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Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis.

ABSTRACT: Present study aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. We searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I². Fourteen studies of 2568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.8% (95% confidence interval [CI] 11.44-18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.4 days (95% CI 32.65-38.24 days), and from the last negative to the recurrent positive result was 9.8 days (95% CI 7.31-12.22 days). Patients with younger age and a longer initial illness were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes, severe disease, and a low lymphocyte count were less likely to experience. Present study concluded that the incidence of recurrent SARS-CoV-2 positivity was 14.8% suggesting further studies must be conducted to elucidate the possibility of infectious individuals with prolonged or recurrent RNA positivity.

SUBMITTER: Azam M

PROVIDER: S-EPMC7691365 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis.

Azam Mahalul M Sulistiana Rina R Ratnawati Martha M Fibriana Arulita Ika AI Bahrudin Udin U Widyaningrum Dian D Aljunid Syed Mohamed SM

Scientific reports 20201126 1

Present study aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity. We searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was as ...[more]

PMID: 33244060

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Project description:BackgroundThis study aimed to compare the incidence of myocarditis in COVID-19 vaccines and in severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection groups.MethodsElectronic databases (MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the WHO Global Literature on Coronavirus Disease) and trial registries were searched up to May 2022, for randomized controlled trials and observational cohort studies reporting the risk of myocarditis associated with the COVID-19 vaccines and the risk associated with SARS-CoV-2 infection. We estimated the effect of COVID-19 infection and vaccines on rates of myocarditis by random-effects meta-analyses using the generic inverse variance method. Meta-regression analyses were conducted to assess the effect of sex and age on the incidence of myocarditis.ResultsWe identified 22 eligible studies consisting of 55.5 million vaccinated cohorts and 2.5 million in the infection cohort. The median age was 49 years (interquartile range (IQR): 38-56), and 49% (IQR: 43 to 52%) were men. Of patients diagnosed with myocarditis (in both vaccination and COVID-19 cohort) 1.07% were hospitalized and 0.015% died. The relative risk (RR) for myocarditis was more than seven times higher in the infection group than in the vaccination group [RR: 15 (95% CI: 11.09-19.81, infection group] and RR: 2 (95% CI: 1.44-2.65, vaccine group). Of patients who developed myocarditis after receiving the vaccine or having the infection, 61% (IQR: 39-87%) were men. Meta-regression analysis indicated that men and younger populations had a higher risk of myocarditis. A slow decline in the rates of myocarditis was observed as a function of time from vaccination. The risk of bias was low.ConclusionIn this systematic review and meta-analysis, we found that the risk of myocarditis is more than seven fold higher in persons who were infected with the SARS-CoV-2 than in those who received the vaccine. These findings support the continued use of mRNA COVID-19 vaccines among all eligible persons per CDC and WHO recommendations.

Project description:BackgroundThe optimal isolation duration for patients with COVID-19 remains unclear. To support an update of World Health Organization (WHO)'s Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalisation and death among secondary cases.MethodsWe searched the WHO COVID-19 database for studies up to Feb 27, 2023. We included clinical studies of any design with COVID-19 patients confirmed by PCR test or rapid antigen test addressing the impact of any isolation strategy on preventing the spread of COVID-19. There were no restrictions on publication language, publication status, age of patients, severity of COVID-19, variants of SARS-COV-2, comorbidity of patients, isolation location, or co-interventions. We performed random-effects meta-analyses to summarise testing rates of persistent test positivity rates after COVID-19 infection. We performed pre-specified subgroup analyses by symptom status and meta-regression analyses for the proportion of fully vaccinated patients. We developed a model to compare the effects of three isolation strategies on onward transmission leading to hospitalisation and death. The three isolation strategies were (1) 5-day isolation, with no test to release; (2) removal of isolation based on a negative test; and (3) 10-day isolation, with no test to release. The model incorporates estimates of test positivity rates, effective reproduction number, isolation adherence, false negative rate, and hospitalisation rates or case fatality rates. To assess the impact of varying isolation adherence and false negative rates on rapid antigen testing, we conducted some sensitivity analyses. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. The protocol is registered with PROSPERO (CRD42022348626).FindingsFifteen studies addressing persistent test positivity rates including 4188 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8%-40.0%) had a significantly lower rapid antigen test positive rate than symptomatic patients (68.1%, 95% CI: 40.6%-90.3%) on day 5. The rapid antigen test positive rate was 21.5% (95% CI: 0-64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between 5-day isolation and 10-day isolation in hospitalisations (23 more hospitalisations of secondary cases per 10,000 patients isolated, 95% uncertainty interval (UI) 14 more to 33 more) and mortality (5 more per 10,000 patients, 95% UI 1 to 9 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of 5- versus 10-day isolation was much greater in hospitalisations (RD 186 more per 10,000 patients, 95% UI 113 more to 276 more; very low certainty) and mortality (RD 41 more per 10,000 patients, 95% UI 11 more to 73 more; very low certainty). There may be little or no difference between removing isolation based on a negative antigen test and 10-day isolation in the onward transmission leading to hospitalisation or death, but the average isolation period (mean difference -3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty).Interpretation5 days versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalisation and mortality; however, in symptomatic patients, the level of onward transmission is concerning and may lead to high hospitalisation and death rates. The evidence is, however, very uncertain.FundingThis work was done in collaboration with WHO.

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Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis.

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Recurrent SARS-CoV-2 RNA positivity after COVID-19: a systematic review and meta-analysis.

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