SARS-CoV-2 recurrent RNA positivity after recovering from coronavirus disease 2019 (COVID-19): a meta-analysis

Main Article Content

Camilla Mattiuzzi
Brandon M. Henry
Fabian Sanchis-Gomar
Giuseppe Lippi

Keywords

coronavirus, COVID-19, SARS-CoV-2, testing, recurrence

Abstract

Background and aim: Isolation of subjects with active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a pivotal preventive measure in the ongoing coronavirus disease 2019 (COVID-19) pandemic. A growing number of studies reported cases of recurrent SARS-CoV-2 RNA positivity following disease recovery, which were identified with a critical literature search and then meta-analyzed in this article. Materials and Methods: A digital search was performed in Medline and Web of Science, using the keywords “coronavirus disease 2019” OR “COVID-19” OR “severe acute respiratory disease 2” OR “SARS-CoV-2” AND “recurrence” OR “repositivization” OR “retesting”, without date or language restrictions. Recovery was defined as resolution of symptoms, with at least two consecutive negative molecular tests. Results: A total number of 17 studies, with 5,182 COVID-19 patients, were included. SARS-CoV-2 recurrent RNA positivity in recovered COVID-19 patients ranged between 7-23% across the studies, with follow-up testing between 1-60 days. The estimated cumulative rate of SARS-CoV-2 recurrent RNA positivity was 12% (95% confidence interval, 12-13%; I2, 74%). Conclusions: Repeated molecular testing on respiratory tracts specimens at 1 and 2 months after recovery from COVID-19 is strongly advisable for early identification, isolation and clinical management of subjects with SARS-CoV-2 recurrent RNA positivity.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 622 | PDF Downloads 231

References

1. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed 2020;91:157-160.
2. Khullar D, Bond AM, Schpero WL. COVID-19 and the Financial Health of US Hospitals. JAMA. 2020 May 4. doi: 10.1001/jama.2020.6269. Epub ahead of print.
3. Borak J. Airborne Transmission of COVID-19. Occup Med (Lond) 2020;70:297-299.
4. Shao S, Zhou D, He R, Li J, Zou S, Mallery K, Kumar S, Yang S, Hong J. Risk assessment of airborne transmission of COVID-19 by asymptomatic individuals under different practical settings. Version 2. ArXiv [Preprint]. 2020 Jul 7:arXiv:2007.03645v2.
5. Lippi G, Adeli K, Ferrari M, et al. Biosafety measures for preventing infection from COVID-19 in clinical laboratories: IFCC Taskforce Recommendations. Clin Chem Lab Med 2020;58:1053-1062.
6. Lippi G, Henry BM, Bovo C, Sanchis-Gomar F. Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19). Diagnosis (Berl) 2020;7:85-90
7. López L, Rodó X. The end of social confinement and COVID-19 re-emergence risk. Nat Hum Behav 2020;4:746-755.
8. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020;395:1973-1987.
9. Keeling MJ, Hollingsworth TD, Read JM. Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19). J Epidemiol Community Health. 2020 Jun 23:jech-2020-214051. doi: 10.1136/jech-2020-214051. Epub ahead of print.
10. Pradhan D, Biswasroy P, Kumar Naik P, Ghosh G, Rath G. A Review of Current Interventions for COVID-19 Prevention. Arch Med Res 2020;51:363-374.
11. Lippi G, Plebani M. Asymptomatic COVID-19 transmission: the importance of avoiding official miscommunication. Diagnosis (Berl). 2020 Jul 13. doi: 10.1515/dx-2020-0085. Epub ahead of print.
12. Foppiani A, Bertoli S, Battezzati A, Zuccotti G. Data to guide the application of the new WHO criteria for releasing COVID-19 patients from isolation. Pharmacol Res. 2020 Jul 11;160:105063. doi: 10.1016/j.phrs.2020.105063. Epub ahead of print
13. Abdullah MS, Chong PL, Asli R, et al. Post discharge positive re-tests in COVID-19: common but clinically non-significant. Infect Dis (Lond). 2020 Jun 24:1-3. doi: 10.1080/23744235.2020.1780309. Epub ahead of print.
14. Cento V, Colagrossi L, Nava A, et al. Persistent positivity and fluctuations of SARS-CoV-2 RNA in clinically-recovered COVID-19 patients. J Infect. 2020 Jun 20:S0163-4453(20)30405-9. doi: 10.1016/j.jinf.2020.06.024. Epub ahead of print.
15. Deng W, Guang TW, Yang M, et al. Positive results for patients with COVID-19 discharged form hospital in Chongqing, China. Version 2. BMC Infect Dis 2020;20:429.
16. Hao S, Lian J, Lu Y, et al. Decreased B Cells on Admission Associated With Prolonged Viral RNA Shedding From the Respiratory Tract in Coronavirus Disease 2019: A Case-Control Study. J Infect Dis 2020;222:367-371.
17. Hartman WR, Hess AS, Connor JP. Persistent viral RNA shedding after COVID-19 symptom resolution in older convalescent plasma donors. Transfusion. 2020 Jun 13:10.1111/trf.15927. doi: 10.1111/trf.15927. Epub ahead of print.
18. Hu R, Jiang Z, Gao H, et al. Recurrent Positive Reverse Transcriptase-Polymerase Chain Reaction Results for Coronavirus Disease 2019 in Patients Discharged From a Hospital in China. JAMA Netw Open 2020;3:e2010475.
19. Huang J, Zheng L, Li Z, et al. Recurrence of SARS-CoV-2 PCR positivity in COVID-19 patients: a single center experience and potential implications. MedRxiv 2020.05.06.20089573. Doi: 10.1101/2020.05.06.20089573.
20. Liu T, Wu S, Zeng G, et al. Recurrent positive SARS-CoV-2: Immune certificate may not be valid. J Med Virol. 2020 May 29:10.1002/jmv.26074. doi: 10.1002/jmv.26074. Epub ahead of print.
21. Tian M, Long Y, Hong Y, Zhang X, Zha Y. The treatment and follow-up of "recurrence" with discharged COVID-19 patients: Data from Guizhou, China. Environ Microbiol. 2020 Jul 6:10.1111/1462-2920.15156. doi: 10.1111/1462-2920.15156. Epub ahead of print.
22. Wang X, Xu H, Jiang H, et al. The Clinical Features and Outcomes of Discharged Coronavirus Disease 2019 PatientsA Prospective Cohort Study. QJM. 2020 May 22:hcaa178. doi: 10.1093/qjmed/hcaa178. Epub ahead of print.
23. Wu J, Liu X, Liu J, et al. Coronavirus Disease 2019 Test Results After Clinical Recovery and Hospital Discharge Among Patients in China. JAMA Netw Open 2020;3:e209759.
24. Xiao AT, Tong YX, Zhang S. False negative of RT-PCR and prolonged nucleic acid conversion in COVID-19: Rather than recurrence. J Med Virol. 2020 Apr 9:10.1002/jmv.25855. doi: 10.1002/jmv.25855. Epub ahead of print.
25. Ye G, Pan Z, Pan Y, et al. Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation. J Infect 2020;80:e14-e17.
26. Yuan B, Liu HQ, Yang ZR, et al. Recurrence of positive SARS-CoV-2 viral RNA in recovered COVID-19 patients during medical isolation observation. Sci Rep 2020;10:11887.
27. Yuan J, Kou S, Liang Y, Zeng J, Pan Y, Liu L. PCR Assays Turned Positive in 25 Discharged COVID-19 Patients. Clin Infect Dis. 2020 Apr 8:ciaa398. doi: 10.1093/cid/ciaa398. Epub ahead of print.
28. Zhu H, Fu L, Jin Y, et al. Clinical features of COVID-19 convalescent patients with re-positive nucleic acid detection. J Clin Lab Anal. 2020 Jun 7:e23392. doi: 10.1002/jcla.23392. Epub ahead of print.
29. Zou Y, Wang BR, Sun L, et al. The issue of recurrently positive patients who recovered from COVID-19 according to the current discharge criteria: investigation of patients from multiple medical institutions in Wuhan, China. J Infect Dis. 2020 Jun 3:jiaa301. doi: 10.1093/infdis/jiaa301. Epub ahead of print..
30. Lippi G, Henry BM, Sanchis-Gomar F, Mattiuzzi C. Updates on laboratory investigations in coronavirus disease 2019 (COVID-19). Acta BioMed. 2020 Jul 13;91(3): Epub ahead of print. Doi: 10.23750/abm.v91i3.10187.
31. Long QX, Tang XJ, Shi QL, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections. Nat Med. 2020 Jun 18. doi: 10.1038/s41591-020-0965-6. Epub ahead of print.
32. Ibarrondo FJ, Fulcher JA, Goodman-Meza D, et al. Rapid Decay of Anti–SARS-CoV-2 Antibodies in Persons with Mild Covid-19. N Engl J Med. Published online July 21, 2020. doi:10.1056/NEJMc2025179.
33. Tiwari M, Mishra D. Investigating the genomic landscape of novel coronavirus (2019-nCoV) to identify non-synonymous mutations for use in diagnosis and drug design. J Clin Virol 2020;128:104441.
34. Wang K, Zhang X, Sun J, et al. Differences of SARS-CoV-2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With COVID-19. Chest. 2020 Jun 20:S0012-3692(20)31718-9. doi: 10.1016/j.chest.2020.06.015. Epub ahead of print.
35. Clementi N, Ferrarese R, Tonelli M, et al. Lower nasopharyngeal viral load during the latest phase of COVID-19 pandemic in a Northern Italy University Hospital. Clin Chem Lab Med. 2020 Jun 29. doi: 10.1515/cclm-2020-0815. Epub ahead of print.
36. Muenchhoff M, Mairhofer H, Nitschko H, et al. Multicentre comparison of quantitative PCR-based assays to detect SARS-CoV-2, Germany, March 2020. Euro Surveill 2020;25:2001057.
37. Law SK, Leung AWN, Xu C. Is reinfection possible after recovery from COVID-19? Hong Kong Med J 2020;26:264-265.
38. Lippi G, Simundic AM, Plebani M. Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 2020;58:1070-1076.
39. Batisse D, Benech N, Botelho-Nevers E, et al. Clinical recurrences of COVID-19 symptoms after recovery: viral relapse, reinfection or inflammatory rebound? J Infect. 2020 Jun 30:S0163-4453(20)30454-0. doi: 10.1016/j.jinf.2020.06.073. Epub ahead of print.
40. Arvin AM, Fink K, Schmid MA, et al. A perspective on potential antibody-dependent enhancement of SARS-CoV-2. Nature. 2020 Jul 13. doi: 10.1038/s41586-020-2538-8. Epub ahead of print.

Most read articles by the same author(s)