Health and Me

Rachel V Thomas

WHO Recommends Tongue Swabs For Faster Tuberculosis Diagnosis, Curbing Transmission

In a significant breakthrough for faster diagnosis of <a href="https://www.healthandme.com/health/tuberculosis">tuberculosis</a> -- the world’s most infectious disease --, the World Health Organization (WHO) has recommended tongue swab tests.

The new recommendations come as many people with TB do not produce sputum, but are contributing to transmission. The swab tests may not only expand access to testing but also enable early and timely treatment that can help break chains of TB transmission.

The updated guidance also includes recommendations for the use of near point-of-care molecular tests - the nucleic acid amplification tests (NPOC-NAATs) for <a href="https://www.healthandme.com/health/drug-resistant-tb">drug-resistant TB</a> and pooling of sputa as a diagnostic strategy for the initial detection of TB and drug resistance.

“The WHO has just issued recommendations on new near-point-of-care (NPOC) tests for the diagnosis of #TB; easy-to-collect tongue swab samples to expand access to testing; &amp; a cost-saving sputum pooling strategy to increase testing efficiency for TB &amp; RR-TB,” Tereza Kasaeva, Director - WHO department on HIV, Tuberculosis, Hepatitis, in a post on social media platform X. 

“These new recommendations mark a major step toward making #TB testing faster and more accessible,” she said, while calling on countries to roll out the guidelines to close diagnostic gaps. 

Tongue swabs are new, readily available, and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB, with and without drug resistance. 

The global health body recommends using the low-complexity automated NAATs as initial diagnostic tests in adults and adolescents with signs and symptoms of lung TB. 

However, in cases where respiratory samples such as sputum (expectorated or induced), tracheal aspirate, and bronchoalveolar lavage (BAL) cannot be obtained, tongue swabs may be used as initial diagnostic tests for TB.

Tongue swabs may be collected by trained personnel or self-collected with guidance from trained personnel. 

Dr Rakesh PS, from the International Union Against Tuberculosis and Lung Disease (The Union), in a LinkedIn post mentioned individuals having no or minimal symptoms, and often cannot present respiratory specimens.

"Tongue swabs offer a practical way to include this otherwise “missed” group in the diagnostic pathway. By enabling testing of individuals who would otherwise be excluded, tongue swab–based testing can enhance the efficiency of active systematic screening," Dr. Rakesh said.

"Tongue swabs are a strategic alternative when obtaining a respiratory specimen is difficult or not possible -- and, when used appropriately, they can strengthen our fight against TB," he added. 

NPOC-NAATs are swab-based molecular tests for TB detection that can produce results from a primary sputum or tongue swab sample in less than one hour. These tests use instruments that can be battery-operated and do not require specialized infrastructure for use or storage. 

The tests can be done in basic peripheral laboratories, such as those that perform smear microscopy, and health clinics, mobile units, or community sites that do not have laboratories. 

They can be performed by health care workers with basic technical skills because they do not require laboratory methods like precision pipetting. 

In sputum pooling, samples from several individuals are mixed and tested together. It is a proven strategy to improve testing efficiency and reduce costs in resource-constrained environments.

While being preventable and curable, TB remains a top infectious killer, with an estimated 10.7 to 10.8 million new cases and 1.23–1.25 million deaths in 2024, as per WHO.

The infectious disease disproportionately affects low- and middle-income countries. 

While TB incidence rates have shown a slight, uneven decline since 2015, the overall burden remains high, with 30 countries accounting for 87 percent of global cases, led by India, Indonesia, China, the Philippines, and Pakistan. 

Health Conditions A-Z

health

Tuberculosis

Drug-resistant TB

tongue swab tests

sputum

World Health Organization

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In a significant breakthrough for faster diagnosis of tuberculosis -- the world’s most infectious disease --, the World Health Organization (WHO) has recommended tongue swab tests. The new recommendations come as many people with TB do not produce sputum, but are contributing to transmission. The swab tests may not only expand access to testing but also enable early and timely treatment that can help break chains of TB transmission.The updated guidance also includes recommendations for the use of near point-of-care molecular tests - the nucleic acid amplification tests (NPOC-NAATs) for drug-resistant TB and pooling of sputa as a diagnostic strategy for the initial detection of TB and drug resistance. “The WHO has just issued recommendations on new near-point-of-care (NPOC) tests for the diagnosis of #TB; easy-to-collect tongue swab samples to expand access to testing; & a cost-saving sputum pooling strategy to increase testing efficiency for TB & RR-TB,” Tereza Kasaeva, Director - WHO department on HIV, Tuberculosis, Hepatitis, in a post on social media platform X.  “These new recommendations mark a major step toward making #TB testing faster and more accessible,” she said, while calling on countries to roll out the guidelines to close diagnostic gaps.  What Are Tongue Swabs Tongue swabs are new, readily available, and easy-to-collect specimens for use with NPOC-NAATs and low-complexity automated NAATs (LC-aNAATs) for the initial detection of TB, with and without drug resistance.  The global health body recommends using the low-complexity automated NAATs as initial diagnostic tests in adults and adolescents with signs and symptoms of lung TB. However, in cases where respiratory samples such as sputum (expectorated or induced), tracheal aspirate, and bronchoalveolar lavage (BAL) cannot be obtained, tongue swabs may be used as initial diagnostic tests for TB.Tongue swabs may be collected by trained personnel or self-collected with guidance from trained personnel.  Dr Rakesh PS, from the International Union Against Tuberculosis and Lung Disease (The Union), in a LinkedIn post mentioned individuals having no or minimal symptoms, and often cannot present respiratory specimens. "Tongue swabs offer a practical way to include this otherwise “missed” group in the diagnostic pathway. By enabling testing of individuals who would otherwise be excluded, tongue swab–based testing can enhance the efficiency of active systematic screening," Dr. Rakesh said."Tongue swabs are a strategic alternative when obtaining a respiratory specimen is difficult or not possible -- and, when used appropriately, they can strengthen our fight against TB," he added. What Are NPOC-NAATsNPOC-NAATs are swab-based molecular tests for TB detection that can produce results from a primary sputum or tongue swab sample in less than one hour. These tests use instruments that can be battery-operated and do not require specialized infrastructure for use or storage. The tests can be done in basic peripheral laboratories, such as those that perform smear microscopy, and health clinics, mobile units, or community sites that do not have laboratories. They can be performed by health care workers with basic technical skills because they do not require laboratory methods like precision pipetting. What Is Sputa Pooling  In sputum pooling, samples from several individuals are mixed and tested together. It is a proven strategy to improve testing efficiency and reduce costs in resource-constrained environments.Global TB burdenWhile being preventable and curable, TB remains a top infectious killer, with an estimated 10.7 to 10.8 million new cases and 1.23–1.25 million deaths in 2024, as per WHO.The infectious disease disproportionately affects low- and middle-income countries. While TB incidence rates have shown a slight, uneven decline since 2015, the overall burden remains high, with 30 countries accounting for 87 percent of global cases, led by India, Indonesia, China, the Philippines, and Pakistan.  