SARS-CoV-2 late shedding may be infectious between immunocompromised hosts

Kaila, Ville; Sirkeoja, Simo; Blomqvist, Soile; Rannikko, Juha; Viskari, Hanna; Lyly-Yrjänäinen, Tiina; Syrjänen, Jaana

doi:10.1080/23744235.2021.1939891

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…In addition, they may transmit viral infection after they are considered to be no longer infectious, as shown by a case report in which transmission from one immunocompromised patient to another occurred on day 28 of illness. 99 The public health implications for society are that they are potential transmitters of a virus that may have undergone mutations during its long tenure in that individual, under the influence of associated therapeutics that may have been received. 100 To stem the spread of new variants arising in such circumstances, it is imperative to devise effective ways of treating these patients and achieving viral clearance.…”

Section: Persistent Positivitymentioning

confidence: 99%

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Avery

2022

Transplantation

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Major changes have occurred in therapeutics for coronavirus-19 (COVID-19) infection over the past 12–18 mo, most notably in early outpatient therapy. In most cases, solid organ transplant recipients were not included in the original clinical trials of these agents, so studies of real-world outcomes have been important in building our understanding of their utility. This review examines what is known about clinical outcomes in solid organ transplant recipients with newer therapies. SARS-CoV-2 monoclonal antibodies for early treatment or prophylaxis have likely prevented many hospitalizations and deaths. In addition, convalescent plasma, the oral drugs nirmatrelvir/ritonavir and molnupiravir, remdesivir for early outpatient treatment, anti-inflammatory therapy, and investigational virus-specific T-cell therapy will be discussed. Finally, the later consequences of COVID-19, such as secondary infections, long COVID symptoms, and persistent active infection, are identified as areas for future research.

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Section: Persistent Positivitymentioning

confidence: 99%

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Avery

2022

Transplantation

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“…However, in immunocompromised patients, mortality is generally higher, and in patients asymptomatic or post-recovery, prolonged RT-PCR positivity and virus isolation have been reported (2,3). These risks appear to be higher in patients receiving anti-CD20 therapy (4). In this report, we describe a patient with symptomatic COVID-19 which persisted for nine months, and with which he had been infected during anti-CD20 therapy for follicular lymphoma.…”

mentioning

confidence: 83%

Casirivimab/Imdevimab for Active COVID-19 Pneumonia Which Persisted for Nine Months in a Patient with Follicular Lymphoma during Anti-CD20 Therapy

et al. 2022

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Immunocompromised patients are more likely to develop severe COVID-19, and exhibit high mortality. It is also hypothesized that chronic infection in these patients can be a risk factor for developing new variants. We describe a patient with prolonged active infection of COVID-19 who became infected during treatment with an anti-CD20 antibody (obinutuzumab) for follicular lymphoma. This patient had persistent RT-PCR positivity and live virus isolation for nine months despite treatment with remdesivir and other potential antiviral therapies. The computed tomography image of the chest showed that the viral pneumonia repeatedly appeared and disappeared in different lobes, as if a new infection had occurred continuously. The patient's SARS-CoV-2 antibody titer was negative throughout the illness, even after two doses of the BNT162b2 mRNA vaccine were administered in the seventh month of infection. A combination of monoclonal antibody therapy against COVID-19 (casirivimab and imdevimab) and antivirals resulted in negative RT-PCR results, and the virus was no longer isolated. The patient was clinically cured. During the 9-month active infection period, no fixed mutations in the spike (S) protein were detected, and the in vitro susceptibility to remdesivir was retained. Therapeutic administration of anti-SARS-CoV-2 monoclonal antibodies is essential in immunocompromised patients. Therefore, measures to prevent resistance against these key drugs are urgently needed.

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“…To the extent that viral persistence is a heritable trait for the virus (164), and onward transmission from long COVID cases is possible, we can expect natural selection to act over time to favor an increase in the propensity for acute COVID-19 to lead to long COVID. At this point, there are no documented examples of onward transmission from long COVID cases (although chronic cases of COVID-19 in immunosuppressed patients have been compellingly shown to be infectious (164)(165)(166)(167). Important caveats for the lack of evidence of onward transmission from long COVID patients are the extremely limited effectiveness of contact tracing, particularly in Western countries with a high disease burden, early in the pandemic (168,169) and the cessation of COVID-19 contact tracing worldwide.…”

Section: Virulence and Sars-cov-2 Pathogenesismentioning

confidence: 99%

Pathways to altered virulence of SARS-CoV-2

White¹,

Egeren²,

Stoddard³

et al. 2023

Preprint

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The recently emerged SARS-CoV-2 virus has led to a prolonged pandemic characterized by ongoing viral evolution. Vaccines have been an important piece in the strategy to combat the virus but have been insufficient to contain it as the virus continues to evolve to evade immunity developed by vaccination and infection. A consistent argument is that vaccination or prior immunity will lead to less severe infections. In this review, we address the question of whether the virus can evolve to become more virulent, despite prior infection. We describe the intrinsic characteristics of the virus and their relationship to altered virulence. We show that it is likely that viral evolution is subject to evolutionary drift, and it cannot be assumed that the virus will necessarily evolve to be less virulent, or that prior immunity will offer durable protection against severe disease. This has strong implications for public health strategies to confront the ongoing challenges presented by SARS-CoV-2 and implies that there are significant risks to a strategy based on the assumption of waning virulence.

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SARS-CoV-2 late shedding may be infectious between immunocompromised hosts

Cited by 9 publications

References 7 publications

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Casirivimab/Imdevimab for Active COVID-19 Pneumonia Which Persisted for Nine Months in a Patient with Follicular Lymphoma during Anti-CD20 Therapy

Pathways to altered virulence of SARS-CoV-2

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