AUTHOR=Ana Laura Guzmán-Ortiz , Abraham Josué Nevárez-Ramírez , Briceida López-Martínez , Israel Parra-Ortega , Tania Angeles-Floriano , Nancy Martínez-Rodríguez , Lourdes Jamaica-Balderas , Daniela De la Rosa-Zamboni , Fernando Ortega-Riosvelasco , Carlos Mauricio Jaramillo-Esparza , Sergio René Bonilla-Pellegrini , Irineo Reyna-Trinidad , Horacio Márquez-González , Oscar Medina-Contreras , Héctor Quezada 

TITLE=Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.642781

DOI=10.3389/fped.2021.642781

ISSN=2296-2360

ABSTRACT=<p><bold>Background:</bold> The reference standard for the molecular diagnostic testing for COVID-19 is the use of nasopharyngeal or combined nasopharyngeal and oropharyngeal (NP/OP) swabs. Saliva has been proposed as a minimally invasive specimen whose collection reduces the risks for health care personnel.</p><p><bold>Objective:</bold> To assess the suitability of saliva for COVID-19 diagnosis as a replacement of the reference standard NP/OP swab in the setting of a tertiary care pediatric unit.</p><p><bold>Study design:</bold> A paired study based in the prospective cohort design in patients suspected of having COVID-19.</p><p><bold>Methods:</bold> RT-PCR was used to detect SARS-CoV-2 in paired samples of saliva and NP/OP swab collected from May through August 2020 from 156 pediatric participants, of whom 128 has at least one comorbidity and 91 showed clinical symptoms related to SARS-CoV-2 infection. Additionally, we studied a group of 326 members of the hospital staff, of whom 271 had symptoms related to SARS-CoV-2 infection.</p><p><bold>Results:</bold> In the group of pediatric participants the sensitivity of the diagnostic test in saliva was 82.3% (95% CI 56.6–96.2) and the specificity 95.6% (95% CI 90.8–98.4). The prevalence of COVID-19 was 10.9% (17/156). In 6 of the 23 participants who tested positive for SARS-CoV-2 in at least one specimen type, the virus was detected in saliva but not in NP/OP swab, while in 3 participants the NP/OP swab was positive and saliva negative. In the group of adults, the sensitivity of the test in saliva was 77.8% (95% CI 67.2–86.3) and prevalence 24.8% (81/326). Discordant results between the two types of specimens showed a significant association with low viral load in the pharynx of adults but not of pediatric participants.</p><p><bold>Interpretation:</bold> In the context of a pediatric tertiary care hospital, the sensibility of the test in saliva is not high enough to replace the use of NP/OP swab for COVID-19 diagnosis. Neither NP/OP swab nor saliva could detect all the participants infected with SARS-CoV-2.</p>