Transmissibility of COVID-19 depends on the viral load around onset in adult and symptomatic patients.
Transmissibility of COVID-19 depends on the viral load around onset in adult and symptomatic patients.
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DOI：
10.1371/journal.pone.0243597
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Yamamoto Y
中科院分区：
文献类型：
--
作者：
Kawasuji H;Takegoshi Y;Kaneda M;Ueno A;Miyajima Y;Kawago K;Fukui Y;Yoshida Y;Kimura M;Yamada H;Sakamaki I;Tani H;Morinaga Y;Yamamoto Y
探讨2019新型冠状病毒病（COVID-19）病毒载量与二次传播的关系。从富山大学医院收治和/或测量病毒载量的免疫功能正常的实验室确诊的COVID-19患者中获得流行病学和临床数据。使用病例对照方法，将将疾病传播给至少一名其他患者的索引患者作为“病例”（索引患者）进行分析，并与不是继发性传播原因的患者（非索引患者，作为“对照”进行分析）进行比较。采用标准单相衰减模型，使用非线性回归评估索引和非索引症状患者之间的病毒载量时间进程。共有28例患者纳入分析。在初始样本采集时，有症状患者的中位病毒载量显著高于无症状患者，成人显著高于儿童。在有症状的患者（n = 18）中，非线性回归模型显示，索引患者发病时的估计病毒载量高于非索引患者（中位数[95%置信区间]：分别为6.6 [5.2-8.2]和3.1 [1.5-4.8] log拷贝/μL）。在成人（有症状和无症状）患者（n = 21）中，索引患者初始样本采集时的中位病毒载量显著高于非索引患者（p = 0.015，分别为3.3和1.8 log拷贝/μL）。发病前后高鼻咽病毒载量可能有助于COVID-19的二次传播。病毒载量可能有助于更好地了解为什么在某些情况下观察到传播，而在其他情况下，特别是在家庭接触者中观察不到传播。
To investigate the relationship between viral load and secondary transmission in novel coronavirus disease 2019 (COVID-19). Epidemiological and clinical data were obtained from immunocompetent laboratory-confirmed patients with COVID-19 who were admitted to and/or from whom viral loads were measured at Toyama University Hospital. Using a case-control approach, index patients who transmitted the disease to at least one other patient were analysed as “cases” (index patients) compared with patients who were not the cause of secondary transmission (non-index patients, analysed as “controls”). The viral load time courses were assessed between the index and non-index symptomatic patients using non-linear regression employing a standard one-phase decay model. In total, 28 patients were included in the analysis. Median viral load at the initial sample collection was significantly higher in symptomatic than in asymptomatic patients and in adults than in children. Among symptomatic patients (n = 18), non-linear regression models showed that the estimated viral load at onset was higher in the index than in the non-index patients (median [95% confidence interval]: 6.6 [5.2–8.2] vs. 3.1 [1.5–4.8] log copies/μL, respectively). In adult (symptomatic and asymptomatic) patients (n = 21), median viral load at the initial sample collection was significantly higher in the index than in the non-index patients (p = 0.015, 3.3 vs. 1.8 log copies/μL, respectively). High nasopharyngeal viral loads around onset may contribute to secondary transmission of COVID-19. Viral load may help provide a better understanding of why transmission is observed in some instances, but not in others, especially among household contacts.
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