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SARS-CoV-2 detection, viral load and infectivity over the course of an infection.
J Infect. 2020 09; 81(3):357-371.JI

Abstract

OBJECTIVES

To summarise the evidence on the detection pattern and viral load of SARS-CoV-2 over the course of an infection (including any asymptomatic or pre-symptomatic phase), and the duration of infectivity.

METHODS

A systematic literature search was undertaken in PubMed, Europe PubMed Central and EMBASE from 30 December 2019 to 12 May 2020.

RESULTS

We identified 113 studies conducted in 17 countries. The evidence from upper respiratory tract samples suggests that the viral load of SARS-CoV-2 peaks around symptom onset or a few days thereafter, and becomes undetectable about two weeks after symptom onset; however, viral loads from sputum samples may be higher, peak later and persist for longer. There is evidence of prolonged virus detection in stool samples, with unclear clinical significance. No study was found that definitively measured the duration of infectivity; however, patients may not be infectious for the entire duration of virus detection, as the presence of viral ribonucleic acid may not represent transmissible live virus.

CONCLUSION

There is a relatively consistent trajectory of SARS-CoV-2 viral load over the course of COVID-19 from respiratory tract samples, however the duration of infectivity remains uncertain.

Authors+Show Affiliations

Health Information and Quality Authority, Smithfield, Dublin 7, Ireland. Electronic address: kiwalsh@hiqa.ie.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland; Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland; Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, James Street, Dublin 8, Ireland.Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

32615199

Citation

Walsh, Kieran A., et al. "SARS-CoV-2 Detection, Viral Load and Infectivity Over the Course of an Infection." The Journal of Infection, vol. 81, no. 3, 2020, pp. 357-371.
Walsh KA, Jordan K, Clyne B, et al. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect. 2020;81(3):357-371.
Walsh, K. A., Jordan, K., Clyne, B., Rohde, D., Drummond, L., Byrne, P., Ahern, S., Carty, P. G., O'Brien, K. K., O'Murchu, E., O'Neill, M., Smith, S. M., Ryan, M., & Harrington, P. (2020). SARS-CoV-2 detection, viral load and infectivity over the course of an infection. The Journal of Infection, 81(3), 357-371. https://doi.org/10.1016/j.jinf.2020.06.067
Walsh KA, et al. SARS-CoV-2 Detection, Viral Load and Infectivity Over the Course of an Infection. J Infect. 2020;81(3):357-371. PubMed PMID: 32615199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 detection, viral load and infectivity over the course of an infection. AU - Walsh,Kieran A, AU - Jordan,Karen, AU - Clyne,Barbara, AU - Rohde,Daniela, AU - Drummond,Linda, AU - Byrne,Paula, AU - Ahern,Susan, AU - Carty,Paul G, AU - O'Brien,Kirsty K, AU - O'Murchu,Eamon, AU - O'Neill,Michelle, AU - Smith,Susan M, AU - Ryan,Máirín, AU - Harrington,Patricia, Y1 - 2020/06/29/ PY - 2020/06/17/received PY - 2020/06/23/revised PY - 2020/06/26/accepted PY - 2020/7/3/pubmed PY - 2020/8/29/medline PY - 2020/7/3/entrez KW - COVID-19 KW - Coronavirus KW - Infectivity KW - RNA KW - Review KW - SARS-CoV-2 KW - Viral load SP - 357 EP - 371 JF - The Journal of infection JO - J Infect VL - 81 IS - 3 N2 - OBJECTIVES: To summarise the evidence on the detection pattern and viral load of SARS-CoV-2 over the course of an infection (including any asymptomatic or pre-symptomatic phase), and the duration of infectivity. METHODS: A systematic literature search was undertaken in PubMed, Europe PubMed Central and EMBASE from 30 December 2019 to 12 May 2020. RESULTS: We identified 113 studies conducted in 17 countries. The evidence from upper respiratory tract samples suggests that the viral load of SARS-CoV-2 peaks around symptom onset or a few days thereafter, and becomes undetectable about two weeks after symptom onset; however, viral loads from sputum samples may be higher, peak later and persist for longer. There is evidence of prolonged virus detection in stool samples, with unclear clinical significance. No study was found that definitively measured the duration of infectivity; however, patients may not be infectious for the entire duration of virus detection, as the presence of viral ribonucleic acid may not represent transmissible live virus. CONCLUSION: There is a relatively consistent trajectory of SARS-CoV-2 viral load over the course of COVID-19 from respiratory tract samples, however the duration of infectivity remains uncertain. SN - 1532-2742 UR - https://www.unboundmedicine.com/medline/citation/32615199/SARS_CoV_2_detection_viral_load_and_infectivity_over_the_course_of_an_infection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(20)30449-7 DB - PRIME DP - Unbound Medicine ER -