复检核酸阳性的新型冠状病毒感染者分布及传染性特征分析  

Distribution and infectious characteristics of re-positive cases infected with SARS-CoV-2

作　　者：李志丽 李昱[1] 陈秋兰[1] 杨孝坤 赵宏婷 姜欣丽 范思萌 李丹[1] 秦颖[1] 彭质斌[1] 余建兴 毛乃颖[3] 李中杰[1] Li Zhili;Li Yu;Chen Qiulan;Yang Xiaokun;Zhao Hongting;Jiang Xinli;Fan Simeng;Li Dan;Qin Ying;Peng Zhibin;Yu Jianxing;Mao Naiying;Li Zhongjie(Division of Infectious Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;National Institute for Communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China;National Institute for Viral Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]中国疾病预防控制中心传染病管理处,北京102206 [2]中国疾病预防控制中心传染病预防控制所,北京102206 [3]中国疾病预防控制中心病毒病所,北京102206

出　　处：《中华流行病学杂志》2021年第10期1750-1756,共7页Chinese Journal of Epidemiology

基　　金：国家重点研发计划(2020YFC0846900,2020YFA0708100);国家自然科学基金(82041029);公共卫生应急反应机制运行项目(131031001000200001)。

摘　　要：针对国内外新型冠状病毒(新冠病毒)感染者排毒持久性以及复检核酸阳性者的相关研究文献进行综述,分析复检阳性者的特征与传染性,为完善病例管理与预防新冠病毒传播措施的制定提供科学依据。现有研究结果显示,新冠病毒复检阳性率范围在2.4%-19.8%之间,复检阳性时间中位数为出院后4-15 d。复检阳性后新冠病毒特异性IgM、IgG和IgA抗体血清阳性率分别为11.11%-86.08%、52.00%-100.00%、61.54%-100.00%;总抗体和中和抗体的血清阳性率分别为98.72%和88.46%。复检阳性后病毒载量低于初次感染时的病毒载量。目前,全球至少报告了3 380例复检阳性者,有3例复检阳性者(1例免疫缺陷病例和2例肺部影像学异常病例)的标本中分离到具有传染性的活病毒,有1例应用免疫抑制剂的无症状感染者引起密切接触者感染。复检阳性者具有传染性的风险总体很低,极个别复检阳性者不排除引起续发传播的可能。对于复检阳性者的管理时间和管理方式,可基于病原检测结果对个体传播风险评估后进行确定。Domestic and foreign literatures related to the persistence of SARS-CoV-2 and the re-positive cases infected with SARS-CoV-2 were reviewed,and the characteristics and infectivity of the re-positive cases were analyzed to provide scientific evidence for the improvement of case management and the development of measures to stop the spread of SARS-CoV-2.Existing studies have shown that re-positive rate of SARS-CoV-2 ranged from 2.4%to 19.8%,the median of interval between re-positive detection and discharge was 4-15 days.Following the second course of the disease,the anti-SARS-CoV-2 IgM,IgG and IgA positive rates of the cases were 11.11%-86.08%,52.00%-100.00%and 61.54%-100.00%respectively,the total antibody and neutralizing antibody positive rates were 98.72%and 88.46%.The viral load of the re-positive cases was lower than that in the initial infection.At least 3380 re-positive cases have been reported globally.SARS-CoV-2 strains were isolated from the samples of 3 re-positive cases(1 immunodeficiency case and 2 cases with abnormal pulmonary imaging).There were close contacts that were infected by an asymptomatic case taking immunosuppressive agents.In conclusion,the infectivity of re-positive cases infected with SARS-CoV-2 is generally very low.Rare re-positive cases infected with SARS-CoV-2 might cause further transmission.The management approach for the re-positive cases can be based on the assessment of the individual transmission risk according to the pathogen detection results.

关 键 词：新型冠状病毒 复检阳性 传染性 

分 类 号：R563.1[医药卫生—呼吸系统] R181.3[医药卫生—内科学]