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Volume 39 Issue 6
December 2024

    . doi: 10.1016/j.virs.2024.10.001
    Citation: Jingwen Ai, Jiaxin Zhou, Yang Li, Feng Sun, Shijia Ge, Haocheng Zhang, Yanpeng Wu, Yan Wang, Yilin Zhang, Hongyu Wang, Jianpeng Cai, Xian Zhou, Sen Wang, Rong Li, Zhen Feng, Xiangyanyu Xu, Xuemei Yan, Yuchen Zhao, Juanjuan Zhang, Hongjie Yu, Wenhong Zhang. Viral load dynamics in asymptomatic and symptomatic patients during Omicron BA.2 outbreak in Shanghai, China, 2022: A longitudinal cohort study .VIROLOGICA SINICA, 2024, 39(6) : 851-859.  http://dx.doi.org/10.1016/j.virs.2024.10.001
    shu

    2022年中国上海Omicron BA.2疫情期间无症状和有症状患者的病毒载量动态变化：一项纵向队列研究

    cstr: 32224.14.j.virs.2024.10.001

    • a. 复旦大学附属华山医院, 国家传染病医学中心, 感染科, 上海市传染病与生物安全应急响应重点实验室, 上海 200433;

    • b. 复旦大学公共卫生学院, 公共卫生安全教育部重点实验室, 上海 200433;

    • c. 上海华申微生物与感染研究所, 上海 200050

    • SARS-CoV-2病毒，尤其是Omicron BA.2变异株在2022年导致上海的大规模疫情暴发。然而，Omicron感染后不同临床严重程度病人的病毒载量变化尚不清楚。本研究通过前瞻性队列研究纳入了2022年3月23日至5月15日期间中上海三家医院收治的48,830名COVID-19住院患者。我们利用RT-PCR的循环阈值（Ct 值）作为病毒载量的替代指标进行了系统性核酸检测。我们按临床严重程度分析了病毒排出的动力学特征，并确定了相关风险因素。研究共包含31.06%的无症状病例、67.66%的轻中度病例、1.00%的重症病例和0.29%的危重及死亡病例。入院时，57%的患者检测结果为阳性，病毒载量峰值出现在第4天（Ct值中位数为27.5），随后开始下降，平均病毒排出时间（VST）为6.1天（四分位距为4.0-8.8天）。尽管病毒载量因年龄和临床严重程度不同而存在差异，但Ct值峰值出现的时间相近。未接种疫苗、年龄超过60岁以及患有高血压、肾病（透析和肾移植）、神经系统疾病、风湿病和精神疾病的患者峰值病毒载量升高和VST延长。无症状病例在检测后6天内的具有传染性的概率为40%，轻中度和重症病例的症状消退后仍具有传染性的概率分别为27%和>50%。这些发现表明，初始Ct值可作为严重预后的预测指标。未接种疫苗且患有特定并发症的老年人是高病毒载量和较长病毒排出时间的高风险群体。

    Viral load dynamics in asymptomatic and symptomatic patients during Omicron BA.2 outbreak in Shanghai, China, 2022: A longitudinal cohort study

    • a. Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China;

    • b. School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200433, China;

    • c. Shanghai Huashen Institute of Microbes and Infections, Shanghai 200050, China

    • The SARS-CoV-2 virus, particularly the Omicron BA.2 variant, led to a significant surge in Shanghai, 2022. However, the viral load dynamic in Omicron infections with varying clinical severities remain unclear. This prospective cohort included 48,830 hospitalized coronavirus disease 2019 (COVID-19) patients across three hospitals in Shanghai, China, between 23 March and 15 May, 2022. Systematic nucleic acid testing was performed using RT-PCR Cycle threshold (Ct) value as a proxy of viral load. We analyzed the kinetic characteristics of viral shedding by clinical severity and identified associated risk factors. The study comprised 31.06% asymptomatic cases, 67.66% mild-moderate cases, 1.00% severe cases, 0.29% critical and fatal cases. Upon admission, 57% of patients tested positive, with peak viral load observed at 4 days (median Ct value 27.5), followed by a decrease and an average viral shedding time (VST) of 6.1 days (Interquartile range, 4.0–8.8 days). Although viral load exhibited variation by age and clinical severity, peak Ct values occurred at similar times. Unvaccinated status, age exceeding 60, and comorbidities including hypertension, renal issues kidney dialysis and kidney transplantation, neurological disorders, rheumatism, and psychotic conditions were found to correlate with elevated peak viral load and extended VST. Asymptomatic cases demonstrated a 40% likelihood of contagiousness within 6 days of detection, while mild-moderate and severe cases exhibited post-symptom resolution infectious probabilities of 27% and over 50%, respectively. These findings revealed that the initial Ct values serve as a predictive indicator of severe outcomes. Unvaccinated elderly individuals with particular comorbidities are at high-risk for elevated viral load and prolonged VST.
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      Viral load dynamics in asymptomatic and symptomatic patients during Omicron BA.2 outbreak in Shanghai, China, 2022: A longitudinal cohort study

        Corresponding author: Hongjie Yu, yhj@fudan.edu.cn
        Corresponding author: Wenhong Zhang, zhangwenhong@fudan.edu.cn
      • a. Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200433, China;
      • b. School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai 200433, China;
      • c. Shanghai Huashen Institute of Microbes and Infections, Shanghai 200050, China
      • Received Date: 31 January 2024
      • Accepted Date: 08 October 2024

      Abstract: The SARS-CoV-2 virus, particularly the Omicron BA.2 variant, led to a significant surge in Shanghai, 2022. However, the viral load dynamic in Omicron infections with varying clinical severities remain unclear. This prospective cohort included 48,830 hospitalized coronavirus disease 2019 (COVID-19) patients across three hospitals in Shanghai, China, between 23 March and 15 May, 2022. Systematic nucleic acid testing was performed using RT-PCR Cycle threshold (Ct) value as a proxy of viral load. We analyzed the kinetic characteristics of viral shedding by clinical severity and identified associated risk factors. The study comprised 31.06% asymptomatic cases, 67.66% mild-moderate cases, 1.00% severe cases, 0.29% critical and fatal cases. Upon admission, 57% of patients tested positive, with peak viral load observed at 4 days (median Ct value 27.5), followed by a decrease and an average viral shedding time (VST) of 6.1 days (Interquartile range, 4.0–8.8 days). Although viral load exhibited variation by age and clinical severity, peak Ct values occurred at similar times. Unvaccinated status, age exceeding 60, and comorbidities including hypertension, renal issues kidney dialysis and kidney transplantation, neurological disorders, rheumatism, and psychotic conditions were found to correlate with elevated peak viral load and extended VST. Asymptomatic cases demonstrated a 40% likelihood of contagiousness within 6 days of detection, while mild-moderate and severe cases exhibited post-symptom resolution infectious probabilities of 27% and over 50%, respectively. These findings revealed that the initial Ct values serve as a predictive indicator of severe outcomes. Unvaccinated elderly individuals with particular comorbidities are at high-risk for elevated viral load and prolonged VST.

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