Duration of SARS-CoV-2 RNA positivity from various specimens and clinical characteristics in patients with COVID-19: a systematic review and meta-analysis

Abstract

Background The duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA positivity will be important to prevent the spread of coronavirus disease 2019 (COVID-19). A systematic review and meta-analysis were conducted following PRISMA to determine the duration from several parts of the body and clinical characteristics affecting it. Main text PubMed, Web of Science, Scopus, and CENTRAL were searched for original studies reporting the duration from COVID-19 onset to the disappearance of viral RNA. Of the 1682 studies identified, 100 met the selection criteria and 13,431 patients were included in this study. The duration of SARS-CoV-2 RNA positivity was 18.29 [95% confidence interval: 17.00–19.89] days in the upper respiratory tract samples, 23.79 [20.43–27.16] days in the sputum, 14.60 [12.16–17.05] days in the blood, and 22.38 [18.40–26.35] days in the stool. Sensitivity analysis revealed that the duration was positively correlated with age, comorbidities, severity, and usage of glucocorticoid. Subgroup analysis indicated that the presence or absence of complications had the greatest impact on the difference in DSRP. Conclusions The duration of SARS-CoV-2 RNA positivity was 18.29 days in the upper respiratory tract samples. The duration in the sputum and the stool was longer, while that in the blood was shorter. The duration in the upper respiratory tract samples was longer in older, with any comorbidities, severer, and treated with glucocorticoid. These results provide the basic data for the duration of SARS-CoV-2 RNA positivity, and in the future, the effect of vaccination against SARS-CoV-2 and the SARS-CoV-2 variants on the duration of RNA positivity should be assessed.

SARS-CoV-2 Detection and Culture in Different Biological Specimens from Immunocompetent and Immunosuppressed COVID-19 Patients Infected with Two Different Viral Strains

“…As extensively described for numerous viral infections, both innate immunity and T cell-mediated adaptive immune response are essential for the clearance and long-term inhibition of viral infections [35,36]. It is also important to acknowledge that studies have associated the persistence of SARS-CoV-2 with severity of disease, the presence of comorbidities and use of glucocorticoids [38][39][40][41]. In our series of immunosuppressed patients, all were hospitalized with severe forms of COVID 19.…”

The effect of variation of individual infectiousness on SARS-CoV-2 transmission in households

“…Regarding the magnitude of viral shedding, studies report high variations of temporal viral shedding patterns among individuals ( He et al, 2020 ; Jones et al, 2021 ; Sun et al, 2022 ). In addition, the duration of viral shedding can be highly heterogeneous, with pooled estimates of mean durations ranging from 11.1 to 30.3 days, and almost all reviews reporting high heterogeneity of estimates ( Cevik et al, 2021 ; Chen et al, 2021b ; Díaz et al, 2022 ; Fontana et al, 2021 ; Li et al, 2020b ; Okita et al, 2022 ; Qutub et al, 2022 ; Rahmani et al, 2022 ; Xu et al, 2020 ; Yan et al, 2021 ; Zhang et al, 2021 ). Such heterogeneities still exist in subgroup analyses by age and severity ( Cevik et al, 2021 ; Fontana et al, 2021 ; Okita et al, 2022 ; Qutub et al, 2022 ; Rahmani et al, 2022 ; Xu et al, 2020 ; Yan et al, 2021 ).…”

“…In addition, the duration of viral shedding can be highly heterogeneous, with pooled estimates of mean durations ranging from 11.1 to 30.3 days, and almost all reviews reporting high heterogeneity of estimates ( Cevik et al, 2021 ; Chen et al, 2021b ; Díaz et al, 2022 ; Fontana et al, 2021 ; Li et al, 2020b ; Okita et al, 2022 ; Qutub et al, 2022 ; Rahmani et al, 2022 ; Xu et al, 2020 ; Yan et al, 2021 ; Zhang et al, 2021 ). Such heterogeneities still exist in subgroup analyses by age and severity ( Cevik et al, 2021 ; Fontana et al, 2021 ; Okita et al, 2022 ; Qutub et al, 2022 ; Rahmani et al, 2022 ; Xu et al, 2020 ; Yan et al, 2021 ). The infectious period, proxied by duration of replicant competent virus isolation, is also heterogeneous ( Rahmani et al, 2022 ; Appendix 1—table 14 ).…”

The effect of variation of individual infectiousness on SARS-CoV-2 transmission in households

“…Regarding the magnitude of viral shedding, studies report high variations of temporal viral shedding patterns among individuals (38)(39)(40). In addition, the duration of viral shedding can be highly heterogeneous, with pooled estimates of mean durations ranging from 11.1 days to 30.3 days, and almost all reviews report high heterogeneity of estimates identified from literatures (37,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Such heterogeneities still exist in subgroup analyses by age and severity (37,(41)(42)(43)(44)(45)50).…”

“…In addition, the duration of viral shedding can be highly heterogeneous, with pooled estimates of mean durations ranging from 11.1 days to 30.3 days, and almost all reviews report high heterogeneity of estimates identified from literatures (37,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Such heterogeneities still exist in subgroup analyses by age and severity (37,(41)(42)(43)(44)(45)50). Also, the infectious period, proxied by duration of replicant competent virus isolation, is also heterogeneous (50).…”