TY - JOUR
T1 - Understanding viral shedding of severe acute respiratory coronavirus virus 2 (SARS-CoV-2)
T2 - Review of current literature
AU - Fontana, Lauren M.
AU - Villamagna, Angela Holly
N1 - Publisher Copyright:
© 2021 Infection Control and Hospital Epidemiology. All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - Objective: Transmission of SARS-CoV-2 has significant implications for hospital infection prevention and control, discharge management, and public health. We reviewed available literature to reach an evidenced-based consensus on the expected duration of viral shedding. Design: We queried 4 scholarly repositories and search engines for studies reporting SARS-CoV-2 viral shedding dynamics by PCR and/or culture available through September 8, 2020. We calculated the pooled median duration of viral RNA shedding from respiratory and fecal sources. Results: The review included 77 studies on SARS-CoV-2. All studies reported PCR-based testing and 12 also included viral culture data. Among 28 studies, the overall pooled median duration of RNA shedding from respiratory sources was 18.4 days (95% CI, 15.5-21.3; I2 = 98.87%; P <.01). When stratified by disease severity, the pooled median duration of viral RNA shedding from respiratory sources was 19.8 days (95% CI, 16.2-23.5; I2 = 96.42%; P <.01) among severely ill patients and 17.2 days (95% CI, 14.0-20.5; I2 = 95.64%; P <.01) in mild-To-moderate illness. Viral RNA was detected up to 92 days after symptom onset. Viable virus was isolated by culture from-6 to 20 days relative to symptom onset. Conclusions: SARS-COV-2 RNA shedding can be prolonged, yet high heterogeneity exists. Detection of viral RNA may not correlate with infectivity since available viral culture data suggests shorter durations of shedding of viable virus. Additional data are needed to determine the duration of shedding of viable virus and the implications for risk of transmission.
AB - Objective: Transmission of SARS-CoV-2 has significant implications for hospital infection prevention and control, discharge management, and public health. We reviewed available literature to reach an evidenced-based consensus on the expected duration of viral shedding. Design: We queried 4 scholarly repositories and search engines for studies reporting SARS-CoV-2 viral shedding dynamics by PCR and/or culture available through September 8, 2020. We calculated the pooled median duration of viral RNA shedding from respiratory and fecal sources. Results: The review included 77 studies on SARS-CoV-2. All studies reported PCR-based testing and 12 also included viral culture data. Among 28 studies, the overall pooled median duration of RNA shedding from respiratory sources was 18.4 days (95% CI, 15.5-21.3; I2 = 98.87%; P <.01). When stratified by disease severity, the pooled median duration of viral RNA shedding from respiratory sources was 19.8 days (95% CI, 16.2-23.5; I2 = 96.42%; P <.01) among severely ill patients and 17.2 days (95% CI, 14.0-20.5; I2 = 95.64%; P <.01) in mild-To-moderate illness. Viral RNA was detected up to 92 days after symptom onset. Viable virus was isolated by culture from-6 to 20 days relative to symptom onset. Conclusions: SARS-COV-2 RNA shedding can be prolonged, yet high heterogeneity exists. Detection of viral RNA may not correlate with infectivity since available viral culture data suggests shorter durations of shedding of viable virus. Additional data are needed to determine the duration of shedding of viable virus and the implications for risk of transmission.
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U2 - 10.1017/ice.2020.1273
DO - 10.1017/ice.2020.1273
M3 - Review article
C2 - 33077007
AN - SCOPUS:85095879272
SN - 0899-823X
VL - 42
SP - 659
EP - 668
JO - Infection control and hospital epidemiology
JF - Infection control and hospital epidemiology
IS - 6
ER -