Kamegai Kohei, Itoh Naoya, Ishikane Masahiro, Iwamoto Noriko, Asai Yusuke, Akazawa-Kai Nana, Fuwa Noriko, Takasaki Jin, Hojo Masayuki, Hangaishi Akira, Togano Tomiteru, Teruya Katsuji, Takahashi Kenichiro, Miyamoto Sho, Hirata Yuichiro, Kanno Takayuki, Saito Tomoya, Katano Harutaka, Suzuki Tadaki, Ohmagari Norio
Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, 162-8655, Tokyo, Japan.
Division of Infectious Diseases, Aichi Cancer Center Hospital, Aichi, Japan; Department of Infectious Diseases, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan; Nagoya City University East Medical Center, Aichi, Japan; Department of Clinical Infectious Diseases, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan.
J Infect Chemother. 2025 Apr;31(4):102631. doi: 10.1016/j.jiac.2025.102631. Epub 2025 Jan 21.
The duration of viral shedding and criteria for de-isolation in the hospital among immunocompromised patients with coronavirus disease 2019 (COVID-19) remain unclear. This study aimed to evaluate viral shedding duration in immunocompromised patients infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2.
A prospective cohort study was performed at 2 tertiary medical centers in Japan during the Omicron epidemic waves from July 2022 to January 2023. Nasopharyngeal swabs were serially collected from immunocompromised patients with COVID-19, including those with hematological malignancies, solid tumors, autoimmune diseases, and human immunodeficiency virus infection. Patients were classified as severely or moderately immunocompromised according to the Japanese national guidelines for tixagevimab-cilgavimab. The relationship between patient characteristics, immune status, duration of viral RNA presence, and infectious virus shedding were assessed using Mann-Whitney U and Fisher's exact tests.
Among 41 patients (163 samples), 9 (47 samples) were severely and 32 (116 samples) were moderately immunocompromised. In the severely and moderately immunocompromised groups, 87.2 % and 75.0 % of the samples were viral RNA-positive, while 36.2 % and 35.3 % were culture-positive, respectively. Five culture-positive samples after day 20 were from 2 severely immunocompromised patients on B cell depletion therapy. No culture-positive samples were found for the moderately immunocompromised patients after day 10.
Long-term viral shedding should be closely monitored in severely immunocompromised patients with COVID-19.
2019冠状病毒病（COVID-19）免疫功能低下患者的病毒 shedding 持续时间及医院解除隔离标准仍不明确。本研究旨在评估感染严重急性呼吸综合征冠状病毒2奥密克戎变异株的免疫功能低下患者的病毒 shedding 持续时间。
在2022年7月至2023年1月奥密克戎流行期间，于日本2家三级医疗中心进行了一项前瞻性队列研究。对COVID-19免疫功能低下患者，包括血液系统恶性肿瘤、实体瘤、自身免疫性疾病和人类免疫缺陷病毒感染患者，连续采集鼻咽拭子。根据日本替沙格韦单抗-西加韦单抗国家指南，将患者分为严重或中度免疫功能低下。采用Mann-Whitney U检验和Fisher精确检验评估患者特征、免疫状态、病毒RNA存在持续时间和传染性病毒 shedding 之间的关系。
41例患者（163份样本）中，9例（47份样本）为严重免疫功能低下，32例（116份样本）为中度免疫功能低下。在严重和中度免疫功能低下组中，分别有87.2%和75.0%的样本病毒RNA呈阳性，而培养阳性率分别为36.2%和35.3%。第20天后的5份培养阳性样本来自2例接受B细胞耗竭治疗的严重免疫功能低下患者。中度免疫功能低下患者在第10天后未发现培养阳性样本。
对于COVID-19严重免疫功能低下患者，应密切监测长期病毒 shedding 情况。
