Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19)
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Abstract
Key questions in COVID-19 are the duration and determinants of infectious virus shedding. Here, we report that infectious virus shedding is detected by virus cultures in 23 of the 129 patients (17.8%) hospitalized with COVID-19. The median duration of shedding infectious virus is 8 days post onset of symptoms (IQR 5–11) and drops below 5% after 15.2 days post onset of symptoms (95% confidence interval (CI) 13.4–17.2). Multivariate analyses identify viral loads above 7 log 10 RNA copies/mL (odds ratio [OR] of 14.7 (CI 3.57-58.1; p < 0.001) as independently associated with isolation of infectious SARS-CoV-2 from the respiratory tract. A serum neutralizing antibody titre of at least 1:20 (OR of 0.01 (CI 0.003-0.08; p < 0.001) is independently associated with non-infectious SARS-CoV-2. We conclude that quantitative viral RNA load assays and serological assays could be used in test-based strategies to discontinue or de-escalate infection prevention and control precautions.
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In hospitalized patients, a serum neutralizing antibody titer of at least 1:20 was independently associated with the absence of shedding of infectious SARS-CoV-2.
“In hospitalized patients, we have previously shown that a serum neutralizing antibody titer of at least 1:20 was independently associated with the absence of shedding of infectious SARS-CoV-2 (46).”
From SARS-CoV-2 variants of concern partially escape humoral but not T cell responses in COVID-19 convalescent donors and vaccine recipients (2021) · cites this paper as [46]
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- Authors
- van Kampen, J. J. A., van de Vijver, D. A. M. C., Fraaij, P. L. A., Haagmans, B. L., Lamers, M. M., Okba, N., van den Akker, J. P. C., Endeman, H., Gommers, D. A. M. P. J., Cornelissen, J. J., Hoek, R. A. S., van der Eerden, M. M., Hesselink, D. A., Metselaar, H. J., Verbon, A., de Steenwinkel, J. E. M., Aron, G. I., van Gorp, E. C. M., van Boheemen, S., Voermans, J. C., Boucher, C. A. B., Molenkamp, R., Koopmans, M. P. G., Geurtsvankessel, C., & van der Eijk, A. A.
- Affiliations
- Erasmus MC (NL)
- ORCID
- Venue
- Nature Communications
- Published
- 2021-01-11
- Volume
- 12
- Issue
- 1
- Pages
- 267-267
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC7801729
- OpenAlex
- W3118873013
- Cited by
- 838
- References
- 27
- Citations by year
- 2026: 19 · 2025: 31 · 2024: 59 · 2023: 101 · 2022: 221 · 2021: 316 · 2020: 91
- FWCI
- 55.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- medRxiv (acceptedVersion)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- British Heart Foundation
- European Commission (201413, 601456, 223004)
- Eesti Teadusagentuur (IUT20-60, 2014-2020, IUT24-6, PUT1660, IUT2-4)
- Nierstichting
- National Institutes of Health
- Centers for Disease Control and Prevention
- Biotechnology and Biological Sciences Research Council
- European Regional Development Fund (2014-2020’)
- H2020 European Research Council (771057)
- FP7 Ideas: European Research Council (269045, 284167, 230374)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Keywords
- COVID-19 pandemic, SARS-CoV-2, viral shedding duration, viral load, neutralizing antibodies, viral culture, hospitalized patients, infection control, respiratory tract
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Testing, Aged, Female, Humans, Male, Middle Aged, Respiratory System, RNA, Viral, Multivariate Analysis, Odds Ratio, Virus Shedding, Viral Load
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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