Skip to main content

Advertisement

SpringerLink
Log in

Impact of Prolonged SARS-CoV-2 Viral Shedding on COVID-19 Disease Outcome and Viral Dynamics

  • REVIEW ARTICLE
  • Published:
Indian Journal of Microbiology Aims and scope Submit manuscript

Abstract

This article aimed to review the current literature on the impact of continuous shedding of the COVID-19 virus in infected patients in relation to disease outcome variables and viral dynamics. Electronic databases PubMed, Google Scholar, and MedlinePlus were searched using relevant keywords, restricting the selection to thirty-two peer-reviewed articles and four gray literatures from the WHO websites. Findings from this study showed that several variables such as sex, age, immune status, treatments, and vaccines were found to affect the outcomes associated with the COVID-19 virus shedding. These findings highlight the need for further research using longitudinal whole-genome sequencing of the virus and its variants to increase the understanding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and materials

Not applicable.

Code availability

Not applicable.

References

  1. WHO (2021) Coronavirus disease (COVID-19): How is it transmitted? The World Health Organization. https://www.who.int/health-topics/coronavirus#tab=tab_1. Accessed 12 Nov 2022

  2. WHO (2020) Coronavirus disease (COVID-19): virus evolution. www.who.int/news-room/q-a-detail/sars-cov-2-evolution. Accessed 12 Nov 2022

  3. Achaiah NC, Subbarajasetty SB, Shetty RM (2020) R0 and Re of COVID-19: Can we predict when the pandemic outbreak will be contained? Indian J Crit Care Med 24:1125–1127. https://doi.org/10.5005/jp-jurnals-10071-23649

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Huang SW, Wang SF (2021) SARS-CoV-2 entry related viral and host genetic variations: Implications on COVID-19 severity, immune escape, and infectivity. Int J Mol Sci 22:3060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Izurieta R, Gardellini T, Campos A, Parikh J (2022) Biological determinants of emergence of SARS-CoV-2 variants. IntechOpen, London. https://doi.org/10.5772/intechopen.104758

    Book  Google Scholar 

  6. Lee JS, Yun KW, Jeong H, Kim B, Kim MJ, Park JH, Shin HS, Oh HS, Sung H, Song MG et al (2022) SARS-CoV-2 shedding dynamics and transmission in immunosuppressed patients. Virulence 13:1242–1251. https://doi.org/10.1080/21505594.2022.2101198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Letizia AG, Smith DR, Ge Y, Ramos I, Sealfon RSG, Goforth C, Gonzalez-Reiche AS, Vangeti S, Weir DL, Alshammary H et al (2021) Viable virus shedding during SARS-CoV-2 reinfection. Lancet Respir Med 9:e56–e57. https://doi.org/10.1016/S2213-2600(21)00219-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kim KW, Wang X, Adhikari A, Yeang M, Jenkins F, Naing Z, Walker GJ, Foster CSP, Stelzer-Braid S, Deveson I et al (2022) Persistent high-level shedding of cultivable SARS-CoV-2 Delta virus 33 days after onset of COVID-19 in a hospitalized patient with pneumonia. J Med Virol 94:4043–4046. https://doi.org/10.1002/jmv.27832

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Falahi S, Kenarkoohi A (2020) COVID-19 reinfection: Prolonged shedding or true reinfection? New Microbes New Infect 38:100812. https://doi.org/10.1016/j.nmni.2020.100812

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Long H, Zhao J, Zeng HL, Lu QB, Fang LQ, Wang Q, Wu QM, Liu W (2021) Prolonged viral shedding of SARS-CoV-2 and related factors in symptomatic COVID-19 patients: a prospective study. BMC Infect Dis. https://doi.org/10.1186/s12879-021-07002-w

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jariwal R, Raza N, Valdez M, Aboeed A, Garcia-Pacheco R (2021) Prolonged SARS-CoV2 viral shedding in an elderly patient. Cureus. https://doi.org/10.7759/cureus.15128

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sanyaolu A, Marinkovic A, Prakash S, Haider N, Williams M, Okorie C, Badaru O, Smith S (2022) SARS-CoV-2 Omicron variant (B.1.1.529): a concern with immune escape. World J Virol 11:137–143. https://doi.org/10.5501/wjv.v11.i3.137

    Article  PubMed  PubMed Central  Google Scholar 

  13. WHO (2023) XBB.1.5 rapid risk assessment, 11 January 2023. The World Health Organization. https://www.who.int/docs/default-source/coronaviruse/11jan2023_xbb15_rapid_risk_assessment.pdf. Accessed 14 Jan 2023

  14. Ravi V, Saxena S, Panda PS (2022) Basic virology of SARS-CoV 2. Indian J Med Microbiol 40:182–186. https://doi.org/10.1016/j.ijmmb.2022.02.005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cevik M, Kuppalli K, Kindrachuk J, Peiris M (2020) Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. https://doi.org/10.1136/bmj.m3862

    Article  PubMed  Google Scholar 

  16. WHO (2020) Coronavirus disease (COVID-19) dashboard. The World Health Organization. https://covid19.who.int/info. Accessed 14 Nov 2022

  17. Cao B, Jing X, Liu Y, Wen R, Wang C (2022) Comparison of laboratory parameters in mild vs. severe cases and died vs. survived patients with COVID-19: Systematic review and meta-analysis. J Thorac Dis 14:1478–1487. https://doi.org/10.21037/jtd-22-345

    Article  PubMed  PubMed Central  Google Scholar 

  18. Çalıca Utku A, Budak G, Karabay O, Güçlü E, Okan HD, Vatan A (2020) Main symptoms in patients presenting in the COVID-19 period. Scott Med J 65:127–132. https://doi.org/10.1177/0036933020949253

    Article  PubMed  Google Scholar 

  19. Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, Farahmandian N, Miresmaeili SM, Bahreini E (2020) A comprehensive review of COVID-19 characteristics. Biol Proced Online 22:19. https://doi.org/10.1186/s12575-020-00128-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Paules CI, Marston HD, Fauci AS (2020) Coronavirus infections-more than just the common cold. JAMA 323:707–708. https://doi.org/10.1001/jama.2020.0757

    Article  CAS  PubMed  Google Scholar 

  21. Plebani M (2021) Persistent viral RNA shedding in COVID-19: caution, not fear. EBioMedicine 64:103234. https://doi.org/10.1016/j.ebiom

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Loeffelholz MJ, Tang YW (2021) Detection of SARS-CoV-2 at the point of care. Bioanalysis 13:1213–1223. https://doi.org/10.4155/bio-2021-0078

    Article  CAS  PubMed  Google Scholar 

  23. Batra A, Clark JR, Kang AK, Ali S, Patel TR, Shlobin NA, Hoffman SC, Lim PH, Orban ZS, Visvabharathy L et al (2022) Persistent viral RNA shedding of SARS-CoV-2 is associated with delirium incidence and six-month mortality in hospitalized COVID-19 patients. Geroscience 44:1241–1254. https://doi.org/10.1007/s11357-022-00561

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Owusu D, Pomeroy MA, Lewis NM, Wadhwa A, Yousaf AR, Whitaker B, Dietrich E, Hall AJ, Chu V, Thornburg N et al (2021) Persistent SARS-CoV-2 RNA shedding without evidence of infectiousness: a cohort study of individuals with COVID-19. J Infect Dis 224:1362–1371. https://doi.org/10.1093/infdis/jiab107

    Article  CAS  PubMed  Google Scholar 

  25. Munker D, Osterman A, Stubbe H, Muenchhoff M, Veit T, Weinberger T, Barnikel M, Mumm JN, Milger K, Khatamzas E et al (2021) Dynamics of SARS-CoV-2 shedding in the respiratory tract depends on the severity of disease in COVID-19 patients. Eur Respir J 58:2002724

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lu Y, Li Y, Deng W, Liu M, He Y, Huang L, Lv M, Li J, Du H (2020) Symptomatic infection is associated with prolonged duration of viral shedding in mild coronavirus disease 2019: a retrospective study of 110 children in Wuhan. Pediatr Infect Dis J 39:e95–e99. https://doi.org/10.1097/INF.0000000000002729

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jacobsen H, Klein SL (2021) Sex differences in immunity to viral infections. Front Immunol 12:720952. https://doi.org/10.3389/fimmu.2021.720952

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Torcia MG, Nencioni L, Clemente AM, Civitelli L, Celestino I, Limongi D, Fadigati G, Perissi E, Cozzolino F, Garaci E et al (2012) Sex differences in the response to viral infections: TLR8 and TLR9 ligand stimulation induce higher IL10 production in males. PLoS ONE 7:e39853. https://doi.org/10.1371/journal.pone.0039853

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Taneja V (2018) Sex hormones determine immune response. Front Immunol 9:1931. https://doi.org/10.3389/fimmu.2018.01931

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Zhang Y, Cen M, Hu M, Du L, Hu W, Kim JJ, Dai N (2021) Prevalence and persistent shedding of fecal SARS-CoV-2 RNA in patients with COVID-19 infection: a systematic review and meta-analysis. Clin Transl Gastroenterol 12:e00343. https://doi.org/10.14309/ctg.0000000000000343

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yan D, Liu XY, Zhu YN, Huang L, Dan BT, Zhang GJ, Gao YH (2020) Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection. Eur Respir J 56:2000799. https://doi.org/10.1183/13993003.00799-2020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Song KH, Kim DM, Lee H, Ham SY, Oh SM, Jeong H, Jung J, Kang CK, Park JY, Kang YM et al (2021) Dynamics of viral load and anti-SARS-CoV-2 antibodies in patients with positive RT-PCR results after recovery from COVID-19. KJIM 36:11–14. https://doi.org/10.3904/kjim.2020.325

    Article  CAS  Google Scholar 

  33. Harari S, Tahor M, Rutsinsky N, Meijer S, Miller D, Hening O, Halutz O, Levytskyi K, Ben-Ami R, Adler A et al (2022) Drivers of adaptive evolution during chronic SARS-CoV-2 infections. Nat Med 28:1501–1508. https://doi.org/10.1038/s41591-022-01882-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lythgoe KA, Hall M, Ferretti L, de Cesare M, MacIntyre-Cockett G, Trebes A, Andersson M, Otecko N, Wise EL, Moore N, Lynch J (2021) SARS-CoV-2 within-host diversity and transmission. Science 372:eabg0821. https://doi.org/10.1126/Science.Abg0821

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kim KS, Iwanami S, Oda T, Fujita Y, Kuba K, Miyazaki T, Ejima K, Iwami S (2021) Incomplete antiviral treatment may induce longer durations of viral shedding during SARS-CoV-2 infection. Life Sci Alliance 4:e202101049. https://doi.org/10.26508/lsa.202101049

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lee S, Kim T, Lee E, Lee C, Kim H, Rhee H, Park SY, Son HJ, Yu S, Park JW, Choo EJ (2020) Clinical course and molecular viral shedding among asymptomatic and symptomatic patients with SARS-CoV-2 infection in a community treatment center in the Republic of Korea. JAMA Intern Med 180:1447–1452. https://doi.org/10.1001/jamainternmed.2020.3862

    Article  CAS  PubMed  Google Scholar 

  37. Hammond J, Leister-Tebbe H, Gardner A, Abreu P, Bao W, Wisemandle W, Baniecki M, Hendrick VM, Damle B, Simón-Campos A et al (2022) Oral nirmatrelvir for high-risk, non-hospitalized adults with COVID-19. NEJM 386:1397–1408. https://doi.org/10.1056/NEJMoa2118542

    Article  CAS  PubMed  Google Scholar 

  38. Machkovech HM, Hahn AM, Wang JG, Grubaugh ND, Halfmann PJ, Johnson MC, Lemieux JE, O’Connor DH, Piantadosi A, Wei W, Friedrich TC (2024) Persistent SARS-CoV-2 infection: significance and implications. Lancet Infect Dis. https://doi.org/10.1016/S1473-3099(23)00815-0

    Article  PubMed  Google Scholar 

  39. Klivleyeva N, Lukmanova G, Glebova T, Shamenova M, Ongarbayeva N, Saktaganov N, Baimukhametova A, Basiseitt S, Ismagulova D, Kassymova G et al (2023) Spread of pathogens causing respiratory viral diseases before and during COVID-19 pandemic in Kazakhstan. Indian J Microbiol 63:129–138. https://doi.org/10.1007/s12088-023-01064-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Ha KM (2023) Targeting the variants of COVID-19 via the unlimited approach. Indian J Microbiol 63:152–154. https://doi.org/10.1007/s12088-023-01057-w

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bajaj A, Purohit HJ (2020) Understanding SARS-CoV-2: genetic diversity, transmission, and cure in human. Indian J Microbiol 60:398–401. https://doi.org/10.1007/s12088-020-00869-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. D’Youville University, Buffalo, NY, USA

    Adekunle Sanyaolu

  2. Saint James School of Medicine, The Quarter 2640, Anguilla

    Aleksandra Marinkovic, Stephanie Prakash, Vyshnavy Balendra & Kareem Hamdy

  3. All Saints University School of Medicine, Roseau, Dominica

    Nafees Haider

  4. Loyola University Medical Center, Maywood, IL, USA

    Abu Fahad Abbasi

  5. Caribbean Medical University, Willemstad, Curaçao

    Zaheeda Hosein

  6. University of Calgary, Calgary, AB, Canada

    Kokab Younis

  7. Nigerian Institute of Medical Research, Lagos, Nigeria

    Stella Smith

  8. Federal Ministry of Health, Abuja, Nigeria

    Adekunle Sanyaolu & Olanrewaju Badaru

  9. Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, FL, USA

    Ricardo Izurieta

  10. Universidad de las Américas, Quito, 170513, Ecuador

    Ricardo Izurieta

Authors
  1. Adekunle Sanyaolu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aleksandra Marinkovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vyshnavy Balendra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kareem Hamdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nafees Haider
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Abu Fahad Abbasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zaheeda Hosein
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kokab Younis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stella Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Olanrewaju Badaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ricardo Izurieta
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, AS and RI. Original draft preparation, AM, SP, VB, KH, NH, AFA, ZH, KY. Revised and editing, AS, RI, SS, OB. Approved the version to be published, AS. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved, AS.

Corresponding author

Correspondence to Adekunle Sanyaolu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable

Consent for publication

Not applicable

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sanyaolu, A., Marinkovic, A., Prakash, S. et al. Impact of Prolonged SARS-CoV-2 Viral Shedding on COVID-19 Disease Outcome and Viral Dynamics. Indian J Microbiol (2024). https://doi.org/10.1007/s12088-024-01238-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12088-024-01238-1

Keywords

Search

Navigation