Diagnostic Accuracy of Saliva for SARS-CoV-2 Detection in State-sponsored Quarantine in Thailand
DOI:
https://doi.org/10.59096/osir.v14i1.262697Keywords:
nasopharyngeal swab, saliva, SARS-CoV-2, state quarantine, ThailandAbstract
The aim of this study was to assess the diagnostic accuracy of saliva for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes among people in state-sponsored quarantine in Thailand. A cohort of 233 Thais in state-sponsored quarantine in Bangkok was enrolled into the study. Baseline demographic characteristics, presence of underlying diseases, and symptoms related to COVID-19 were collected on day 1 of the quarantine. Saliva specimens and nasopharyngeal (NP) swabs collected on day 7 at the quarantine premises were tested for SARS-CoV-2 RNA by real-time reverse transcription polymerase chain reaction. Overall, the viral RNA was detected in 32 (13.7%) NP swab samples, but only in 12 (5.2%) of the saliva samples. No person had NP negative but saliva positive result. Among the SARS-CoV-2 infected cases, nearly 20% had COVID-19-like illness and around 80% were asymptomatic. Sensitivity and specificity of saliva specimen were found to be 37.5% (95% confidence interval (CI)=21.1-56.3%) and 100% (95% CI=98.2-100%), respectively compared to the NP swab specimens. The area under the receiver operating characteristic curve was found to be 0.7 (95% CI=0.6-0.8). Our findings indicate that despite no false-positives, a high false-negative rate can occur with saliva specimen due to its low sensitivity, which limits its application in ruling out SARS-CoV-2 infection in quarantine settings.
References
Okada P, Buathong R, Phuygun S, Thanadachakul T, Parnmen S, Wongboot W, et al. Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand. January 2020. Euro Surveill. 2020;25(8). doi:10.2807/1560-7917.ES.2020.25.8.2000097
Namwat C, Suphanchaimat R, Nittayasoot N, Iamsirithaworn S. Thailand’s response against coronavirus disease 2019: challenges and lessons learned. OSIR. 2020 Mar;13(1):33-7.
Department of Disease Control, Ministry of Public Health Thailand. Covid-19 Situation Reports [Internet]. Nonthaburi: Department of Disease Control, Ministry of Public Health, Thailand; [cited 2020 Jul 13]. <https://covid19.ddc.moph.go.th/en>
Worldometers. COVID-19 Coronavirus Pandemic 2020 [Internet]. [place unknown]: Worldometers; [cited 2020 Jul 13]. <https://www.worldometers.info/coronavirus/>
Sapkota D, Thapa SB, Hasseus B, Jensen JL. Saliva testing for COVID-19?. Br Dent J. 2020;228(9):658-9.
Czumbel LM, Kiss S, Farkas N, Mandel I, Hegyi AE, Nagy AK, et al. Saliva as a candidate for COVID-19 diagnostic testing: a meta-analysis. Front Med (Lausanne). 2020 Aug 4;7:465. doi:10.3389/fmed.2020.00465.
Hamid H, Khurshid Z, Adanir N, Zafar MS, Zohaib S. COVID-19 pandemic and role of human saliva as a testing biofluid in point-of-care technology. Eur J Dent. 2020 Dec;14(S01):S123-S129. doi:10.1055/s-0040-1713020 .
Xu R, Cui B, Duan X, Zhang P, Zhou X, Yuan Q. Saliva: potential diagnostic value and transmission of 2019-nCoV. Int J Oral Sci 2020;12(1):11. doi:10.1038/s41368-020-0080-z
Pasomsub E, Watcharananan SP, Boonyawat K, Janchompoo P, Wongtabtim G, Suksuwan W, et al. Saliva sample as a non-invasive specimen for the diagnosis of coronavirus disease 2019: a cross-sectional study. Clin Microbiol Infect. 2021 Feb;27(2):285.e1-285.e4. doi:10.1016/j.cmi.2020.05.001.
Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193-204. doi: 10.1016/j.jbi.2014.02.013.
Mathot L, Wallin M, Sjöblom T. Automated serial extraction of DNA and RNA from biobanked tissue specimens. BMC Biotechnol. 2013 Aug 19;13:66. doi: 10.1186/1472-6750-13-66.
Bustin SA, Nolan T. Pitfalls of quantitative real-time reverse-transcription polymerase chain reaction. J Biomol Tech. 2004 Sep;15(3):155-66.
Gumaste P. Advantages and Limitations of real time Reverse Transcription Polymerase Chain Reaction (real time RT-PCR) [blog on the Internet]. Mumbai: SRL Dr. Avinash Phadke Labs; 2020 Apr 13 [cited 2021 Feb 16]. <https://phadkelabs.com/blog/advantages-and-limitations-of-real-time-reverse-transcription-polymerase-chain-reaction-real-time-rt-pcr/>
Okada PA, Wongboot W, Thanadachakul T, Puygun S, Kala S, Meechalard W, et al. Development of DMSc COVID-19 Real-time RT-PCR. Bullentin of The department of Medical Sciences. 2020;62(3):143-54. Thai.
WHO Collaborating Center for Reference and Research on Influenza. Real-time RT-PCR Protocol for the Detection of Avian Influenza A (H7N9) Virus [Internet]. Beijing: World Health Organization; 2013 Apr 8 [updated 2013 Apr 15; cited 2020 May 15]. <https://www.who.int/influenza/gisrs_laboratory/cnic_realtime_rt_pcr_protocol_a_h7n9.pdf>
Woloshin S, Patel N, Kesselheim AS. False negative tests for SARS-CoV-2 infection— challenges and implications. N Engl J Med. 2020 Aug 6; 383(6):e38. doi:10.1056/NEJMp2015897.
Nagura-Ikeda M, Imai K, Tabata S, Miyoshi K, Murahara N, Mizuno T, et al. Clinical evaluation of self-collected saliva by RT-qPCR, direct RT-qPCR, RT-LAMP, and a rapid antigen test to diagnose COVID-19. J Clin Microbiol. 2020 Aug 24;58(9):e01438-20. doi:10.1128/JCM.01438-20.
Williams E, Bond K, Zhang B, Putland M, Williamson DA. Saliva as a non-invasive specimen for detection of SARS-CoV-2. J Clin Microbiol. 2020 Jul 23;58(8):e00776-20. doi:10.1128/JCM.00776-20.
Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P, et al. Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs. N Engl J Med. 2020; 383:1283-6. doi:10.1056/NEJMc2016359.
Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis . 2020 Jun;20(6):656-7. doi:10.1016/S1473-3099(20)30232-2.
Chau NVV, Thanh Lam V, Thanh Dung N, Yen LM, Minh NNQ, Hung LM, et al. The natural history and transmission potential of asymptomatic SARS-CoV-2 infection. Clin Infect Dis. 2020 Jun 4;71(10):2679–87. doi:10.1093/cid/ciaa711.
Becker D, Sandoval E, Amin A, De Hoff P, Diets A, Leonetti N, et al. Saliva is less sensitive than nasopharyngeal swabs for COVID-19 detection in the community setting. medRxiv 2020.05.11.20092338 [Preprint]. 2020 May 17 [cited 2020 Jul 22]. <https://doi.org/10.1101/2020.05.11.20092338ฬ
Skolimowska K, Rayment M, Jones R, Madona P, Moore LSP, Randell P. Non-invasive saliva specimens for the diagnosis of COVID-19: caution in mild outpatient cohorts with low prevalence. Clin Microbiol Infect. 2020 Dec;26(12):1711-3. doi: 10.1016/j.cmi.2020.07.015.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14;395(10227):912-20.
Gholami N, Hosseini Sabzvari B, Razzaghi A, Salah S. Effect of stress, anxiety and depression on unstimulated salivary flow rate and xerostomia. J Dent Res Dent Clin Dent Prospects. 2017 Fall;11(4):247-52.
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