Validating saliva as a biological sample for cost-effective, rapid and routine screening for SARS-CoV-2

Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR bas...

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Bibliographic Details
Published inIndian journal of medical microbiology Vol. 45; p. 100384
Main Authors Ansil, B R, George, Carolin Elizabeth, Chandrasingh, Sindhulina, Viswanathan, Ashwin, Thattai, Mukund, Raghu, Padinjat, Devadiga, Santhosha, Harikumar, Arun Geetha, Harsha, Pulleri Kandi, Nair, Indu, Ramakrishnan, Uma, Mayor, Satyajit
Format Journal Article
LanguageEnglish
Published United States 01.09.2023
Subjects
Cost-Benefit Analysis
COVID-19 - diagnosis
Humans
India
Nasopharynx
Saliva
SARS-CoV-2
Specimen Handling
India
Nasopharyngeal swab
Respiratory virus
SARS-CoV-2
SalivaDirect
Surveillance
Pandemic
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Summary:Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR based SARS-CoV-2 detection. We collected paired nasopharyngeal/oropharyngeal swabs and saliva samples from suspected positive SARS-CoV-2 patients and tested using RT-PCR. We used generalized linear models to investigate factors that explain result agreement. Further, we used simulations to evaluate the effectiveness of saliva-based screening in restricting the spread of infection in a large campus such as an educational institution. We observed a 75.4% agreement between saliva and N/OPS-VTM, that increased drastically to 83% in samples stored for less than three days. Such samples processed within two days of collection showed 74.5% test sensitivity. Our simulations suggest that a test with 75% sensitivity, but high daily capacity can be very effective in limiting the size of infection clusters in a workspace. Guided by these results, we successfully implemented a saliva-based screening in the Bangalore Life Sciences Cluster (BLiSC) campus. These results suggest that saliva may be a viable alternate source for SARS-CoV-2 surveillance if samples are processed immediately. Although saliva shows slightly lower sensitivity levels when compared to N/OPS-VTM, saliva collection is logistically advantageous. We strongly recommend the implementation of saliva-based screening strategies for large workplaces and in schools, as well as for population-level screening and routine surveillance as we learn to live with the SARS-CoV-2 virus.
ISSN:1998-3646