The Natural History and Transmission Potential of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection
The Natural History and Transmission Potential of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection
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DOI：
10.1093/cid/ciaa711
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发表时间：
2020-11-15
影响因子：
11.8
通讯作者：
Le Van Tan
中科院分区：
文献类型：
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作者：
Nguyen Van Vinh Chau;Vo Thanh Lam;Le Van Tan
背景。对无症状严重急性呼吸综合征冠状病毒2型（SARSCoV-2）感染的自然病史了解甚少。我们在越南胡志明市2019冠状病毒病检疫中心进行了一项前瞻性研究。我们招募了经逆转录聚合酶链反应（RT-PCR）确诊的SARS-CoV-2感染的隔离人群，收集了临床资料、旅行和接触史、入组时的唾液和每日鼻咽/咽喉拭子（nts）用于RT-PCR检测。我们比较了无症状和有症状个体的自然病史和传播潜力。2020年3月10日至4月4日期间，14000名被隔离的人接受了SARS-CoV-2检测；49个是积极的。其中，30人参加了这项研究：13人（43%）从未有症状，17人（57%）有症状。17例（57%）参与者输入性病例。与有症状者相比，无症状者在入组时收集的NTS中检测到SARS-CoV-2的可能性较低（8/13 [62%]vs 17/17 [100%]; P = .02）。27份唾液样本中有20份（74%）检测到SARS-CoV-2 RNA（无症状组11份中有7份[64%]，有症状组16份中有13份[81%]，P = 0.56）。RT-PCR阳性概率分析显示，无症状组的病毒清除速度快于有症状组（前19天差异P < 0.001）。这种差异在随访的第一周最为明显。两名无症状个体似乎将SARS-CoV-2传播给了4名接触者。无症状的SARS-CoV-2感染很常见，可以通过唾液或NTSs分析检测到。NTS病毒载量在无症状的个体中下降得更快，但这些个体似乎能够将病毒传播给他人。
Background. Little is known about the natural history of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection.Methods. We conducted a prospective study at a quarantine center for coronavirus disease 2019 in Ho Chi Minh City, Vietnam. We enrolled quarantined people with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, collecting clinical data, travel and contact history, and saliva at enrollment and daily nasopharyngeal/throat swabs (NTSs) for RT-PCR testing. We compared the natural history and transmission potential of asymptomatic and symptomatic individuals.Results. Between 10 March and 4 April 2020, 14 000 quarantined people were tested for SARS-CoV-2; 49 were positive. Of these, 30 participated in the study: 13 (43%) never had symptoms and 17 (57%) were symptomatic. Seventeen (57%) participants imported cases. Compared with symptomatic individuals, asymptomatic people were less likely to have detectable SARS-CoV-2 in NTS collected at enrollment (8/13 [62%] vs 17/17 [100%]; P = .02). SARS-CoV-2 RNA was detected in 20 of 27 (74%) available saliva samples (7 of 11 [64%] in the asymptomatic group and 13 of 16 [81%] in the symptomatic group; P = .56). Analysis of RT-PCR positivity probability showed that asymptomatic participants had faster viral clearance than symptomatic participants (P < .001 for difference over the first 19 days). This difference was most pronounced during the first week of follow-up. Two of the asymptomatic individuals appeared to transmit SARS-CoV-2 to 4 contacts.Conclusions. Asymptomatic SARS-CoV-2 infection is common and can be detected by analysis of saliva or NTSs. The NTS viral loads fall faster in asymptomatic individuals, but these individuals appear able to transmit the virus to others.