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Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.
To, Kelvin Kai-Wang; Tsang, Owen Tak-Yin; Leung, Wai-Shing; Tam, Anthony Raymond; Wu, Tak-Chiu; Lung, David Christopher; Yip, Cyril Chik-Yan; Cai, Jian-Piao; Chan, Jacky Man-Chun; Chik, Thomas Shiu-Hong; Lau, Daphne Pui-Ling; Choi, Chris Yau-Chung; Chen, Lin-Lei; Chan, Wan-Mui; Chan, Kwok-Hung; Ip, Jonathan Daniel; Ng, Anthony Chin-Ki; Poon, Rosana Wing-Shan; Luo, Cui-Ting; Cheng, Vincent Chi-Chung; Chan, Jasper Fuk-Woo; Hung, Ivan Fan-Ngai; Chen, Zhiwei; Chen, Honglin; Yuen, Kwok-Yung.
  • To KK; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The Uni
  • Tsang OT; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Leung WS; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Tam AR; Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
  • Wu TC; Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.
  • Lung DC; Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.
  • Yip CC; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Cai JP; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chan JM; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Chik TS; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Lau DP; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Choi CY; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
  • Chen LL; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chan WM; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chan KH; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Ip JD; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Ng AC; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Poon RW; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Luo CT; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Cheng VC; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chan JF; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The Uni
  • Hung IF; Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chen Z; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Chen H; State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
  • Yuen KY; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. Electronic address: kyyuen@hku.hk.
Lancet Infect Dis ; 20(5): 565-574, 2020 05.
Article in English | MEDLINE | ID: covidwho-14173
Semantic information from SemMedBD (by NLM)
1. Borg Category-Ratio 10 Perceived Exertion Score 5 PROCESS_OF Community
Subject
Borg Category-Ratio 10 Perceived Exertion Score 5
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PROCESS_OF
Object
Community
2. Respiratory Tract Infections CAUSES Discomfort
Subject
Respiratory Tract Infections
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CAUSES
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Discomfort
3. COVID-19 PROCESS_OF Patients
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COVID-19
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PROCESS_OF
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Patients
4. Patients LOCATION_OF saliva
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Patients
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LOCATION_OF
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saliva
5. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Persons
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American College of Cardiology/American Heart Association Lesion Complexity Score C
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PROCESS_OF
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Persons
6. Infectious disease prevention / control USES Antiviral Agents
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Infectious disease prevention / control
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USES
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Antiviral Agents
7. Reverse Transcriptase Polymerase Chain Reaction METHOD_OF Diagnosis
Subject
Reverse Transcriptase Polymerase Chain Reaction
Predicate
METHOD_OF
Object
Diagnosis
8. Borg Category-Ratio 10 Perceived Exertion Score 5 PROCESS_OF Community
Subject
Borg Category-Ratio 10 Perceived Exertion Score 5
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PROCESS_OF
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Community
9. Respiratory Tract Infections CAUSES Discomfort
Subject
Respiratory Tract Infections
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CAUSES
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Discomfort
10. COVID-19 PROCESS_OF Patients
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COVID-19
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PROCESS_OF
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Patients
11. Patients LOCATION_OF saliva
Subject
Patients
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LOCATION_OF
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saliva
12. American College of Cardiology/American Heart Association Lesion Complexity Score C PROCESS_OF Persons
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
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PROCESS_OF
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Persons
13. Infectious disease prevention / control USES Antiviral Agents
Subject
Infectious disease prevention / control
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USES
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Antiviral Agents
14. Reverse Transcriptase Polymerase Chain Reaction METHOD_OF Diagnosis
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Diagnosis
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) causes severe community and nosocomial outbreaks. Comprehensive data for serial respiratory viral load and serum antibody responses from patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not yet available. Nasopharyngeal and throat swabs are usually obtained for serial viral load monitoring of respiratory infections but gathering these specimens can cause discomfort for patients and put health-care workers at risk. We aimed to ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses.

METHODS:

We did a cohort study at two hospitals in Hong Kong. We included patients with laboratory-confirmed COVID-19. We obtained samples of blood, urine, posterior oropharyngeal saliva, and rectal swabs. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). Antibody levels against the SARS-CoV-2 internal nucleoprotein (NP) and surface spike protein receptor binding domain (RBD) were measured using EIA. Whole-genome sequencing was done to identify possible mutations arising during infection.

FINDINGS:

Between Jan 22, 2020, and Feb 12, 2020, 30 patients were screened for inclusion, of whom 23 were included (median age 62 years [range 37-75]). The median viral load in posterior oropharyngeal saliva or other respiratory specimens at presentation was 5·2 log10 copies per mL (IQR 4·1-7·0). Salivary viral load was highest during the first week after symptom onset and subsequently declined with time (slope -0·15, 95% CI -0·19 to -0·11; R2=0·71). In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load (Spearman's ρ=0·48, 95% CI 0·074-0·75; p=0·020). For 16 patients with serum samples available 14 days or longer after symptom onset, rates of seropositivity were 94% for anti-NP IgG (n=15), 88% for anti-NP IgM (n=14), 100% for anti-RBD IgG (n=16), and 94% for anti-RBD IgM (n=15). Anti-SARS-CoV-2-NP or anti-SARS-CoV-2-RBD IgG levels correlated with virus neutralisation titre (R2>0·9). No genome mutations were detected on serial samples.

INTERPRETATION:

Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers. Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic. This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for high-risk individuals. Serological assay can complement RT-qPCR for diagnosis.

FUNDING:

Richard and Carol Yu, May Tam Mak Mei Yin, The Shaw Foundation Hong Kong, Michael Tong, Marina Lee, Government Consultancy Service, and Sanming Project of Medicine.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Saliva / Coronavirus Infections / Betacoronavirus / Antibodies, Viral Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Saliva / Coronavirus Infections / Betacoronavirus / Antibodies, Viral Type of study: Diagnostic study / Etiology study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article