Antigen rapid tests, nasopharyngeal PCR and saliva PCR to detect SARS-CoV-2: A prospective comparative clinical trial

• Published in: PloS one Vol. 18; no. 2; p. e0282150
• Main Authors: Schwob, Jean-Marc, Miauton, Alix, Petrovic, Dusan, Perdrix, Jean, Senn, Nicolas, Gouveia, Alexandre, Jaton, Katia, Opota, Onya, Maillard, Alain, Minghelli, Gianni, Cornuz, Jacques, Greub, Gilbert, Genton, Blaise, D'Acremont, Valérie
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.02.2023; Public Library of Science (PLoS)
• Subjects: Analysis; Antigens; Antigens, Viral; Biology and Life Sciences; Clinical trials; Comparative analysis; Consent; Coronaviruses; COVID-19; COVID-19 Testing; Diagnostic tests; Disease transmission; Evaluation; Health aspects; Humans; Laboratories; Medicine and Health Sciences; Patients; Polymerase Chain Reaction; Prospective Studies; Research and Analysis Methods; Saliva; Sample size; SARS-CoV-2; Sensitivity; Sensitivity and Specificity; Severe acute respiratory syndrome coronavirus 2; Viral diseases; Viruses; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0282150

Nasopharyngeal antigen Rapid Diagnostic Tests (RDTs), saliva RT-PCR and nasopharyngeal (NP) RT-PCR have shown different performance characteristics to detect patients infected by SARS-CoV-2, according to the viral load (VL)-and thus transmissibility. In October 2020, we conducted a prospective trial involving patients presenting at testing centres with symptoms of COVID-19. We compared detection rates and performance of RDT, saliva PCR and nasopharyngeal (NP) PCR, according to VL and symptoms duration. Out of 949 patients enrolled, 928 patients had all three tests performed. Detection rates were 35.2% (95%CI 32.2-38.4%) by RDT, 39.8% (36.6-43.0%) by saliva PCR, 40.1% (36.9-43.3%) by NP PCR, and 41.5% (38.3-44.7%) by any test. For those with viral loads (VL) ≥106 copies/ml, detection rates were 30.3% (27.3-33.3), 31.4% (28.4-34.5), 31.5% (28.5-34.6), and 31.6% (28.6-34.7%) respectively. Sensitivity of RDT compared to NP PCR was 87.4% (83.6-90.6%) for all positive patients, 94.5% (91.5-96.7%) for those with VL≥105 and 96.5% (93.6-98.3%) for those with VL≥106. Sensitivity of STANDARD-Q®, Panbio™ and COVID-VIRO® Ag tests were 92.9% (86.4-96.9%), 86.1% (78.6-91.7%) and 84.1% (76.9-89.7%), respectively. For those with VL≥106, sensitivity was 96.6% (90.5-99.3%), 97.8% (92.1-99.7%) and 95.3% (89.4-98.5%) respectively. No patient with VL<104 was detected by RDT. Specificity of RDT was 100% (99.3-100%) compared to any PCR. RDT sensitivity was similar <4 days (87.8%, 83.5-91.3%) and ≥4 days (85.7%, 75.9-92.6%) after symptoms onset (p = 0.6). Sensitivity of saliva and NP PCR were 95.7% (93.1-97.5%) and 96.5% (94.1-98.1%), respectively, compared to the other PCR. RDT results allow rapid identification of COVID cases with immediate isolation of most contagious individuals. RDT can thus be a game changer both in ambulatory care and community testing aimed at stopping transmission chains, and even more so in resource-constrained settings thanks to its very low price. When PCR is performed, saliva could replace NP swabbing. ClinicalTrial.gov Identifier: NCT04613310 (03/11/2020).