Transmissibility and Viral Load of SARS-CoV-2 in Oral Secretions

August 10, 2023 updated by: National Institute of Dental and Craniofacial Research (NIDCR)

Transmissibility and Viral Load of SARS-CoV-2 Through Oral Secretions

Background:

COVID-19 is a worldwide pandemic and currently there is no effective therapy or vaccine. SARS-CoV-2, the virus that causes the COVID-19 respiratory infection, appears to be very contagious however all the modes of transmission are unclear. Transmission may occur in up to 25 percent of cases when there are no symptoms (asymptomatic). Before there are any symptoms, droplet spray during speaking may increase transmission from person to person; most of the spray is saliva. Researchers at the NIH would like to test saliva for the virus before symptoms are reported. Additionally, they would like to examine the importance of using masks to prevent transmission. They hope to better understand how COVID-19 is spread among people and how it can be prevented. For this study they would like to collect samples from the nose (nasopharyngeal swab), mouth (spit sample), eye (conjunctival fluid) and blood to test for the virus and if it is contagious.

Objectives:

To determine if the SARS-CoV-2 virus is present in saliva in asymptomatic individuals who are COVID-19 positive. To determine if using masks can prevent transmission.

Eligibility:

People ages 18 and older without symptoms or with mild symptoms (e.g., low grade fever,

mild malaise, minor sore throat, runny nose, or sneezing) who have been in close contact (e.g. live in the same house) with someone who has tested positive for COVID-19 or people who have tested positive for COVID-19 and have mild (e.g., low grade fever, mild malaise, minor sore throat, runny nose, or sneezing) or no symptoms.

Design and Procedures:

For screening, interested participants will contact a study team member. The interested participant will be asked to provide documentation of COVID-19 positive status, their symptoms, or their contact to a COVID-19 positive person.

Participants will be asked to come to the NIH drive-up COVID-19 testing site or NIH Clinical Center (Bethesda, MD) for 2 or more visits in 15 days for the following procedures: nasal swab for COVID-19 and viral load, verbal symptom assessment, saliva collection, and speaking exercise to capture oral fluid. During this time, participants will also be asked to participate in phone calls with the study staff and to complete questionnaires electronically. Participants will have weekly telephone calls to discuss their symptoms and 2-5 drive-up visits to the NIH within 28 days. If visits are scheduled at the Clinical Center, participants will have the option to participate in providing blood sample(s), a conjunctival swab and 1-2 salivary gland biopsies.

If a participant has tested positive, they may be asked to return to the NIH after they have recovered from COVID-19 for additional sampling.

The following procedures are part of this research:

  • Speaking exercise - participants will be asked to read a short script with and without wearing a mask. The droplets they produce while they speak will be collected.
  • Saliva collection - participants will spit into a cup and have saliva collected from different areas of the mouth. They should not eat 90 minutes before this but drinking water or juice is acceptable. They may have their tongue painted with a sour liquid to increase their saliva.
  • Nasal swab- participants will have a swab rubbed inside their nose.
  • Nasopharyngeal swab - participants that are close contacts of COVID-19 positive individual(s) and need a COVID-19 test, will have a swab inserted through the nose to rub the back of their throat.
  • Questionnaires - participants will complete questionnaires about their symptoms electronically at home.

The following procedures are optional for participants to agree to participate in and will be performed in the Clinical Center:

  • Blood sample(s) - participants will have blood collection via venipuncture.
  • Conjunctival swab - participants will have the inner lower eyelid wiped with swab.
  • Minor salivary gland biopsy - participants will have tiny glands in mouth removed. Procedure will be done in the hospital.

Participants will be paid up to a total of $300 for the study, based on the number of visits to NIH and the types of procedures performed. Payment will be: $50 on Day 1, Day 15 and at the recovery visit. Participants who agree to the optional conjunctival swab and/or biopsy will be paid $50 for each conjunctival swab (up to 1) and/or $50 for each salivary biopsy (up to 2).

If at any time the participants start to have moderate or severe respiratory symptoms, their participation in the study will end and they should seek care with their local provider.

Study Overview

Status

Completed

Conditions

Detailed Description

COVID-19 is a worldwide pandemic without an effective therapy. A series of reports have implicated that asymptomatic transmission occurs in at least 25% SARS-CoV-2 cases. We hypothesize that droplet emission from oral fluids generated during speaking could be an important and actionable factor driving asymptomatic transmission. We aim to collect oral and nasal secretions, conjunctival fluid and blood to test for viral load and viral infectivity in 1) asymptomatic or mildly symptomatic high-risk subjects with unknown SARS-CoV-2 status, but with a history of close personal contact with a SARS-CoV-2 positive person and 2) asymptomatic or mildly symptomatic subjects who are SARS-CoV-2 positive. 3) COVID-19 positive individuals retesting as negative can be enrolled to complete the electronic questionnaire(s) assessment and allow for evaluation of history of symptoms. 4) COVID-19 positive individuals admitted to the NIH Clinical Center can be enrolled as a symptomatic comparison cohort.

Study Type

Observational

Enrollment (Actual)

55

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Maryland
      • Bethesda, Maryland, United States, 20892
        • National Institutes of Health Clinical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

1) asymptomatic high-risk subjects with known history of close personal contact with a COVID-19 positive person not tested (SARS-CoV2 status unknown)2) asymptomatic or mildly symptomatic (fever withoutcough, sneezing or shortness of breath) subjects who are COVID-19 positive 3) COVID-19 positive individuals retesting negative can be enrolled to complete the electronic questionnaire(s) assessment and allow evaluation of history of symptoms. 4) COVID-19 positive individuals enrolled and admitted to the NIH Clinical Center for other protocols.

Description

  • INCLUSION CRITERIA:

In order to be eligible to participate in this study, an individual must meet all the following criteria:

  1. Willing and able to sign and date the informed consent form
  2. Willing to comply with all study procedures and available for study visits and calls
  3. Male or female, aged >= 18 years of age
  4. Persons who test COVID-19 positive in past 48 hours (verbal confirmation followed by documented test results, sent electronically) and are asymptomatic or have mild symptoms (e.g., fever, mild malaise, sore throat or sneezing) individuals who have re-tested and are negative may be enrolled to understand progression and resolution of disease; persons hospitalized at the NIH Clinical Center meeting Inclusion Criteria 1-3 may be enrolled on this study
  5. Persons considered high risk for COVID-19 due to personal contact within the past 7 days with a COVID-19 positive individual (e.g., co-habitating family member of COVID-19 positive) and has no symptoms or mild symptoms of COVID-19 - verbal confirmation followed by documented test results of positive individual, sent electronically

EXCLUSION CRITERION:

An individual who meets any of the following criteria will be excluded from participation in this study:

1. COVID-19 positive subjects with active moderate or severe symptoms of cough or shortness of breath (upper and lower respiratory symptoms) or currently requiring hospitalization at a hospital other than NIH Clinical Center (recovering COVID-19 positive patients can be enrolled).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Group 1
asymptomatic or mildly symptomatic high-risk subjects with unknown SARS-CoV-2 status but with known history of close personal contact with a COVID-19 positive person.
Group 2
asymptomatic or mildly symptomatic (e.g., low grade fever, mild malaise, minor sore throat, runny nose, or sneezing) subjects who are COVID-19 positive.
Group 3
COVID-19 positive individuals retesting negative can be enrolled to complete the electronic questionnaire(s) and allow evaluation of history of symptoms.
Group 4
COVID-19 positive individuals enrolled and admitted to the NIH Clinical Center for other protocols.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
To determine SARS-CoV-2 viral load and infectivity insaliva that may contribute to asymptomatic transmission
detection of virus in saliva, blood and conjunctival fluid

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Institute of Dental and Craniofacial Research (NIDCR)

Investigators

  • Principal Investigator: Blake M Warner, D.D.S., National Institute of Dental and Craniofacial Research (NIDCR)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 16, 2020

Primary Completion (Actual)

December 15, 2021

Study Completion (Actual)

January 27, 2022

Study Registration Dates

First Submitted

April 15, 2020

First Submitted That Met QC Criteria

April 15, 2020

First Posted (Actual)

April 16, 2020

Study Record Updates

Last Update Posted (Actual)

August 14, 2023

Last Update Submitted That Met QC Criteria

August 10, 2023

Last Verified

August 7, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 200094
  • 20-D-0094

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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