Related Experiment Video
Updated: Aug 20, 2025
Efficient SARS-CoV-2 Quantitative Reverse Transcriptase PCR Saliva Diagnostic Strategy utilizing Open-Source Pipetting Robots
Published on: February 11, 2022
Stick with the nose…Saliva rapid antigen testing is not a viable method for testing children under 5 years old
Shidan Tosif1,2,3, Lai-Yang Lee4, Jill Nguyen2
1Department of General Medicine & Immunisation Service, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
Insights
Nasal rapid antigen tests (RATs) are more feasible and sensitive for detecting SARS-CoV-2 in children under five than saliva RATs. Nasal RATs are preferred by parents due to easier collection compared to saliva tests.
Area of Science:
- Pediatric infectious diseases
- Diagnostic testing
- Respiratory virus detection
Background:
- Rapid antigen tests (RATs) for respiratory viruses in young children present challenges due to compliance and procedural distress.
- Evaluating alternative testing methods is crucial for accurate and efficient diagnosis in pediatric populations.
Purpose of the Study:
- To assess the sensitivity and feasibility of self-collected nasal and saliva RATs in children under five years of age.
- To compare these RAT methods against a combined nose and throat (CTN) swab PCR test for SARS-CoV-2 detection.
Main Methods:
- Children aged 1 month to 5 years with confirmed COVID-19 or recent household contact were included.
- Parents collected samples using saliva RAT, nasal RAT, and CTN swab PCR.
- SARS-CoV-2 cycle threshold (Ct) values from PCR were compared with RAT results, and parent preferences were recorded.
Main Results:
- Nasal RAT sensitivity was 0.889 (95% CI 0.739-0.969), significantly higher than saliva RAT sensitivity (0.158, 95% CI 0.034-0.396).
- Only 54% of parents successfully collected a saliva RAT, while nasal RAT collection was more feasible.
- Parents preferred nasal RATs for future testing despite rating saliva RATs as more comfortable, due to collection difficulties with saliva.
Conclusions:
- Nasal rapid antigen testing is a more feasible and sensitive method for SARS-CoV-2 detection in young children compared to saliva RAT.
- The findings support the use of nasal RATs as a practical diagnostic tool for young children, addressing compliance and procedural challenges.
Aim:
Respiratory testing with rapid antigen tests (RATs) in children under 5 years of age may be uncomfortable and presents specific challenges to testing due to compliance and procedural distress. The aim of this study was to investigate sensitivity and feasibility of self-collected nasal and saliva RAT tests compared with a combined nose and throat (CTN) swab PCR in children under 5.
Methods:
Children aged between 1 month and 5 years, with confirmed COVID-19 or who were a household contact within 7 days were included. A saliva RAT, nasal RAT and CTN swab were collected by the parent. SARS-CoV-2 cycle threshold (Ct) values for CTN tested by PCR were compared with saliva and nasal RAT results. Parent preference for method of sample was recorded.
Results:
Forty-one children were recruited with median age of 1.5 (interquartile range 0.7-4.0) years. Only 22/41 (54%) of parents were able to successfully collect a saliva RAT from their child. Sensitivity of the nasal RAT and saliva RAT was 0.889 (95% confidence interval (CI) 0.739-0.969) and 0.158 (95% CI 0.034-0.396), respectively. Upper limit of nasal RAT detection by CTN Ct value was higher than saliva (36.05 vs. 27.29). While saliva RAT was rated most comfortable, nasal RAT was rated the preferred specimen by parents for future testing, due to saliva collection difficulties and time taken.
Conclusions:
Rapid antigen testing with nasal RAT is a more feasible and sensitive method for SARS-CoV-2 detection in young children compared with saliva RAT.
