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Self-Collected Anterior Nasal and Saliva Specimens versus Health Care Worker-Collected Nasopharyngeal Swabs for the Molecular Detection of SARS-CoV-2.

Author(s): Hanson KE, Barker AP, Hillyard DR, Gilmore N, Barrett JW, Orlandi RR, Shakir SM

Publication: J Clin Microbiol, 2020, Vol. 58, Page

PubMed ID: 32817233 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared detection of SARS-CoV-2 in matched self-collected anterior nasal swab and saliva specimens with healthcare worker–collected nasopharyngeal swab specimens. Swab specimens were collected by healthcare-workers (details not provided) from 354 patients (47% female, 53% male) with symptoms suggestive of SARS-CoV-2 infection which included one or more of the following: fever, cough, shortness of breath, sore throat, malaise, chills, and/or a decreased sense of smell or taste. Participants were instructed to swab both nostrils with flocked swabs and then pool saliva in their mouth without coughing and repeatedly spit a minimum of 1 mL saliva into a sterile, empty tube. A healthcare worker then collected a nasopharyngeal specimen using a foam swab. All swabs were placed in tubes containing sterile phosphate-buffered saline solution, transported at 4°C to the lab with the saliva specimens, and stored refrigerated until processed ≤5 days. All specimens were analyzed using an Hologic Aptima SARS-CoV-2 transcription-mediated amplification assay.

   Summary of Findings:

   SARS-Cov-2 diagnostic concordance was high between healthcare worker-collected nasopharyngeal swab specimens and self-collected nasal swab and saliva specimens (κ=0.889 and κ=0.912, respectively). The percent positive agreement was 86.3% between nasopharyngeal swab and nasal swab specimens and 93.8% between nasopharyngeal swab and saliva specimens and the percent negative agreement was 99.6% for nasopharyngeal swab versus nasal swab specimens and 97.8% for nasopharyngeal swabs versus saliva specimens. Overall, 66 (18.6%) patients had SARS-CoV-2 detected in all three specimen types, 13 (3.7%) in two specimen types, and seven (2.0%) in one specimen type. Of the 13 cases in which SARS-CoV-2 was detected in two of the three specimens, nine (69.2%) had SARS-CoV-2 detected in nasopharyngeal swab and saliva specimens, three (23%) had SARS-CoV-2 detected in nasopharyngeal swab and nasal swab specimens, and a single patient (7.7%) had SARS-CoV-2 detected in saliva and nasal swab specimen. Of the seven cases in which SARS-CoV-2 was detected a single specimen, two (28.6%) were detected in nasopharyngeal swab only, five (71.4%) in saliva only, and none were detected solely in nasal swab specimens. Positivity rates were higher for nasopharyngeal swab (22.5%; 80/354) and saliva specimens (22.9%; 81/354) than for nasal swab specimens (19.7%; 70/354) but this did not reach statistical significance.

   Biospecimens

   • Cell - Nasal cavity
   • Bodily Fluid - Saliva
   • Cell - Nasopharynx

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Pneumonia/Respiratory Infection

   Platform:

   Analyte	Technology Platform
   RNA	RNA amplification

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of cell acquisition	Healthcare worker–collected swabs Self-collected nasal swabs Self-collected saliva
   Biospecimen Acquisition	Biospecimen location	Saliva Nasal cavity Nasopharynx

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