Understanding viral shedding of severe acute respiratory coronavirus virus 2 (SARS-CoV-2): Review of current literature

Lauren M. Fontana, Angela Holly Villamagna

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations

Abstract

OBJECTIVE: Transmission of SARS-CoV-2 has significant implications for hospital infection prevention and control, discharge management, and public health. We reviewed available literature to reach an evidenced-based consensus on the expected duration of viral shedding.

DESIGN: We queried 4 scholarly repositories and search engines for studies reporting SARS-CoV-2 viral shedding dynamics by PCR and/or culture available through September 8, 2020. We calculated the pooled median duration of viral RNA shedding from respiratory and fecal sources.

RESULTS: The review included 77 studies on SARS-CoV-2. All studies reported PCR-based testing and 12 also included viral culture data. Among 28 studies, the overall pooled median duration of RNA shedding from respiratory sources was 18.4 days (95% CI, 15.5-21.3; I2 = 98.87%; P < .01). When stratified by disease severity, the pooled median duration of viral RNA shedding from respiratory sources was 19.8 days (95% CI, 16.2-23.5; I2 = 96.42%; P < .01) among severely ill patients and 17.2 days (95% CI, 14.0-20.5; I2 = 95.64%; P < .01) in mild-to-moderate illness. Viral RNA was detected up to 92 days after symptom onset. Viable virus was isolated by culture from -6 to 20 days relative to symptom onset.

CONCLUSIONS: SARS-COV-2 RNA shedding can be prolonged, yet high heterogeneity exists. Detection of viral RNA may not correlate with infectivity since available viral culture data suggests shorter durations of shedding of viable virus. Additional data are needed to determine the duration of shedding of viable virus and the implications for risk of transmission.

Original languageEnglish (US)
Pages (from-to)659-668
Number of pages10
JournalInfection Control and Hospital Epidemiology
Volume42
Issue number6
DOIs
StatePublished - Jun 2021

Bibliographical note

Funding Information:
No financial support was provided relevant to this article.

Publisher Copyright:
© 2021 Infection Control and Hospital Epidemiology. All rights reserved.

Keywords

  • COVID-19/transmission
  • Humans
  • RNA, Viral/metabolism
  • SARS-CoV-2/physiology
  • Time Factors
  • Virus Shedding

PubMed: MeSH publication types

  • Review
  • Journal Article

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