ATS Journals: 新冠患者症状消失8天后仍具有传染性,10月后或有疫情高峰

2020-04-02 顾露露 生物探索

根据最新数据统计,全球新冠肺炎累计确诊病例数已经突破86万例,累计死亡病例超过4.2万例;美国新冠肺炎确诊病例累计破18.7万例,仍是全球确诊病例最多的国家。

根据最新数据统计,全球新冠肺炎累计确诊病例数已经突破86万例,累计死亡病例超过4.2万例;美国新冠肺炎确诊病例累计破18.7万例,仍是全球确诊病例最多的国家。

再看国内,4月8日零时起,作为中国新冠肺炎疫情中心的武汉将解除“离汉(武汉市)离鄂(湖北省)通道”管控措施,这意味着从1月23日开始封城的日子即将结束。全国都在井然有序地复工复产,回归正常。

最新研究:新冠患者症状消失8天后仍具有传染性

但近日,中美研究人员合作的一项小型研究发现,部分COVID-19轻症患者在症状消失后仍携带病毒达8天之久。此前也有媒体报道,德国一名确诊患者发烧后病毒滴度很高,但症状消失后却仍然感染了两个紧密接触者。这也意味着,某些COVID-19康复患者可能需要延长隔离期。


图片来源:NIAID

最新研究结果以“Time Kinetics of Viral Clearance and Resolution of Symptoms in NovelCoronavirus Infection”为题发表在《American Journal ofRespiratory and Critical Care Medicine》期刊上。

具体来说,为了弄清病毒清除和症状分解的时间动力学,该研究小组选择了16例确诊的COVID-19患者,他们于2020年1月28日至2月9日期间在北京解放军总医院治疗中心接受治疗并出院。患者平均年龄35.5岁,主要症状为发热(14/16)、咳嗽(11/16)、咽痛((5/16))和呼吸困难(2/16)。

患者接受了一系列药物治疗。15例患者用α-干扰素以及其他抗病毒药物,包括奥司他韦(1/16)),洛匹那韦/利托那韦(11/16),阿昔洛韦(1/16),莫西沙星(5/16),甲基泼尼松龙(2/16),丙种球蛋白(2/16),万古霉素(1/16)和美罗培南(1/16)单独或组合使用。只有一名患者需要呼吸支持。

研究人员收集并分析了所有患者隔日采集的咽拭子样本。采用聚合酶链反应(PCR)检测SARS-CoV-2病毒。患者经过至少两次连续的PCR检测呈阴性确认后出院。出院后患者被要求在家中隔离两周,并在一周后到医院进行随访,以确认病毒阴性状态。

结果发现,除了1名患者外,所有患者从感染到症状发作的时间(潜伏期)为5天,症状平均持续时间为8天。然而,在症状消失后,患者保持传染性的时间从1天到8天不等。最重要的是,一半(8/16)的患者在症状消失后仍保持病毒阳性。2例为糖尿病患者,1例为肺结核患者,均未影响COVID-19感染的时间。

研究人员指出,另一项针对COVID-19幸存者的研究报告了相似的病毒清除动力学——该病毒持续存在20天,死亡率超过40%。这些信息可以为临床医生和决策者提供有用的工具,以确保康复患者不会传播病毒。

中国人民解放军总医院肺病重症医学学院教授解立新博士说道,“如果你患有COVID-19引起的轻度呼吸道症状,并且为了不感染他人而留在家里,请在恢复后再将隔离期延长2周,以确保不会感染他人。”

美国耶鲁大学医学院肺科、重症监护和睡眠医学部医学讲师Lokesh Sharma博士补充道,“我们的研究中最重要的发现是,有一半的患者在症状消失后仍在继续排出病毒。更严重的感染者可能需要更长的病毒脱落时间。”

当然,这项研究也有局限,涉及人数较少,且所有的病人都是较轻的感染。此外,也不清楚类似的结果是否适用于更脆弱的患者,如老年人、免疫系统受到抑制的患者和接受免疫抑制治疗的患者。

此前报道:新冠病毒在症状消除后可在体内至少存活两周

在此之前,发表在《JAMA》杂志上的一篇研究结果表明,这种新型冠状病毒在症状消除后可在体内至少存活两周。研究追踪了4名30至36岁的医务人员,他们在1月1日至2月15日期间患上了COVID-19,并在武汉大学中南医院接受了治疗(奥司他韦治疗)。所有人都康复了,只有一人在患病期间住院。

这些患者在症状缓解和COVID-19两次检测呈阴性(连续两天)后被认为已经康复。康复后,患者被要求在家中隔离5天。5天后,他们继续接受咽喉拭子检测冠状病毒,恢复后检测持续了13天。

美国密歇根理工大学(Michigan Tech University)的病毒学家Ebenezer Tumban曾对此表示,病毒在体内停留在较低水平的情况并不少见,即使患者已经康复。抗病毒治疗结束后,病毒可能又开始在低水平上复制。没有足够的病毒来造成组织损伤,所以病人感觉不到任何症状。但是病毒拷贝的数量已经足够高了,测试可以再次捕捉到它们。

结语

当前境外疫情大流行呈加速趋势,我国防输入压力持续加大。疫情究竟何时能够结束,目前没有标准答案。新冠肺炎医疗救助上海专家组组长、复旦大学附属华山医院感染科主任张文宏教授此前表示,“最美好的季节将会是今年的金秋10月,这个时候可能是个低谷,后面可能会有个高峰,所以今年基本上是绵延不断。”

新冠肺炎在未来仍有极大的不确定性,疫情的结束时间目前还不能预测,但起决定作用的还是人民。少出门、戴口罩、勤洗手、不聚集。

原始出处:
De Chang , et al. Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection. ATS Journals. Received: March 05, 2020

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    2020-08-29 一叶知秋
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    2020-05-14 xzw113
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    2020-04-03 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1906504, encodeId=8f9619065044c, content=<a href='/topic/show?id=317e5805e9d' target=_blank style='color:#2F92EE;'>#新冠患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58057, encryptionId=317e5805e9d, topicName=新冠患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Mon Oct 05 12:46:32 CST 2020, time=2020-10-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2068262, encodeId=eea0206826240, content=<a href='/topic/show?id=e94b298327' target=_blank style='color:#2F92EE;'>#ATS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2983, encryptionId=e94b298327, topicName=ATS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sat Aug 29 06:46:32 CST 2020, time=2020-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1911515, encodeId=f7ff191151504, content=<a href='/topic/show?id=77b3259009f' target=_blank style='color:#2F92EE;'>#传染性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=25900, encryptionId=77b3259009f, topicName=传染性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2317301, createdName=xzw113, createdTime=Thu May 14 03:46:32 CST 2020, time=2020-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1027611, encodeId=5eb4102e61158, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Apr 03 00:46:32 CST 2020, time=2020-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=381276, encodeId=24873812e6cc, content=學習了很有用不錯, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Apr 03 00:23:35 CST 2020, time=2020-04-03, status=1, ipAttribution=)]
    2020-04-03 飛歌

    學習了很有用不錯

    0

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