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Change in Saliva RT-PCR Sensitivity Over the Course of SARS-CoV-2 Infection

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

While real-time reverse transcriptase–polymerase chain reaction (RT-PCR) on nasopharyngeal swabs is the current standard for SARS-CoV-2 detection, saliva is an attractive alternative for diagnosis and screening due to ease of collection and minimal supply requirements.1,2 Studies on the sensitivity of saliva-based SARS-CoV-2 molecular testing have shown considerable variability.3 We conducted a prospective, longitudinal study to investigate the testing time frame that optimizes saliva sensitivity for SARS-CoV-2 detection.

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Article Information

Accepted for Publication: August 1, 2021.

Published Online: August 13, 2021. doi:10.1001/jama.2021.13967

Corresponding Author: Pia S. Pannaraj, MD, MPH, Pediatrics and Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Division of Infectious Diseases, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS #51, Los Angeles, CA 90027 (ppannaraj@chla.usc.edu).

Author Contributions: Mr Congrave-Wilson and Dr Pannaraj had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Pannaraj is accountable for all aspects including accuracy and integrity of the work.

Concept and design: Congrave-Wilson, Lee, Pannaraj.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Congrave-Wilson, Lee, Jumarang, Perez.

Critical revision of the manuscript for important intellectual content: Congrave-Wilson, Bender, Dien Bard, Pannaraj.

Statistical analysis: Congrave-Wilson, Lee, Pannaraj.

Obtained funding: Pannaraj.

Administrative, technical, or material support: Jumarang, Perez, Dien Bard.

Supervision: Lee, Pannaraj.

Conflict of Interest Disclosures: Dr Pannaraj reported receiving consultant fees from Sanofi-Pasteur and Seqirus, research funding from Pfizer and AstraZeneca for unrelated studies, and grants from MedImmune. No other disclosures were reported.

Funding/Support: This study was funded by grant U01AI144616-02S1 from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. The funds were used for salary support for staff and materials to conduct the study.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Ariana Peralta, AS, Melissa Lucero Tanaka, MD, Adrianna Sainz, BS, Carolyn Jennifer Marentes Ruiz, MD, and Lauren Turner, MS, who helped to collect specimens; and Wesley Cheng, BS, for help with REDCap. All received salary support from the study and are staff at Children’s Hospital Los Angeles.

References
1.
Centers for Disease Control and Prevention. Interim guidelines for collecting and handling of clinical specimens for COVID-19 testing. Accessed February 23, 2021. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
2.
Moreno-Contreras  J , Espinoza  MA , Sandoval-Jaime  C ,  et al.  Saliva sampling and its direct lysis, an excellent option to increase the number of SARS-CoV-2 diagnostic tests in settings with supply shortages.   J Clin Microbiol. 2020;58(10):e01659-e20. doi:10.1128/JCM.01659-20PubMedGoogle ScholarCrossref
3.
Riccò  M , Ranzieri  S , Peruzzi  S ,  et al.  RT-qPCR assays based on saliva rather than on nasopharyngeal swabs are possible but should be interpreted with caution: results from a systematic review and meta-analysis.   Acta Biomed. 2020;91(3):e2020025. doi:10.23750/abm.v91i3.10020PubMedGoogle Scholar
4.
Jaafar  R , Aherfi  S , Wurtz  N ,  et al.  Correlation between 3790 quantitative polymerase chain reaction-positives samples and positive cell cultures including 1941 severe acute respiratory syndrome coronavirus 2 isolates.   Clin Infect Dis. 2021;72(11):e921. doi:10.1093/cid/ciaa1491PubMedGoogle Scholar
5.
Nacher  M , Mergeay-Fabre  M , Blanchet  D ,  et al.  Prospective comparison of saliva and nasopharyngeal swab sampling for mass screening for COVID-19.   Front Med (Lausanne). 2021;8:621160. doi:10.3389/fmed.2021.621160PubMedGoogle Scholar
6.
Owusu  D , Pomeroy  MA , Lewis  NM ,  et al; Household Transmission Study Team.  Persistent SARS-CoV-2 RNA shedding without evidence of infectiousness: a cohort study of individuals with COVID-19.   J Infect Dis. Published online February 27, 2021. doi:10.1093/infdis/jiab107PubMedGoogle Scholar
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