• Marie L Landry, Jody Criscuolo, and David R Peaper.
• Clinical Virology Laboratory, Yale New Haven Hospital, New Haven, Connecticut, United States; Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520, United States; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520, United States. Electronic address: marie.landry@yale.edu.
• J. Clin. Virol. 2020 Sep 1; 130: 104567.

BackgroundA major expansion in SARS CoV-2 testing is urgently needed. Saliva is an attractive option as an alternative for nasopharyngeal swabs (NPS), since saliva can be self-collected, is non-invasive, and sample quality is not dependent on the expertise of the collector.ObjectiveTo compare SARS CoV-2 positivity on paired NPS and saliva samples.Study DesignNPS and paired saliva samples were prospectively collected from symptomatic outpatients suspected of having COVID-19 and were tested by real-time RT-PCR.ResultsIn total, 35/124 (26.6 %) samples were RT-PCR positive, with 33/35 positive by NPS (sensitivity = 94.3 % (95 % CI 81.4%-99.0%)) and 30/35 by pure saliva (sensitivity = 85.7 % (95 % CI 70.6%-93.7%)), for an overall agreement of 117/124 (94.4 %). The median cycle threshold value was significantly lower for NPS than for saliva (p = 0.0331). A third or more of pure saliva samples from symptomatic patients were thick, stringy, and difficult to pipet.ConclusionsReal-time RT-PCR of pure saliva had an overall sensitivity for SARS CoV-2 RNA detection of 85.7 % when compared to simultaneously collected NPS. Our study highlighted the need to optimize collection and processing before saliva can be used for high volume testing.Copyright © 2020 Elsevier B.V. All rights reserved.

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