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Cycle threshold dynamics of non–severe acute respiratory coronavirus virus 2 (SARS-CoV-2) respiratory viruses

Published online by Cambridge University Press:  18 January 2024

Selina Ehrenzeller Open the ORCID record for Selina Ehrenzeller [Opens in a new window] ,
Rebecca Zaffini ,
Nicole D. Pecora Open the ORCID record for Nicole D. Pecora [Opens in a new window] ,
Sanjat Kanjilal Open the ORCID record for Sanjat Kanjilal [Opens in a new window] ,
Chanu Rhee Open the ORCID record for Chanu Rhee [Opens in a new window]  and
Michael Klompas Open the ORCID record for Michael Klompas [Opens in a new window]
Selina Ehrenzeller
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland Department of Medicine, Limmattal Hospital Zurich, Schlieren, Switzerland
Rebecca Zaffini
Affiliation:
Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Nicole D. Pecora
Affiliation:
Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Sanjat Kanjilal
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Chanu Rhee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
Michael Klompas*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
*
Corresponding author: Michael Klompas; Email: mklompas@bwh.harvard.edu
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Abstract

Objective:

Many providers use severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cycle thresholds (Ct values) as approximate measures of viral burden in association with other clinical data to inform decisions about treatment and isolation. We characterized temporal changes in Ct values for non–SARS-CoV-2 respiratory viruses as a first step to determine whether cycle thresholds could play a similar role in the management of non–SARS-CoV-2 respiratory viruses.

Design:

Retrospective cohort study.

Setting:

Brigham and Women’s Hospital, Boston.

Methods:

We retrospectively identified all adult patients with positive nasopharyngeal PCRs for influenza, respiratory syncytial virus (RSV), parainfluenza, human metapneumovirus (HMPV), rhinovirus, or adenovirus between January 2022 and March 2023. We plotted Ct distributions relative to days since symptom onset, and we assessed whether distributions varied by immunosuppression and other comorbidities.

Results:

We analyzed 1,863 positive samples: 506 influenza, 502 rhinovirus, 430 RSV, 219 HMPV, 180 parainfluenza, 26 adenovirus. Ct values were generally 25–30 on the day of symptom onset, lower over the ensuing 1–3 days, and progressively higher thereafter with Ct values ≥30 after 1 week for most viruses. Ct values were generally higher and more stable over time for rhinovirus. There was no association between immunocompromised status and median intervals from symptom onset until Ct values were ≥30.

Conclusions:

Ct values relative to symptom onset for influenza, RSV, and other non–SARS-CoV-2 respiratory viruses generally mirror patterns seen with SARS-CoV-2. Further data on associations between Ct values and viral viability, transmissibility, host characteristics, and response to treatment for non-SARS-CoV-2 respiratory viruses are needed to determine how clinicians and infection preventionists might integrate Ct values into treatment and isolation decisions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 5 , May 2024 , pp. 630 - 634
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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