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Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection.
J Med Virol. 2011 Jan; 83(1):5-9.JM

Abstract

Little is known about the kinetics of viral shedding of pandemic influenza A/H1N1 2009 virus. Influenza RNA, as a surrogate for viral clearance, was therefore measured on days 1, 5, 7, and 10 or more in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. A total of 72 patients who were admitted to hospital with confirmed pandemic influenza A/H1N1 2009 at a tertiary care hospital, Seoul, South Korea, between 1 September and 11 November 2009 were evaluated. The median duration of viral shedding, as assessed by RT-PCR, was 9 days, as determined by the Kaplan-Meier method. Patients who were positive by RT-PCR at their last assay, but who were discharged before the next RT-PCR test due to symptom improvement, were censored from the analysis. If such patients were included, with the assumption that they had negative viral status at discharge, the median duration of viral shedding was 5 days (interquartile range, 2-8 days). These calculations thus suggest that the true median duration of viral shedding is between 5 and 9 days. Univariate analysis showed that delayed administration of antiviral therapy and comorbidity were associated with slower viral clearance. Multivariate analysis showed that oseltamivir started after the first day of symptoms (OR 2.7, 95% CI 1.2-5.7) was associated independently with slower viral clearance. These findings indicate that, in about 50% of patients admitted to hospital with pandemic influenza A/H1N1 2009, virus can be positive as tested by RT-PCR on the eighth day after developing symptoms of influenza. The present findings also indicate that starting antiviral therapy within 24 hr of the onset of symptoms is associated with more rapid viral clearance.

Authors+Show Affiliations

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21108333

Citation

Na, Shin, et al. "Duration of Viral Shedding in Patients Admitted to Hospital With Pandemic Influenza A/H1N1 2009 Infection." Journal of Medical Virology, vol. 83, no. 1, 2011, pp. 5-9.
Na S, Chong YP, Kim MN, et al. Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. J Med Virol. 2011;83(1):5-9.
Na, S., Chong, Y. P., Kim, M. N., Kim, W. Y., Kim, W., Hong, S. B., Lim, C. M., Koh, Y., Kwon, J. W., Hong, S. J., Lee, S. O., Choi, S. H., Kim, Y. S., Woo, J. H., & Kim, S. H. (2011). Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. Journal of Medical Virology, 83(1), 5-9. https://doi.org/10.1002/jmv.21935
Na S, et al. Duration of Viral Shedding in Patients Admitted to Hospital With Pandemic Influenza A/H1N1 2009 Infection. J Med Virol. 2011;83(1):5-9. PubMed PMID: 21108333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duration of viral shedding in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. AU - Na,Shin, AU - Chong,Yong Pil, AU - Kim,Mi-Na, AU - Kim,Won Young, AU - Kim,Won, AU - Hong,Sang-Bum, AU - Lim,Chae-Man, AU - Koh,Younsuck, AU - Kwon,Ji-Won, AU - Hong,Soo-Jong, AU - Lee,Sang-Oh, AU - Choi,Sang-Ho, AU - Kim,Yang Soo, AU - Woo,Jun Hee, AU - Kim,Sung-Han, PY - 2010/11/26/entrez PY - 2010/11/26/pubmed PY - 2011/3/3/medline SP - 5 EP - 9 JF - Journal of medical virology JO - J. Med. Virol. VL - 83 IS - 1 N2 - Little is known about the kinetics of viral shedding of pandemic influenza A/H1N1 2009 virus. Influenza RNA, as a surrogate for viral clearance, was therefore measured on days 1, 5, 7, and 10 or more in patients admitted to hospital with pandemic influenza A/H1N1 2009 infection. A total of 72 patients who were admitted to hospital with confirmed pandemic influenza A/H1N1 2009 at a tertiary care hospital, Seoul, South Korea, between 1 September and 11 November 2009 were evaluated. The median duration of viral shedding, as assessed by RT-PCR, was 9 days, as determined by the Kaplan-Meier method. Patients who were positive by RT-PCR at their last assay, but who were discharged before the next RT-PCR test due to symptom improvement, were censored from the analysis. If such patients were included, with the assumption that they had negative viral status at discharge, the median duration of viral shedding was 5 days (interquartile range, 2-8 days). These calculations thus suggest that the true median duration of viral shedding is between 5 and 9 days. Univariate analysis showed that delayed administration of antiviral therapy and comorbidity were associated with slower viral clearance. Multivariate analysis showed that oseltamivir started after the first day of symptoms (OR 2.7, 95% CI 1.2-5.7) was associated independently with slower viral clearance. These findings indicate that, in about 50% of patients admitted to hospital with pandemic influenza A/H1N1 2009, virus can be positive as tested by RT-PCR on the eighth day after developing symptoms of influenza. The present findings also indicate that starting antiviral therapy within 24 hr of the onset of symptoms is associated with more rapid viral clearance. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/21108333/Duration_of_viral_shedding_in_patients_admitted_to_hospital_with_pandemic_influenza_A/H1N1_2009_infection_ L2 - https://doi.org/10.1002/jmv.21935 DB - PRIME DP - Unbound Medicine ER -