Transmissibility and viral replication of SARS‐COV‐2 in immunocompromised patients

Abstract

Most of the available data are for the immunocompetent population, and the duration of live-virus shedding and transmissibility is well-understood in this population. However, the date regarding infectiousness and shedding of SARS-CoV-2 in the immunocompromised patients is scarce, with no specific guidelines regarding the isolation precautions of these patients. We summarized the findings of all the available studies published until now regarding transmissibility and replication of SARS-CoV-2 in immunosuppressed patients. Studies that reported data regarding viral shedding and replication from respiratory samples (oropharynx or nasopharynx) in immunosuppressed adults with COVID-19 were included. A total of 21 studies, including 69 patients (mean age 52.2 years, and 62.3% males) were included. All patients had persistently positive RT-PCR for > 3 weeks, with median duration of 50.5 days (Interquartile range [IQR] 35-74 days. Five studies[3-7] (including nine patients) reported positive viral cultures with median time of 26 days (IQR 19-94.5). Two studies[7, 8] (including eight patients) reported detecting sub-genomic RNA (sg-RNA) with median duration of 59 days (IQR 29-78). Our review emphasizes the prolonged RT-PCR positivity and viral replication of SAR-CoV-2 in the immunosuppressed population. Our review highlights the importance of close follow-up and prolonged isolation precautions in immunosuppressed patients with persistently positive SARS-CoV-2 RT-PCR. Since viral culture may not be readily available, it may be reasonable to employ sg-RNA as an additional tool for detecting the infectious virus. Further studies with larger sample sizes are needed to evaluate the SARS-CoV-2 shedding and sg-RNA correlation to viral cultures in immunocompromised patients. This article is protected by copyright. All rights reserved.