{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:06:05Z","timestamp":1792393565156,"version":"4.4.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI131617"],"award-info":[{"award-number":["R01AI131617"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011132","name":"Rutgers, The State University of New Jersey","doi-asserted-by":"publisher","award":["Center for COVID-19 Response and Pandemic Preparedness"],"award-info":[{"award-number":["Center for COVID-19 Response and Pandemic Preparedness"]}],"id":[{"id":"10.13039\/100011132","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Saliva has been a COVID-19 diagnostic specimen of interest due to its simple collection, scalability, and yield. Yet COVID-19 testing and estimates of the infectious period remain largely based on nasopharyngeal and nasal swabs. We sought to evaluate whether saliva testing captured prolonged presence of SARS-CoV-2 and potential infectiousness later in the disease course. We conducted an observational study of symptomatic COVID-19 patients at University Hospital in Newark, NJ. Paired saliva and nasal specimens from 96 patients were analyzed, including longitudinal analysis of paired observations from 28 of these patients who had multiple time-points. Saliva detected significantly more cases of COVID-19 beyond 5 days (86.1% [99\/115] saliva vs 48.7% [56\/115] nasal, p-value &lt; 0.001), 9 days (79.4% [50\/63] saliva vs 36.5% [23\/63] nasal, p-value &lt; 0.001) and 14 days (71.4% [20\/28] saliva vs 32.1% [9\/28] nasal, p-value = 0.010) of symptoms. Additionally, saliva yielded lower cycle thresholds across all time periods, indicative of higher viral loads in saliva. In the longitudinal analysis, a log-rank analysis indicated that the survival curve for saliva was significantly different from the curve for nasal swabs (p&lt;0.001) with a median survival time for saliva of 18 days compared to 13 days for nasal swabs. We additionally performed saliva viral cultures among a similar COVID-19 patient cohort and noted patients with positive saliva viral cultures between 7 to 28 days of symptoms. Findings from this study suggest that SARS-CoV-2 RNA persists longer and in higher abundance in saliva compared to nasal swabs, with potential of prolonged propagating virus. Testing saliva may thus increase yield for detecting potentially infectious virus even beyond the first five days of symptomatic COVID-19.<\/jats:p>","DOI":"10.1371\/journal.pone.0282708","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T17:51:46Z","timestamp":1678989106000},"page":"e0282708","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Persistence of SARS-CoV-2 in saliva: Implications for late-stage diagnosis and infectious duration"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4338-7455","authenticated-orcid":true,"given":"Abby","family":"Chopoorian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padmapriya","family":"Banada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Reiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Elson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Desind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2468-7575","authenticated-orcid":true,"given":"Claire","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukalyani","family":"Banik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Hennig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2706-9660","authenticated-orcid":true,"given":"Aanchal","family":"Wats","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Togba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-2975","authenticated-orcid":true,"given":"Abraham","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naranjargal","family":"Daivaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Palo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1139-7667","authenticated-orcid":true,"given":"Mitchell","family":"Hirsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carter","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Saiganesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Alland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5587-4731","authenticated-orcid":true,"given":"Yingda L.","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"pone.0282708.ref001","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12879-022-07095-x","article-title":"RT-PCR negative COVID-19","volume":"22","author":"H Parmar","year":"2022","journal-title":"BMC Infect Dis"},{"key":"pone.0282708.ref002","doi-asserted-by":"crossref","first-page":"4549","DOI":"10.1002\/jmv.26949","article-title":"Back to normal; serological testing for COVID-19 diagnosis unveils missed infections","volume":"93","author":"T Tsuchida","year":"2021","journal-title":"J Med Virol"},{"key":"pone.0282708.ref003","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1001\/jama.2021.13967","article-title":"Change in Saliva RT-PCR Sensitivity Over the Course of SARS-CoV-2 Infection","volume":"326","author":"Z Congrave-Wilson","year":"2021","journal-title":"JAMA"},{"key":"pone.0282708.ref004","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1056\/NEJMc2202092","article-title":"Duration of Shedding of Culturable Virus in SARS-CoV-2 Omicron (BA.1) Infection","volume":"387","author":"J Boucau","year":"2022","journal-title":"N Engl J Med"},{"key":"pone.0282708.ref005","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41586-020-2196-x","article-title":"Virological assessment of hospitalized patients with COVID-2019","volume":"581","author":"R W\u00f6lfel","year":"2020","journal-title":"Nature"},{"key":"pone.0282708.ref006","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1093\/cid\/ciaa638","article-title":"Predicting Infectious Severe Acute Respiratory Syndrome Coronavirus 2 From Diagnostic Samples","volume":"71","author":"J Bullard","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0282708.ref007","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jinf.2020.03.063","article-title":"Prolonged virus shedding even after seroconversion in a patient with COVID-19","volume":"81","author":"W-D Liu","year":"2020","journal-title":"J Infect"},{"key":"pone.0282708.ref008","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1038\/s41467-020-20568-4","article-title":"Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)","volume":"12","author":"JJA van Kampen","year":"2021","journal-title":"Nat Commun"},{"key":"pone.0282708.ref009","first-page":"e00128","article-title":"Comparison of Saliva and Midturbinate Swabs for Detection of SARS-CoV-2","volume":"10","author":"J Lai","year":"2022","journal-title":"Microbiol Spectr"},{"key":"pone.0282708.ref010","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1007\/s00784-020-03248-x","article-title":"Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis","volume":"24","author":"R Sabino-Silva","year":"2020","journal-title":"Clin Oral Investig"},{"key":"pone.0282708.ref011","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1136\/jclinpath-2020-206788","article-title":"Is FURIN gene expression in salivary glands related to SARS-CoV-2 infectivity through saliva?","volume":"74","author":"L Zupin","year":"2021","journal-title":"J Clin Pathol"},{"key":"pone.0282708.ref012","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41405-021-00064-7","article-title":"Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions","volume":"7","author":"P Kapoor","year":"2021","journal-title":"BDJ Open"},{"key":"pone.0282708.ref013","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1056\/NEJMc2016359","article-title":"Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2","volume":"383","author":"AL Wyllie","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0282708.ref014","doi-asserted-by":"crossref","first-page":"001380","DOI":"10.1099\/jmm.0.001380","article-title":"Sample collection and transport strategies to enhance yield, accessibility, and biosafety of COVID-19 RT-PCR testing","volume":"70","author":"P Banada","year":"2021","journal-title":"J Med Microbiol"},{"key":"pone.0282708.ref015","doi-asserted-by":"crossref","first-page":"e3106","DOI":"10.1093\/cid\/ciaa1589","article-title":"Self-Collected Oral Fluid and Nasal Swabs Demonstrate Comparable Sensitivity to Clinician Collected Nasopharyngeal Swabs for Coronavirus Disease 2019 Detection","volume":"73","author":"N Kojima","year":"2021","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"pone.0282708.ref016","doi-asserted-by":"crossref","first-page":"3134","DOI":"10.1038\/s41598-021-82787-z","article-title":"Saliva is more sensitive than nasopharyngeal or nasal swabs for diagnosis of asymptomatic and mild COVID-19 infection","volume":"11","author":"AKJ Teo","year":"2021","journal-title":"Sci Rep"},{"key":"pone.0282708.ref017","unstructured":"Interim Guidelines for Collecting and Handling of Clinical Specimens for COVID-19 Testing. 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