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Viral loads and duration of viral shedding in adult patients hospitalized with influenza

Lee, Nelson, Chan, Paul K. S., Hui, David S. C., Rainer, Timothy Hudson, Wong, Eric, Choi, Kin-Wing, Lui, Grace C. Y., Wong, Bonnie C. K., Wong, Rita Y. K., Lam, Wai-Yip, Chu, Ida M. T., Lai, Raymond W. M., Cockram, Clive S. and Sung, Joseph J. Y. 2009. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. Journal of Infectious Diseases 200 (4) , pp. 492-500. 10.1086/600383

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Abstract

Background The goal of this study was to characterize viral loads and factors affecting viral clearance in persons with severe influenza Methods This was a 1-year prospective, observational study involving consecutive adults hospitalized with influenza. Nasal and throat swabs were collected at presentation, then daily until 1 week after symptom onset. Real-time reverse-transcriptase polymerase chain reaction to determine viral RNA concentration and virus isolation were performed. Viral RNA concentration was analyzed using multiple linear or logistic regressions or mixed-effect models Results One hundred forty-seven inpatients with influenza A (H3N2) infection were studied (mean age ± standard deviation, 72±16 years). Viral RNA concentration at presentation positively correlated with symptom scores and was significantly higher than that among time-matched outpatients (control subjects). Patients with major comorbidities had high viral RNA concentration even when presenting >2 days after symptom onset (mean ± standard deviation, 5.06±1.85 vs 3.62±2.13 log10 copies/mL; P=.005; β, +0.86 [95% confidence interval, +0.03 to +1.68]). Viral RNA concentration demonstrated a nonlinear decrease with time; 26% of oseltamivir-treated and 57% of untreated patients had RNA detected at 1 week after symptom onset. Oseltamivir started on or before symptom day 4 was independently associated with an accelerated decrease in viral RNA concentration (mean β [standard error], −1.19 [0.43] and −0.68 [0.33] log10 copies/mL for patients treated on day 1 and days 2–3, respectively; P<.05) and viral RNA clearance at 1 week (odds ratio, 0.10 [95% confidence interval, 0.03–0.35] and 0.30 [0.10–0.90] for patients treated on day 1–2 and day 3–4, respectively). Conversely, major comorbidities and systemic corticosteroid use for asthma or chronic obstructive pulmonary disease exacerbations were associated with slower viral clearance. Viral RNA clearance was associated with a shorter hospital stay (7.0 vs 13.5 days; P=.001) Conclusion Patients hospitalized with severe influenza have more active and prolonged viral replication. Weakened host defenses slow viral clearance, whereas antivirals started within the first 4 days of illness enhance viral clearance

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Oxford University Press
ISSN: 0022-1899
Date of Acceptance: 9 March 2009
Last Modified: 04 Jun 2017 09:15
URI: http://orca-mwe.cf.ac.uk/id/eprint/92743

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