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dc.contributor.authorStankiewicz Karita, Helen C
dc.contributor.authorDong, Tracy Q
dc.contributor.authorJohnston, Christine
dc.contributor.authorNeuzil, Kathleen M
dc.contributor.authorPaasche-Orlow, Michael K
dc.contributor.authorKissinger, Patricia J
dc.contributor.authorBershteyn, Anna
dc.contributor.authorThorpe, Lorna E
dc.contributor.authorDeming, Meagan
dc.contributor.authorKottkamp, Angelica
dc.contributor.authorLaufer, Miriam
dc.contributor.authorLandovitz, Raphael J
dc.contributor.authorLuk, Alfred
dc.contributor.authorHoffman, Risa
dc.contributor.authorRoychoudhury, Pavitra
dc.contributor.authorMagaret, Craig A
dc.contributor.authorGreninger, Alexander L
dc.contributor.authorHuang, Meei-Li
dc.contributor.authorJerome, Keith R
dc.contributor.authorWener, Mark
dc.contributor.authorCelum, Connie
dc.contributor.authorChu, Helen Y
dc.contributor.authorBaeten, Jared M
dc.contributor.authorWald, Anna
dc.contributor.authorBarnabas, Ruanne V
dc.contributor.authorBrown, Elizabeth R
dc.date.accessioned2022-01-19T13:37:26Z
dc.date.available2022-01-19T13:37:26Z
dc.date.issued2022-01-04
dc.identifier.urihttp://hdl.handle.net/10713/17533
dc.description.abstractImportance: The SARS-CoV-2 viral trajectory has not been well characterized in incident infections. These data are needed to inform natural history, prevention practices, and therapeutic development. Objective: To characterize early SARS-CoV-2 viral RNA load (hereafter referred to as viral load) in individuals with incident infections in association with COVID-19 symptom onset and severity. Design, Setting, and Participants: This prospective cohort study was a secondary data analysis of a remotely conducted study that enrolled 829 asymptomatic community-based participants recently exposed (<96 hours) to persons with SARS-CoV-2 from 41 US states from March 31 to August 21, 2020. Two cohorts were studied: (1) participants who were SARS-CoV-2 negative at baseline and tested positive during study follow-up, and (2) participants who had 2 or more positive swabs during follow-up, regardless of the initial (baseline) swab result. Participants collected daily midturbinate swab samples for SARS-CoV-2 RNA detection and maintained symptom diaries for 14 days. Exposure: Laboratory-confirmed SARS-CoV-2 infection. Main Outcomes and Measures: The observed SARS-CoV-2 viral load among incident infections was summarized, and piecewise linear mixed-effects models were used to estimate the characteristics of viral trajectories in association with COVID-19 symptom onset and severity. Results: A total of 97 participants (55 women [57%]; median age, 37 years [IQR, 27-52 years]) developed incident infections during follow-up. Forty-Two participants (43%) had viral shedding for 1 day (median peak viral load cycle threshold [Ct] value, 38.5 [95% CI, 38.3-39.0]), 18 (19%) for 2 to 6 days (median Ct value, 36.7 [95% CI, 30.2-38.1]), and 31 (32%) for 7 days or more (median Ct value, 18.3 [95% CI, 17.4-22.0]). The cycle threshold value has an inverse association with viral load. Six participants (6%) had 1 to 6 days of viral shedding with censored duration. The peak mean (SD) viral load was observed on day 3 of shedding (Ct value, 33.8 [95% CI, 31.9-35.6]). Based on the statistical models fitted to 129 participants (60 men [47%]; median age, 38 years [IQR, 25-54 years]) with 2 or more SARS-CoV-2-positive swab samples, persons reporting moderate or severe symptoms tended to have a higher peak mean viral load than those who were asymptomatic (Ct value, 23.3 [95% CI, 22.6-24.0] vs 30.7 [95% CI, 29.8-31.4]). Mild symptoms generally started within 1 day of peak viral load, and moderate or severe symptoms 2 days after peak viral load. All 535 sequenced samples detected the G614 variant (Wuhan strain). Conclusions and Relevance: This cohort study suggests that having incident SARS-CoV-2 G614 infection was associated with a rapid viral load peak followed by slower decay. COVID-19 symptom onset generally coincided with peak viral load, which correlated positively with symptom severity. This longitudinal evaluation of the SARS-CoV-2 G614 with frequent molecular testing serves as a reference for comparing emergent viral lineages to inform clinical trial designs and public health strategies to contain the spread of the virus.en_US
dc.description.urihttps://doi.org/10.1001/jamanetworkopen.2021.42796en_US
dc.language.isoenen_US
dc.publisherAmerican Medical Associationen_US
dc.relation.ispartofJAMA Network Openen_US
dc.titleTrajectory of Viral RNA Load Among Persons With Incident SARS-CoV-2 G614 Infection (Wuhan Strain) in Association With COVID-19 Symptom Onset and Severity.en_US
dc.typeArticleen_US
dc.identifier.doi10.1001/jamanetworkopen.2021.42796
dc.identifier.pmid35006245
dc.source.journaltitleJAMA network open
dc.source.volume5
dc.source.issue1
dc.source.beginpagee2142796
dc.source.endpage
dc.source.countryUnited States
dc.source.countryUnited States
dc.source.countryUnited States


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