{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:11:14Z","timestamp":1786446674635,"version":"build-2736575974"},"reference-count":14,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T00:00:00Z","timestamp":1610496000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X21000027_as1\"><jats:title>Background:<\/jats:title><jats:p>Widespread testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) is necessary to curb the spread of coronavirus disease 2019 (COVID-19), but testing is undermined when the only option is a nasopharyngeal swab. Self-collected swab techniques can overcome many of the disadvantages of a nasopharyngeal swab, but they require evaluation.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21000027_as2\"><jats:title>Methods:<\/jats:title><jats:p>Three self-collected non-nasopharyngeal swab techniques (saline gargle, oral swab and combined oral-anterior nasal swab) were compared to a nasopharyngeal swab for SARS-CoV-2 detection at multiple COVID-19 assessment centers in Toronto, Canada. The performance characteristics of each test were assessed.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21000027_as3\"><jats:title>Results:<\/jats:title><jats:p>The adjusted sensitivity of the saline gargle was 0.90 (95% CI 0.86-0.94), the oral swab was 0.82 (95% CI, 0.72\u20130.89) and the combined oral\u2013anterior nasal swab was 0.87 (95% CI, 0.77\u20130.93) compared to a nasopharyngeal swab, which demonstrated a sensitivity of \u02dc90% when all positive tests were the reference standard. The median cycle threshold values for the SARS-CoV-2 E-gene for concordant and discordant saline gargle specimens were 17 and 31 (<jats:italic>P<\/jats:italic> &lt; .001), for the oral swabs these values were 17 and 28 (<jats:italic>P<\/jats:italic> &lt; .001), and for oral\u2013anterior nasal swabs these values were 18 and 31 (<jats:italic>P<\/jats:italic> = .007).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X21000027_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Self-collected saline gargle and an oral\u2013anterior nasal swab have a similar sensitivity to a nasopharyngeal swab for the detection of SARS-CoV-2. These alternative collection techniques are cheap and can eliminate barriers to testing, particularly in underserved populations.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2021.2","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T08:33:08Z","timestamp":1610526788000},"page":"1340-1344","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":42,"title":["Detection of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in outpatients: A multicenter comparison of self-collected saline gargle, oral swab, and combined oral\u2013anterior nasal swab to a provider collected nasopharyngeal swab"],"prefix":"10.1017","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1256-309X","authenticated-orcid":false,"given":"Christopher E.","family":"Kandel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela Anca","family":"Serbanescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff E.","family":"Powis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bulir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Callahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Katz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine","family":"McCready","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary","family":"Racher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Sheldrake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Quon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid Kyle","family":"Vojdani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"McGeer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee W.","family":"Goneau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Vermeiren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,1,13]]},"reference":[{"key":"S0899823X21000027_ref8","article-title":"Sensitivity of nasopharyngeal swabs and saliva for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)","author":"Jamal","year":"2020","journal-title":"Clin Infect Dis"},{"key":"S0899823X21000027_ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMvcm2010260"},{"key":"S0899823X21000027_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa377"},{"key":"S0899823X21000027_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa638"},{"key":"S0899823X21000027_ref11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2016321"},{"key":"S0899823X21000027_ref3","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2521-4"},{"key":"S0899823X21000027_ref4","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2020.00465"},{"key":"S0899823X21000027_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2020.104433"},{"key":"S0899823X21000027_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2020.104510"},{"key":"S0899823X21000027_ref5","doi-asserted-by":"publisher","DOI":"10.3390\/v12111314"},{"key":"S0899823X21000027_ref10","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4422"},{"key":"S0899823X21000027_ref6","article-title":"Self-collected saline gargle samples as an alternative to healthcare-worker\u2013collected nasopharyngeal swabs for COVID-19 diagnosis in outpatients","author":"Goldfarb","year":"2020","journal-title":"medRxiv"},{"key":"S0899823X21000027_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30157-2"},{"key":"S0899823X21000027_ref9","article-title":"Considerations for diagnostic COVID-19 tests","author":"Vandenberg","year":"2020","journal-title":"Nat Rev Microbiol"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X21000027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T13:51:38Z","timestamp":1636725098000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X21000027\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,13]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["S0899823X21000027"],"URL":"https:\/\/doi.org\/10.1017\/ice.2021.2","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,13]]},"assertion":[{"value":"\u00a9 The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}