Post by Nadica (She/Her) on Nov 24, 2024 1:13:50 GMT
Longitudinal Assessment of Solid Organ Transplant Recipients with SARS-CoV-2 Infection - Preprint Posted Nov 23, 2024
Abstract
Background: Compared to immunocompetent individuals, those who are immunocompromised, including solid organ transplant (SOT) recipients, have higher SARS-CoV-2-related morbidity and mortality. We determined the duration of SARS-CoV-2 RNA positivity to evaluate viral persistence in SOT recipients. Methods: This study prospectively followed SOT recipients who recently tested positive for SARS-CoV-2. The duration of viral RNA shedding in nasal swabs and stool samples was tracked, and viral genome sequencing was performed where possible. Persistent infection was defined as a positive nucleic acid amplification test (NAAT) for SARS-CoV-2 at 28 days or later after initial infection. This duration was chosen based on the CDC recommendation that immunocompromised individuals isolate for at least 20 days 1, compared to 10 days for non-immunocompromised individuals. Results: Of 30 SOT recipients, 12 (40%) had SARS-CoV-2 RNA in nasal swabs or stool 28 or more days after the first positive SARS-CoV-2 test. IC-015 had high viral loads (Ct<30) at 28 days, with continued detection for 54 days. Conclusion: In 12 of 30 SOT subjects, SARS-CoV-2 RNA was detected at or beyond 28 days post-detection (dpd), despite vaccination and antibody and/or antiviral treatment in most participants. Three subjects tested positive for SARS-CoV-2 RNA past 50 dpd. The CDC recommendation for 20 days of isolation may be insufficient for SOT recipients. Viral persistence in the setting of host immune suppression, coupled with exposure to antiviral treatments, raises concern about the selection of unusual viral variants.
Abstract
Background: Compared to immunocompetent individuals, those who are immunocompromised, including solid organ transplant (SOT) recipients, have higher SARS-CoV-2-related morbidity and mortality. We determined the duration of SARS-CoV-2 RNA positivity to evaluate viral persistence in SOT recipients. Methods: This study prospectively followed SOT recipients who recently tested positive for SARS-CoV-2. The duration of viral RNA shedding in nasal swabs and stool samples was tracked, and viral genome sequencing was performed where possible. Persistent infection was defined as a positive nucleic acid amplification test (NAAT) for SARS-CoV-2 at 28 days or later after initial infection. This duration was chosen based on the CDC recommendation that immunocompromised individuals isolate for at least 20 days 1, compared to 10 days for non-immunocompromised individuals. Results: Of 30 SOT recipients, 12 (40%) had SARS-CoV-2 RNA in nasal swabs or stool 28 or more days after the first positive SARS-CoV-2 test. IC-015 had high viral loads (Ct<30) at 28 days, with continued detection for 54 days. Conclusion: In 12 of 30 SOT subjects, SARS-CoV-2 RNA was detected at or beyond 28 days post-detection (dpd), despite vaccination and antibody and/or antiviral treatment in most participants. Three subjects tested positive for SARS-CoV-2 RNA past 50 dpd. The CDC recommendation for 20 days of isolation may be insufficient for SOT recipients. Viral persistence in the setting of host immune suppression, coupled with exposure to antiviral treatments, raises concern about the selection of unusual viral variants.