Viral Shedding and Clinical Illness in Naturally Acquired Influenza Virus Infections

• Published in: The Journal of infectious diseases Vol. 201; no. 10; pp. 1509 - 1516
• Main Authors: Lau, Lincoln L. H., Cowling, Benjamin J., Fang, Vicky J., Chan, Kwok-Hung, Lau, Eric H. Y., Lipsitch, Marc, Cheng, Calvin K. Y., Houck, Peter M., Uyeki, Timothy M., Peiris, J. S. Malik, Leung, Gabriel M.
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 15-05-2010; University of Chicago Press; Oxford University Press; Infectious Diseases Society of America
• Subjects: Biological and medical sciences; Cercopithecine herpesvirus 1; Community-Acquired Infections; Diseases; Fever; Fundamental and applied biological sciences. Psychology; Humans; Infections; Infectious diseases; Influenza A virus; Influenza A virus - physiology; Influenza B virus - physiology; Influenza virus; Influenza, Human - pathology; Influenza, Human - virology; Medical sciences; Microbiology; Miscellaneous; Orthomyxoviridae; Reverse transcriptase polymerase chain reaction; Symptoms; Time Factors; Viral Load; Virology; Virus Shedding; Viruses; Virus; Infection; Orthomyxoviridae; Influenzavirus; Dissemination; Viral disease
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/652241

Background. Volunteer challenge studies have provided detailed data on viral shedding from the respiratory tract before and through the course of experimental influenza virus infection. There are no comparable quantitative data to our knowledge on naturally acquired infections. Methods. In a community-based study in Hong Kong in 2008, we followed up initially healthy individuals to quantify trends in viral shedding on the basis of cultures and reverse-transcription polymerase chain reaction (RT-PCR) through the course of illness associated with seasonal influenza A and B virus infection. Results. Trends in symptom scores more closely matched changes in molecular viral loads measured with RT-PCR for influenza A than for influenza B. For influenza A virus infections, the replicating viral loads determined with cultures decreased to undetectable levels earlier after illness onset than did molecular viral loads. Most viral shedding occurred during the first 2–3 days after illness onset, and we estimated that 1%–8% of infectiousness occurs prior to illness onset. Only 14% of infections with detectable shedding at RT-PCR were asymptomatic, and viral shedding was low in these cases. Conclusions. Our results suggest that “silent spreaders” (ie, individuals who are infectious while asymptomatic or presymptomatic) may be less important in the spread of influenza epidemics than previously thought.