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Source: Thailand Medical - SARS-CoV-2 Viral Shedding  Apr 01, 2022  2 months ago
BREAKING! Immunocompetent Vaccinated Pregnant Japanese Woman Infected With SARS-CoV-2 Exhibits Viral Shedding For More Than 221 Days!
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BREAKING! Immunocompetent Vaccinated Pregnant Japanese Woman Infected With SARS-CoV-2 Exhibits Viral Shedding For More Than 221 Days!
Source: Thailand Medical - SARS-CoV-2 Viral Shedding  Apr 01, 2022  2 months ago
Researchers and physicians from Ibaraki Prefectural Central Hospital-Japan, Jichi Medical University and University of Tsukuba Hospital have reported a case study of a double mRNA vaccinated pregnant Japanese woman infected with SARS-CoV-2 that exhibited viral shedding for more than 221 days!


 
The study team described a case of probable prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Alpha (B.1.1.7) variant shedding for 221 days from the diagnosis, in a healthy 20-year-old Japanese pregnant woman with a normal delivery.
 
To date, this is the longest duration of SARS-CoV-2 shedding reported in an immunocompetent individual.
 
The cases study was published in the peer reviewed Journal of Infection and Chemotherapy. https://www.sciencedirect.com/science/article/pii/S1341321X22000915
 
It should be noted that ever since the SARS-CoV-2 coronavirus first debuted in Wuhan-China in late 2019, there has been many cases reports of both immunocompromised as well as immunocompetent individuals exhibiting viral shedding for extended periods of time from the initial date of testing positive for the infection via RT-PCR tests. In fact, the so-called isolation or quarantine duration periods set by stupid health authorities ranging from 21 or 14 days or 10 days to even 5 days etc are simply nonsenses that do not really have any scientific basis!
 
This study describes an immunocompetent individual with prolonged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding 221 days after her initial coronavirus disease 2019 (COVID-19) diagnosis.
 
Typically, pregnant women are tested for SARS-CoV-2 infection before hospital admission. Generally, pregnant women are questioned about the presence of any symptoms and history related to travel, occupation, and close contact with infected individuals.
 
It is a standard protocol that whenever a moderate to high risk of infection is predicted, pregnant women should be tested. However, some healthcare facilities test all pregnant women, irrespective of symptoms and personal history.
 
In this case report, a 20-year-old Japanese woman was diagnosed with COVID-19 at the end of May 2021, which was identified by a SARS-CoV-2 antigen test. The female patient had a fever and no other symptoms and was quarantined for 10 days.
 
It was noted that since this initial diagnosis, the patient did not visit crowded places or display any symptoms. Her family members also did not exhibit any COVID-19 symptoms.
 
It was later found that the patient was about eight weeks pregnant during the time she had a fever.
 
It was also noted that in September and October 2021, she was vaccinated with two doses of a COVID-19 messenger ribonucleic acid (mRNA) vaccine.
 
Corresponding author, Dr Dai Akine from the Division of Infectious Diseases, Department of Medicine, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center told Thailand Medical News, “In December 2021, the patient was admitted to the hospital for delivery. She had an uncomplicated pregnancy and normal vaginal delivery. The female patient underwent a routine SARS-CoV-2 re verse transcription-polymerase chain reaction (RT-PCR) test on a nasal and oral swab, which was collected during admission. The patient was found to be SARS-CoV-2 positive with a cycle threshold (Ct) value of 36.4, thus indicating a low viral load. This was 221 days after the initial COVID-19 diagnosis.”
 
The specimen samples taken from the patient in this study were analyzed for the presence of mutations indicative of the variant. To this end, the samples showed the presence of the Alpha variant, whereas Delta and Omicron variant mutations were confirmed to be absent. Genomic sequencing was challenging due to the low viral load in the samples.
 
It should be noted that in December 2021, the Alpha variant was no longer in circulation in Japan, as the COVID-19 wave caused by the Alpha variant in Japan ended in July 2021. The patient had no symptoms or known contact with SARS-CoV-2-positive individuals. Since the patient’s viral load was very low, it was concluded that this was a case of prolonged viral shedding; the longest duration ever reported.
 
This female patient, geographically, is from Ibaraki Prefecture, where the Alpha variant was dominant from April to July 2021. Comparatively, the Delta variant was the dominant circulating strain in this area by mid-September 2021, which is when it almost completely replaced the Alpha variant.
 
It is important to note that when the patient in the current study was tested SARS-CoV-2 positive, the Omicron variant was dominant in the region. Almost all SARS-CoV-2 infections in January and February 2022 were due to the Omicron variant. If the woman was re-infected, it would more likely have been due to the Delta or Omicron variant.
 
Numerous past studies have shown that individuals with mild to moderate and severe COVID-19 can test RT-PCR positive up to 17.2 days and 19.8 days after the symptom onset, respectively. Additional reports of prolonged viral shedding have also been published.
 
From existing published data, the average duration of SARS-CoV-2 shedding was 17.0 days and the maximum duration was 83 days. Usually, prolonged viral shedding is associated with older age, hypertension, coronary artery disease, and diabetes mellitus; however, pregnancy has not been previously associated with this phenomenon.
 
One previous case study reports prolonged viral shedding during pregnancy after 104 days of the initial positive test.
 
The study team stresses that there remains a lack of understanding of the mechanism for prolonged viral shedding during pregnancy.
 
It is important to note that during pregnancy, there are physiological changes in the immune environment within the maternal body that are predominantly Th2 cell-mediated with attenuation of Th1 cell-mediated immunity. As a result, a pregnant woman is susceptible to intracellular pathogens, including viruses.
 
Importantly, studies have shown that the lungs of pregnant mice have an eight times higher viral load of influenza virus than non-pregnant mice. This implies that viral clearance is impeded during pregnancy.
 
It is already known that Th2-dominant immunity promotes the expression of anti-inflammatory cytokines. Thus, it is possible that in pregnant women, the immune response to SARS-CoV-2 infection is Th2-dominant, which may result in mild COVID-19 symptoms in pregnant women. Thus, the Th2-dominant state may cause prolonged viral shedding and prevent severe COVID-19 in this patient population.
 
One limitation of the study was that due to the low viral load in the patient’s sample, no genomic sequence data was available. Therefore, Alpha variant confirmation was done by variant strain screening PCR test.
 
The study findings also show that viral persistence is an existing issue, that vaccinated individuals can also shed the virus, hence contribute to spreading the virus and that most importantly that even immunocompetent individuals can have prolonged viral shedding.
 
For more on Viral Shedding And SARS-CoV-2, keep on logging to Thailand Medical News.
 

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