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  • Review Article
  • Published:

Asymptomatic viruses detectable in saliva in the first year of life: a narrative review

Pediatric Research volume 95, pages 508–531 (2024)Cite this article

Abstract

Viral infections are common in children. Many can be asymptomatic or have delayed health consequences. In view of increasing availability of point-of-care viral detection technologies, with possible application in newborn screening, this review aimed to (1) identify potentially asymptomatic viruses detectable in infants under one year old, via saliva/nasopharyngeal swab, and (2) describe associations between viruses and long-term health conditions. We systematically searched Embase(Ovid), Medline(Ovid) and PubMed, then further searched the literature in a tiered approach. From the 143 articles included, 28 potentially asymptomatic viruses were identified. Our second search revealed associations with a range of delayed health conditions, with most related to the severity of initial symptoms. Many respiratory viruses were linked with development of recurrent wheeze or asthma. Of note, some potentially asymptomatic viruses are linked with later non-communicable diseases: adenovirus serotype 36 and obesity, Enterovirus-A71 associated Hand, Foot, Mouth Disease and Attention-Deficit Hyperactivity Disorder, Ebstein Barr Virus (EBV) and malignancy, EBV and multiple sclerosis, HHV-6 and epilepsy, HBoV-1 and lung fibrosis and Norovirus and functional gastrointestinal disorders. Our review identified many potentially asymptomatic viruses, detectable in early life with potential delayed health consequences, that could be important to screen for in the future using rapid point-of-care viral detection methods.

Impact

  • Novel point-of-care viral detection technologies enable rapid detection of viruses, both old and emerging. In view of increasing capability to screen for viruses, this is the first review to explore which potentially asymptomatic viruses, that are detectable using saliva and/or nasopharyngeal swabs in infants less than one year of age, are associated with delayed adverse health conditions. Further research into detecting such viruses in early life and their delayed health outcomes may pave new ways to prevent non-communicable diseases in the future.

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Fig. 1: PRISMA flowchart of Aim 1 literature search.
Fig. 2: World Map figure showing countries/regions of included studies.

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Data availability

All data generated or analysed during this study are included in this published article (and its supplementary information files).

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Acknowledgements

We thank Ms Poh Chua for her assistance designing the search strategy.

Funding

This student project did not receive any funding. Research at the Murdoch Children’s Research Institute is supported by the Victorian government’s Operational Infrastructure Support Programme. A/Prof Sung was supported by a Melbourne Children’s Clinician Scientist Fellowship 2021. A/Prof Sung and Dr Gillespie were funded by a National Health and Medical Research Council (NHMRC) Clinical Trails and Cohort Studies grant (2006491). The authors have no conflicts of interest to declare.

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Author notes

  1. These authors contributed equally: Melody Goh, Charissa Joy.

Authors and Affiliations

  1. Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia

    Melody Goh

  2. Prevention Innovation, Murdoch Children’s Research Institute, Parkville, VIC, Australia

    Melody Goh, Charissa Joy, Alanna N. Gillespie, Qi Rui Soh, Fan He & Valerie Sung

  3. Monash Children’s Hospital Clayton, Clayton, VIC, Australia

    Charissa Joy & Valerie Sung

  4. Centre for Community Child Health, The Royal Children’s Hospital, Parkville, VIC, Australia

    Alanna N. Gillespie

  5. The University of Melbourne, Faculty of Medicine Dentistry and Health Sciences Melbourne, Melbourne, VIC, Australia

    Qi Rui Soh

  6. John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, VIC, Australia

    Fan He

  7. Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia

    Valerie Sung

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Contributions

M.G., C.J., A.N.G., Q.S. and F.H. contributed to the acquisition and presentation of data. M.G., Q.S. and F.H. performed the literature search for aim 1 and contributed to the acquisition of data. C.J. performed the literature search for aim 2, and together with A.N.G., contributed to the presentation of this data. M.G., A.N.G. and Q.S. contributed to data presentation. A.N.G. and V.S. supervised the data collection and interpretation processes. V.S. conceptualised the study. M.G. drafted the initial draft of the manuscript and revised the manuscript following author input. All authors critically reviewed the manuscript for intellectual content and approved the final version of the manuscript prior to submission.

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Correspondence to Valerie Sung.

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Goh, M., Joy, C., Gillespie, A.N. et al. Asymptomatic viruses detectable in saliva in the first year of life: a narrative review. Pediatr Res 95, 508–531 (2024). https://doi.org/10.1038/s41390-023-02952-0

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