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Savela ES, Winnett A, Romano AE, et al. Quantitative SARS-CoV-2 viral-load curves in paired saliva and nasal swabs inform appropriate respiratory sampling site and analytical test sensitivity required for earliest viral detection. J Clin Microbiol. 2021;JCM0178521doi: 10.1128/JCM.01785-21.
Savela, E. S., Winnett, A., Romano, A. E., Porter, M. K., Shelby, N., Akana, R., Ji, J., Cooper, M. M., Schlenker, N. W., Reyes, J. A., Carter, A. M., Barlow, J. T., Tognazzini, C., Feaster, M., Goh, Y. Y., & Ismagilov, R. F. (2021). Quantitative SARS-CoV-2 viral-load curves in paired saliva and nasal swabs inform appropriate respiratory sampling site and analytical test sensitivity required for earliest viral detection. Journal of clinical microbiology, JCM0178521. https://doi.org/10.1128/JCM.01785-21
Savela, Emily S, et al. "Quantitative SARS-CoV-2 viral-load curves in paired saliva and nasal swabs inform appropriate respiratory sampling site and analytical test sensitivity required for earliest viral detection." Journal of clinical microbiology vol. (2021): JCM0178521. doi: https://doi.org/10.1128/JCM.01785-21
Savela ES, Winnett A, Romano AE, Porter MK, Shelby N, Akana R, Ji J, Cooper MM, Schlenker NW, Reyes JA, Carter AM, Barlow JT, Tognazzini C, Feaster M, Goh YY, Ismagilov RF. Quantitative SARS-CoV-2 viral-load curves in paired saliva and nasal swabs inform appropriate respiratory sampling site and analytical test sensitivity required for earliest viral detection. J Clin Microbiol. 2021 Dec 15;JCM0178521. doi: 10.1128/JCM.01785-21. Epub 2021 Dec 15. PMID: 34911366.
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J Clin Microbiol. 2021 Dec 15;JCM0178521. doi: 10.1128/JCM.01785-21. Epub 2021 Dec 15.

Quantitative SARS-CoV-2 viral-load curves in paired saliva and nasal swabs inform appropriate respiratory sampling site and analytical test sensitivity required for earliest viral detection.

Journal of clinical microbiology

Emily S Savela, Alexander Winnett, Anna E Romano, Michael K Porter, Natasha Shelby, Reid Akana, Jenny Ji, Matthew M Cooper, Noah W Schlenker, Jessica A Reyes, Alyssa M Carter, Jacob T Barlow, Colten Tognazzini, Matthew Feaster, Ying-Ying Goh, Rustem F Ismagilov

Affiliations

  1. California Institute of Technology, 1200 E. California Blvd., Pasadena, CA, USA 91125.
  2. City of Pasadena Public Health Department, 1845 N. Fair Oaks Ave., Pasadena, CA, USA 91103.

PMID: 34911366 DOI: 10.1128/JCM.01785-21

Abstract

Early detection of SARS-CoV-2 infection is critical to reduce asymptomatic and pre-symptomatic transmission, curb the spread of variants, and maximize treatment efficacy. Low-analytical-sensitivity nasal-swab testing is commonly used for surveillance and symptomatic testing, but the ability of these tests to detect the earliest stages of infection has not been established. In this study, conducted between September 2020 and June 2021 in the greater Los Angeles County, California area, initially-SARS-CoV-2-negative household contacts of individuals diagnosed with COVID-19 prospectively self-collected paired anterior-nares nasal-swab and saliva samples twice daily for viral-load quantification by high-sensitivity RT-qPCR and digital-RT-PCR assays. We captured viral-load profiles from the incidence of infection for seven individuals and compared diagnostic sensitivities between respiratory sites. Among unvaccinated persons, testing saliva with a high-analytical-sensitivity assay detected infection up to 4.5 days before viral loads in nasal swabs reached concentrations detectable by low-analytical-sensitivity nasal-swab tests. For most participants, nasal swabs reached higher peak viral loads than saliva, but were undetectable or at lower loads during the first few days of infection. High-analytical-sensitivity saliva testing was most reliable for earliest detection. Our study illustrates the value of acquiring early (within hours after a negative high-sensitivity test) viral-load profiles to guide the appropriate analytical sensitivity and respiratory site for detecting earliest infections. Such data are challenging to acquire but critical to design optimal testing strategies with emerging variants in the current pandemic and to respond to future viral pandemics.

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