Walter Reed Army Institute of Research, Emerging Infectious Diseases Branch, Silver Spring, Maryland, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MarylandUSA.
J Infect Dis. 2022 Nov 11;226(10):1743-1752. doi: 10.1093/infdis/jiac198.
Laboratory screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key mitigation measure to avoid the spread of infection among recruits starting basic combat training in a congregate setting. Because viral nucleic acid can be detected persistently after recovery, we evaluated other laboratory markers to distinguish recruits who could proceed with training from those who were infected.
Recruits isolated for coronavirus disease 2019 (COVID-19) were serially tested for SARS-CoV-2 subgenomic ribonucleic acid (sgRNA), and viral load (VL) by reverse-transcriptase polymerase chain reaction (RT-PCR), and for anti- SARS-CoV-2. Cluster and quadratic discriminant analyses of results were performed.
Among 229 recruits isolated for COVID-19, those with a RT-PCR cycle threshold >30.49 (sensitivity 95%, specificity 96%) or having sgRNA log10 RNA copies/mL <3.09 (sensitivity and specificity 96%) at entry into isolation were likely SARS-CoV-2 uninfected. Viral load >4.58 log10 RNA copies/mL or anti-SARS-CoV-2 signal-to-cutoff ratio <1.38 (VL: sensitivity and specificity 93%; anti-SARS-CoV-2: sensitivity 83%, specificity 79%) had comparatively lower sensitivity and specificity when used alone for discrimination of infected from uninfected.
Orthogonal laboratory assays used in combination with RT-PCR may have utility in determining SARS-CoV-2 infection status for decisions regarding isolation.
实验室筛查严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是避免在集体环境中开始基础战斗训练的新兵中感染传播的关键缓解措施。由于病毒核酸在恢复后可被持续检测到，因此我们评估了其他实验室标志物，以区分可以继续训练的新兵和感染的新兵。
对因 2019 年冠状病毒病（COVID-19）而被隔离的新兵进行 SARS-CoV-2 亚基因组 RNA（sgRNA）和逆转录聚合酶链反应（RT-PCR）的病毒载量（VL）的连续检测，并检测抗 SARS-CoV-2。对结果进行聚类和二次判别分析。
在 229 名因 COVID-19 而被隔离的新兵中，那些 RT-PCR 循环阈值>30.49（灵敏度 95%，特异性 96%）或进入隔离时 sgRNA log10 RNA 拷贝/ml<3.09（灵敏度和特异性 96%）的新兵，可能未感染 SARS-CoV-2。病毒载量>4.58 log10 RNA 拷贝/ml 或抗 SARS-CoV-2 信号与阈值之比<1.38（VL：灵敏度和特异性 93%；抗 SARS-CoV-2：灵敏度 83%，特异性 79%）在单独用于区分感染与未感染时，灵敏度和特异性相对较低。
联合 RT-PCR 使用的正交实验室检测方法可能有助于确定 SARS-CoV-2 的感染状态，以做出隔离决策。
