Department of Medicine, University of Minnesota Infectious Diseases and International Medicine, Minneapolis, MN, USA.
Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Infect Control Hosp Epidemiol. 2021 Jun;42(6):659-668. doi: 10.1017/ice.2020.1273. Epub 2020 Oct 20.
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.
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.
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.
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.
SARS-CoV-2 的传播对医院感染防控、出院管理和公共卫生具有重要意义。我们查阅了现有文献，就病毒脱落的预期持续时间达成了基于证据的共识。
我们在 2020 年 9 月 8 日之前，通过 4 个学术知识库和搜索引擎查询了报道 SARS-CoV-2 病毒脱落动力学的研究，这些研究通过 PCR 和/或培养进行。我们计算了从呼吸道和粪便来源中病毒 RNA 脱落的汇总中位数持续时间。
该综述包括 77 项关于 SARS-CoV-2 的研究。所有研究均报告了基于 PCR 的检测，其中 12 项研究还包括病毒培养数据。在 28 项研究中，呼吸道来源的 RNA 脱落的总体汇总中位数持续时间为 18.4 天（95%CI，15.5-21.3；I²=98.87%；P<.01）。按疾病严重程度分层，严重患者呼吸道来源的病毒 RNA 脱落的汇总中位数持续时间为 19.8 天（95%CI，16.2-23.5；I²=96.42%；P<.01），轻度至中度疾病患者为 17.2 天（95%CI，14.0-20.5；I²=95.64%；P<.01）。在症状出现后，可检测到病毒 RNA 长达 92 天。通过培养从症状出现前 6 天到 20 天可分离到有活力的病毒。
SARS-CoV-2 RNA 脱落可能延长，但存在高度异质性。由于目前的病毒培养数据表明有活力的病毒脱落持续时间较短，因此检测到病毒 RNA 可能与传染性无关。需要更多的数据来确定有活力的病毒脱落的持续时间及其对传播风险的影响。
