• Jane Oliver, Shidan Tosif, Lai-Yang Lee, Anna-Maria Costa, Chelsea Bartel, Katherine Last, Vanessa Clifford, Andrew Daley, Nicole Allard, Catherine Orr, Ashley Nind, Karyn Alexander, Niamh Meagher, Michelle Sait, Susan A Ballard, Eloise Williams, Katherine Bond, Deborah A Williamson, Nigel W Crawford, and Katherine B Gibney.
• The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.
• Med. J. Aust. 2021 Sep 20; 215 (6): 273-278.

ObjectiveTo compare the concordance and acceptability of saliva testing with standard-of-care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in children and in general practice.DesignProspective multicentre diagnostic validation study.SettingRoyal Children's Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July-October 2020.Participants1050 people who provided paired saliva and oropharyngeal-nasal swabs for SARS-CoV-2 testing.Main Outcome MeasuresNumbers of cases in which SARS-CoV-2 was detected in either specimen type by real-time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type.ResultsSARS-CoV-2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58-84%) for saliva and 63% (95% CI, 49-76%) for oropharyngeal-nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70-95%) for saliva and 63% (95% CI, 45-79%) for oropharyngeal-nasal swabs. Adding saliva testing to standard-of-care oropharyngeal-nasal swab testing increased overall case detection by 59% (95% CI, 29-95%). Providing saliva was preferred to an oropharyngeal-nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%).ConclusionIn children over 10 years of age and adults, saliva testing alone may be suitable for SARS-CoV-2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal-nasal swab testing for increasing case detection.© 2021 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.

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