McGill University and McGill International TB Centre, Montreal, Quebec, Canada, and State University of Rio de Janeiro, Rio de Janeiro, Brazil (M.L.B.).
McGill University, Montreal, Quebec, Canada (S.P.).
Ann Intern Med. 2021 Apr;174(4):501-510. doi: 10.7326/M20-6569. Epub 2021 Jan 12.
Nasopharyngeal swabs are the primary sampling method used for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they require a trained health care professional and extensive personal protective equipment.
To determine the difference in sensitivity for SARS-CoV-2 detection between nasopharyngeal swabs and saliva and estimate the incremental cost per additional SARS-CoV-2 infection detected with nasopharyngeal swabs.
Embase, Medline, medRxiv, and bioRxiv were searched from 1 January to 1 November 2020. Cost inputs were from nationally representative sources in Canada and were converted to 2020 U.S. dollars.
Studies including at least 5 paired nasopharyngeal swab and saliva samples and reporting diagnostic accuracy for SARS-CoV-2 detection.
Data were independently extracted using standardized forms, and study quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2).
Thirty-seven studies with 7332 paired samples were included. Against a reference standard of a positive result on either sample, the sensitivity of saliva was 3.4 percentage points lower (95% CI, 9.9 percentage points lower to 3.1 percentage points higher) than that of nasopharyngeal swabs. Among persons with previously confirmed SARS-CoV-2 infection, saliva's sensitivity was 1.5 percentage points higher (CI, 7.3 percentage points lower to 10.3 percentage points higher) than that of nasopharyngeal swabs. Among persons without a previous SARS-CoV-2 diagnosis, saliva was 7.9 percentage points less (CI, 14.7 percentage points less to 0.8 percentage point more) sensitive. In this subgroup, if testing 100 000 persons with a SARS-CoV-2 prevalence of 1%, nasopharyngeal swabs would detect 79 more (95% uncertainty interval, 5 fewer to 166 more) persons with SARS-CoV-2 than saliva, but with an incremental cost per additional infection detected of $8093.
The reference standard was imperfect, and saliva collection procedures varied.
Saliva sampling seems to be a similarly sensitive and less costly alternative that could replace nasopharyngeal swabs for collection of clinical samples for SARS-CoV-2 testing.
McGill Interdisciplinary Initiative in Infection and Immunity. (PROSPERO: CRD42020203415).
鼻咽拭子是检测严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的主要采样方法，但它需要经过培训的医疗保健专业人员和广泛的个人防护设备。
确定鼻咽拭子和唾液检测 SARS-CoV-2 的敏感性差异，并估计使用鼻咽拭子检测 SARS-CoV-2 每增加一例感染的增量成本。
从 2020 年 1 月 1 日至 11 月 1 日，检索了 Embase、Medline、medRxiv 和 bioRxiv。成本投入来自加拿大具有全国代表性的来源，并转换为 2020 年的美元。
包括至少 5 对鼻咽拭子和唾液样本的研究，并报告 SARS-CoV-2 检测的诊断准确性。
使用标准化表格独立提取数据，并使用 QUADAS-2（诊断准确性研究的质量评估）评估研究质量。
共纳入 37 项研究，涉及 7332 对样本。与任何样本均呈阳性的参考标准相比，唾液的敏感性低 3.4 个百分点（95%CI，9.9 个百分点低至 3.1 个百分点高）。在先前确诊 SARS-CoV-2 感染的人群中，唾液的敏感性高 1.5 个百分点（CI，7.3 个百分点低至 10.3 个百分点高）。在没有 SARS-CoV-2 既往诊断的人群中，唾液的敏感性低 7.9 个百分点（CI，14.7 个百分点低至 0.8 个百分点高）。在该亚组中，如果对 SARS-CoV-2 患病率为 1%的 100000 人进行检测，鼻咽拭子检测到的 SARS-CoV-2 感染者将比唾液多 79 人（95%不确定性区间，少 5 人至多 166 人），但每检测到一例额外感染的增量成本为 8093 美元。
参考标准并不完美，唾液采集程序也有所不同。
唾液采样似乎是一种同样敏感且成本较低的替代方法，可以替代鼻咽拭子采集临床样本进行 SARS-CoV-2 检测。
麦吉尔传染病与免疫学跨学科倡议。（PROSPERO：CRD42020203415）
