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Covid-19: Prioritization of iterative salivary tests

The French High Council for Public Health (HCSP) establishes a prioritisation of the public likely to benefit from salivary samples for the diagnosis of Covid-19 by RT-PCR, taking into account the capacity limits.

This prioritization takes into account:

  • the invasive nature of nasopharyngeal sampling, which hinders its acceptance, especially when it is performed iteratively;
  • the capacity of these tests to detect new variants of interest;
  • the uncertain and evolutive epidemiological context of the coming weeks and the need for broad screening;
  • the current limited deployment of saliva tests (approximately 260,000 tests per week).

The HCSP recommends that salivary RT-PCR tests be performed as a priority for the following populations:

Professionals in health facilities (ES) or medico-social facilities (EMS):

  • Weekly iterative screening for cluster investigation;
  • Screening at D0 and D7 after a risk exposure.

Inpatients in ES:

  • Repeated weekly screening for cluster investigation;
  • Screening after exposure at risk at D0 with continued screening at D7 by RT-PCR on nasopharyngeal swab.

EMS residents:

  • Weekly iterative screening for cluster investigation;
  • Screening after a risk exposure on D0, maintaining screening on D7 by RT-PCR on a nasopharyngeal swab.

People caring for or visiting a relative living in an EMS:

  • In unvaccinated persons or those who have only received an incomplete Covid-19 vaccination protocol, saliva screening by RT-PCR, replacing the nasopharyngeal antigen test.

Prioritization of saliva screening:

  • if nasopharyngeal swabbing is not possible;
  • in case of iterative screening (investigation and cluster follow-up);
  • give preference to healthcare workers and EMS staff for iterative screening for cluster follow-up and exposure at risk to protect them, maintain staff resources, detect situations with epidemic potential quickly by improving the acceptability of samples.

As soon as capacities increase, the HCSP proposes to replace nasopharyngeal swabbing with salivary swabbing for the second swabbing at D7 for patients and residents, as well as for the screening of persons intervening or visiting a relative residing in EMS.

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