Duration of SARS-CoV-2 shedding: A population-based, Canadian study.
Duration of SARS-CoV-2 shedding: A population-based, Canadian study.
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DOI：
10.1371/journal.pone.0252217
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Groome PA
中科院分区：
文献类型：
--
作者：
Phillips SP;Wei X;Kwong JC;Gubbay J;Schwartz KL;Majury A;Groome PA
关于SARS-CoV-2脱落的持续时间及其在不同护理环境中的变异性以及年龄、性别、收入和合并症的差异性，存在证据差距。这些证据是理解传染性和再感染的一部分。我们使用一个基于人群的健康管理数据集来检查病毒脱落的直接措施。加拿大安大略的实验室和社会人口数据库被链接，以确定在2020年1月15日至4月30日期间检测阳性（RT-PCR）的人，他们在2020年5月31日之前接受了后续检测。为了最大限度地利用现有数据，我们计算了两个脱落持续时间估计值，定义为初始阳性和最近一次阳性（记录的脱落）或两次阴性检测（记录的消退）之间的时间。我们还报告了使用分位数回归来检查亚组差异的多变量结果。在安大略，在2020年4月30日之前检测呈阳性的16，595人中，有6604人进行了足够的后续检测，可以计算脱落持续时间。4，889例（29%/16，595例）患者记录的脱落中位持续时间为19天（IQR 12-28）。在3，219例（16，595例中的19%）患者中计算的记录的消退中位持续时间为25天（IQR 18-34）。使用两种定义，长期护理住院医师的排泌持续时间长3-5天。在那些生活在高收入社区的人中观察到记录的脱落持续时间较短，为2-4天。在20-49岁人群中，在25%的分布中观察到记录的缓解持续时间较短，为2-3天。只有11.5%的最终阴性检测结果在第14天恢复为阴性状态。在这一庞大的基于人群的COVID-19群体中，病毒脱落持续时间远远超过14天，长期护理居民和生活在不太富裕社区的居民的病毒脱落时间更长。我们的研究结果并没有说明感染的持续时间，但对于理解RT-PCR阳性的预期持续时间和识别再感染是有用的。
There is an evidence gap regarding the duration of SARS-CoV-2 shedding and of its variability across different care settings and by age, sex, income, and co-morbidities. Such evidence is part of understanding of infectivity and reinfection. We examine direct measures of viral shedding using a linked population-based health administrative dataset. Laboratory and sociodemographic databases for Ontario, Canada were linked to identify those testing positive (RT-PCR) between Jan. 15 and April 30, 2020 who underwent subsequent testing by May 31, 2020. To maximise use of available data, we computed two shedding duration estimates defined as the time between initial positive and most recent positive (documented shedding) or second of two negative tests (documented resolution). We also report multivariable results using quantile regression to examine subgroup differences. In Ontario, of the 16,595 who tested positive before April 30, 2020, 6604 had sufficient subsequent testing to allow shedding duration calculation. Documented shedding median duration calculated in 4,889 (29% of 16,595) patients was 19 days (IQR 12–28). Documented resolution median duration calculated in 3,219 (19% of the 16,595) patients was 25 days (IQR 18–34). Long-term care residents had 3–5 day longer shedding durations using both definitions. Shorter documented shedding durations of 2–4 days were observed in those living in higher income neighbourhoods. Shorter documented resolution durations of 2–3 days were observed at the 25th% of the distribution in those aged 20–49. Only 11.5% of those with definitive negative test results reverted to negative status by day 14. Viral shedding continued well beyond 14 days among this large subset of a population-based group with COVID-19, and longer still for long-term care residents and those living in less affluent neighborhoods. Our findings do not speak to duration of infectivity but are useful for understanding the expected duration of RT-PCR positivity and for identifying reinfection.
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