Timing and Predictors of Loss of Infectivity among Healthcare Workers with Primary and Recurrent COVID-19: a Prospective Observational Cohort Study

Stefka Dzieciolowska, H. Charest, Tonya Roy, J. Fafard, S. Carazo, I. Levade, Jean Longtin, Leighanne O. Parkes, Sylvie-Nancy Beaulac, J. Villeneuve, Patrice Savard, Jacques Corbeil, G. De Serres, Y. Longtin
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Abstract

Background: There is a need to understand the duration of infectivity of primary and recurrent COVID-19 and identify predictors of loss of infectivity. Methods: Prospective observational cohort study with serial viral culture, rapid antigen detection test (RADT) and RT-PCR on nasopharyngeal specimens of healthcare workers with COVID-19. The primary outcome was viral culture positivity as indicative of infectivity. Predictors of loss of infectivity were determined using multivariate regression model. The performance of the US CDC criteria (fever resolution, symptom improvement and negative RADT) to predict loss of infectivity was also investigated. Results: 121 participants (91 female [79.3%]; average age, 40 years) were enrolled. Most (n=107, 88.4%) had received [≥]3 SARS-CoV-2 vaccine doses, and 20 (16.5%) had COVID-19 previously. Viral culture positivity decreased from 71.9% (87/121) on day 5 of infection to 18.2% (22/121) on day 10. Participants with recurrent COVID-19 had a lower likelihood of infectivity than those with primary COVID-19 at each follow-up (day 5 OR, 0.14; p<0.001]; day 7 OR, 0.04; p=0.003]) and were all non-infective by day 10 (p=0.02). Independent predictors of infectivity included prior COVID-19 (adjusted OR [aOR] on day 5, 0.005; p=0.003), a RT-PCR Ct value <23 (aOR on day 5, 22.75; p<0.001), but not symptom improvement or RADT result. The CDC criteria would identify 36% (24/67) of all non-infectious individuals on Day 7. However, 17% (5/29) of those meeting all the criteria had a positive viral culture. Conclusions: Infectivity of recurrent COVID-19 is shorter than primary infections. Loss of infectivity algorithms could be optimized.
原发性和复发性COVID-19医护人员传染性丧失的时间和预测因素:一项前瞻性观察队列研究
背景:有必要了解原发性和复发性COVID-19的传染性持续时间,并确定传染性丧失的预测因素。方法:采用连续病毒培养、快速抗原检测(RADT)和RT-PCR对新型冠状病毒肺炎医护人员鼻咽标本进行前瞻性观察队列研究。主要结果是病毒培养阳性作为感染性的指示。使用多变量回归模型确定感染性丧失的预测因子。还研究了美国疾病控制与预防中心(CDC)标准(发热消退、症状改善和阴性RADT)预测传染性丧失的性能。结果:121例受试者(女性91例,占79.3%);平均年龄40岁)。大多数(n=107, 88.4%)接种过[≥]3剂SARS-CoV-2疫苗,20例(16.5%)既往感染过COVID-19。病毒培养阳性从感染第5天的71.9%(87/121)下降到第10天的18.2%(22/121)。在每次随访中,复发性COVID-19患者的感染可能性低于原发COVID-19患者(第5天OR, 0.14;p < 0.001);第7天OR为0.04;P =0.003]),第10天均无感染(P =0.02)。感染的独立预测因子包括既往COVID-19(第5天校正OR [aOR], 0.005;p=0.003), RT-PCR Ct值<23(第5天的aOR为22.75;p<0.001),但没有症状改善或RADT结果。疾病预防控制中心的标准将在第7天确定36%(24/67)的所有非传染性个体。然而,符合所有标准的人中有17%(5/29)的病毒培养呈阳性。结论:复发性COVID-19感染期短于原发感染期。传染性丧失算法可以优化。
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