急性 SARS-CoV-2 感染的病毒动力学及其在诊断和公共卫生策略中的应用。

Viral dynamics of acute SARS-CoV-2 infection and applications to diagnostic and public health strategies.

机构信息

Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.

Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.

出版信息

PLoS Biol. 2021 Jul 12;19(7):e3001333. doi: 10.1371/journal.pbio.3001333. eCollection 2021 Jul.

Abstract

SARS-CoV-2 infections are characterized by viral proliferation and clearance phases and can be followed by low-level persistent viral RNA shedding. The dynamics of viral RNA concentration, particularly in the early stages of infection, can inform clinical measures and interventions such as test-based screening. We used prospective longitudinal quantitative reverse transcription PCR testing to measure the viral RNA trajectories for 68 individuals during the resumption of the 2019-2020 National Basketball Association season. For 46 individuals with acute infections, we inferred the peak viral concentration and the duration of the viral proliferation and clearance phases. According to our mathematical model, we found that viral RNA concentrations peaked an average of 3.3 days (95% credible interval [CI] 2.5, 4.2) after first possible detectability at a cycle threshold value of 22.3 (95% CI 20.5, 23.9). The viral clearance phase lasted longer for symptomatic individuals (10.9 days [95% CI 7.9, 14.4]) than for asymptomatic individuals (7.8 days [95% CI 6.1, 9.7]). A second test within 2 days after an initial positive PCR test substantially improves certainty about a patient's infection stage. The effective sensitivity of a test intended to identify infectious individuals declines substantially with test turnaround time. These findings indicate that SARS-CoV-2 viral concentrations peak rapidly regardless of symptoms. Sequential tests can help reveal a patient's progress through infection stages. Frequent, rapid-turnaround testing is needed to effectively screen individuals before they become infectious.

摘要

SARS-CoV-2 感染的特点是病毒增殖和清除阶段,并且可能伴随着低水平持续的病毒 RNA 脱落。病毒 RNA 浓度的动态变化,尤其是在感染的早期阶段,可以为临床措施和干预提供信息,如基于检测的筛查。我们使用前瞻性纵向定量逆转录聚合酶链反应检测,对 2019-2020 年 NBA 赛季恢复期间 68 名个体的病毒 RNA 轨迹进行了测量。对于 46 名急性感染个体,我们推断了病毒浓度峰值和病毒增殖及清除阶段的持续时间。根据我们的数学模型,我们发现病毒 RNA 浓度在循环阈值为 22.3(95%置信区间[CI]20.5,23.9)时,平均在首次可检测到的 3.3 天后(95%CI2.5,4.2)达到峰值。对于有症状的个体,病毒清除阶段持续时间更长(10.9 天[95%CI7.9,14.4]),而无症状个体持续时间更短(7.8 天[95%CI6.1,9.7])。在初次阳性 PCR 检测后 2 天内进行第二次检测,可以大大提高对患者感染阶段的确定性。旨在识别感染个体的检测的有效灵敏度会随着检测周转时间的延长而大幅下降。这些发现表明,无论是否有症状,SARS-CoV-2 病毒浓度都会迅速达到峰值。连续检测可以帮助揭示患者的感染阶段进展。在个体具有传染性之前,需要频繁、快速周转的检测来有效地对其进行筛查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c35/8297933/e5267d66156b/pbio.3001333.g001.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索