持续的 SARS-CoV-2 RNA 脱落而无传染性证据：一项 COVID-19 患者的队列研究。
Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: A Cohort Study of Individuals With COVID-19.
机构信息
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
J Infect Dis. 2021 Oct 28;224(8):1362-1371. doi: 10.1093/infdis/jiab107.
BACKGROUND
To better understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding and infectivity, we estimated SARS-CoV-2 RNA shedding duration, described participant characteristics associated with the first negative rRT-PCR test (resolution), and determined if replication-competent viruses was recoverable ≥10 days after symptom onset.
METHODS
We collected serial nasopharyngeal specimens from 109 individuals with rRT-PCR-confirmed COVID-19 in Utah and Wisconsin. We calculated viral RNA shedding resolution probability using the Kaplan-Meier estimator and evaluated characteristics associated with shedding resolution using Cox proportional hazards regression. We attempted viral culture for 35 rRT-PCR-positive nasopharyngeal specimens collected ≥10 days after symptom onset.
RESULTS
The likelihood of viral RNA shedding resolution at 10 days after symptom onset was approximately 3%. Time to shedding resolution was shorter among participants aged <18 years (adjusted hazards ratio [aHR], 3.01; 95% confidence interval [CI], 1.6-5.6) and longer among those aged ≥50 years (aHR, 0.50; 95% CI, .3-.9) compared to participants aged 18-49 years. No replication-competent viruses were recovered.
CONCLUSIONS
Although most patients were positive for SARS-CoV-2 for ≥10 days after symptom onset, our findings suggest that individuals with mild to moderate COVID-19 are unlikely to be infectious ≥10 days after symptom onset.
背景
为了更好地了解严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的脱落和传染性，我们估计了 SARS-CoV-2 RNA 的脱落持续时间，描述了与首次 rRT-PCR 检测阴性（分辨率）相关的参与者特征，并确定在症状出现后≥10 天是否可以恢复具有复制能力的病毒。
方法
我们从犹他州和威斯康星州的 109 名经 rRT-PCR 确诊的 COVID-19 患者中收集了一系列鼻咽标本。我们使用 Kaplan-Meier 估计器计算了病毒 RNA 脱落分辨率的概率，并使用 Cox 比例风险回归评估了与脱落分辨率相关的特征。我们尝试对≥10 天症状出现后收集的 35 份 rRT-PCR 阳性鼻咽标本进行病毒培养。
结果
症状出现后 10 天内病毒 RNA 脱落分辨率的可能性约为 3%。年龄<18 岁的参与者（调整后的危险比[aHR]，3.01；95%置信区间[CI]，1.6-5.6）和年龄≥50 岁的参与者（aHR，0.50；95% CI，0.3-0.9）与 18-49 岁的参与者相比，病毒脱落分辨率的时间更短。没有恢复具有复制能力的病毒。
结论
尽管大多数患者在症状出现后≥10 天仍为 SARS-CoV-2 阳性，但我们的发现表明，轻度至中度 COVID-19 患者在症状出现后≥10 天不太可能具有传染性。
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