Virologic characteristics of SARS-CoV-2 infection across evolving omicron subvariants.
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Abstract | BACKGROUND: The SARS-CoV-2 virus has evolved subvariants since the emergence of the omicron variant in 2021. Whether these changes impact viral shedding and transmissibility is not known.METHODS: POSITIVES is a prospective longitudinal cohort of individuals with mild SARS-CoV-2 infection. Ambulatory, immunocompetent participants who did not receive antivirals self-administered 6 anterior nasal swabs over 15 days. Samples were analyzed by qPCR to quantify viral RNA, semi-quantitative viral culture to detect shedding of replication-competent virus, and whole genome sequencing to classify subvariants. Our predictor of interest was omicron subvariant: BA.1x, BA.2x, BA.4/5x, XBB.x and JN.x. Outcomes included RNA levels and duration of shedding replication-competent virus. We additionally explored whether the duration and severity of symptom correlated with duration of viral shedding and whether symptoms are a valid marker for ending isolation.RESULTS: The median peak nasal SARS-CoV-2 RNA (6.0-6.3 log10 RNA copies/mL), median days to peak RNA (4-5 days), median days to undetectable viral RNA (10-12 days) and median days to negative viral culture (3.5-6 days) was similar across omicron subvariants. Number and severity of symptoms were also similar. For all subvariants, a sizeable percentage (range 28.2-52.0%) shed replication-competent virus after fever resolution and improvement of symptoms.CONCLUSION: Despite ongoing viral evolution, key aspects of viral dynamics of SARS-CoV-2 infection, including the duration of shedding replication-competent virus, have not substantially changed across omicron subvariants. Replication-competent shedding of these subvariants is detected for a large proportion of people who meet criteria for ending isolation.FUNDING: This work was supported by the National Institutes of Health (NIH), the Massachusetts Consortium on Pathogen Readiness, and the Massachusetts General Hospital Department of Medicine. |
Year of Publication | 2025
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Journal | JCI insight
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Date Published | 09/2025
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ISSN | 2379-3708
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DOI | 10.1172/jci.insight.192228
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PubMed ID | 40924669
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