3], and over nasal aspirates due to lower risk of aerosol generation. Flocked nasopharyngeal swabs are designed to maximize mucosal contact and more efficiently release contents into the testing medium [4, 5]; however, due to global demand during the pandemic response, a reliable supply of high-quality, flocked swabs and appropriate viral transport medium has been difficult to procure. Furthermore, studies describe variable collection quality of nasopharyngeal specimens leading to diminished sensitivity and potential false-negative results for SARS-CoV2[6–8]. Although samples from the lower respiratory tract such * Nancy Matic [email protected] 1
Division of Medical Microbiology and Virology, Providence Health Care, St. Paul’s Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
2
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
as sputum or bronchoalveolar lavage have been widely used [9–11], only a subset of patients under investigation for COVID-19 are able to expectorate sputum or undergo invasive bronchoscopic procedures. Saliva has been described as an acceptable alternative diagnostic specimen for the detection of common respiratory viruses [12–15], and more recently, SARS-CoV-2 [6, 15–19]. Salivary gland epithelial cells have demonstrated high expression of ACE2 receptors [20, 21], which may enhance the replication of SARS-CoV-2 at this site. Patients may describe the collection of saliva as more
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