title: Viral load in patients infected with pandemic H1N1 2009 influenza A virus.
abstract: Viral shedding profile of infections caused by the pandemic H1N1 2009 influenza A virus has not been reported. The aim of this study was to determine the viral load in different body sites. Viral loads of pandemic H1N1 virus in respiratory specimens, stool, urine, and serum were determined by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Respiratory specimens from patients with seasonal influenza were used as historical controls. Initial pre-treatment viral load were compared between these two groups. Serial respiratory specimens from patients with pandemic H1N1 virus infection were obtained for analysis of viral dynamics. Twenty-two pandemic H1N1 cases and 44 seasonal influenza historical controls were included. The mean initial viral load before oseltamivir therapy was 1.84 x 10(8) copies/ml for pandemic H1N1 virus compared with 3.28 x 10(8) copies/ml in seasonal influenza historical controls (P = 0.085). Among patients with pandemic H1N1 virus infection, peak viral load occurred on the day of onset of symptoms, and declined gradually afterwards, with no virus being detectable in respiratory specimens by RT-PCR 8 days and by culture 5 days after the onset of symptoms respectively, except in one patient. Pandemic H1N1 virus was detected in stool and in urine from 4/9 and 1/14 patients, respectively. Viral culture was also positive from the stool sample with the highest viral load. Younger age was associated with prolonged shedding in the respiratory tract and higher viral load in the stool. Data from this quantitative analysis of viral shedding may have implications for formulating infection control measures.
authors: Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors: Kelvin K W
authors: KK
authors: To
authors: Kwok-Hung
authors: KH
authors: Chan
authors: Iris W S
authors: IW
authors: Li
authors: Tak-Yin
authors: TY
authors: Tsang
authors: Herman
authors: H
authors: Tse
authors: Jasper F W
authors: JF
authors: Chan
authors: Ivan F N
authors: IF
authors: Hung
authors: Sik-To
authors: ST
authors: Lai
authors: Chi-Wai
authors: CW
authors: Leung
authors: Yat-Wah
authors: YW
authors: Kwan
authors: Yu-Lung
authors: YL
authors: Lau
authors: Tak-Keung
authors: TK
authors: Ng
authors: Vincent C C
authors: VC
authors: Cheng
authors: Joseph S M
authors: JS
authors: Peiris
authors: Kwok-Yung
authors: KY
authors: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012137:Respiratory System / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012621:Seasons; D014556:Urine / Q000821:virology; D019562:Viral Load / Q000502:physiology*; D014776:Virus Cultivation; D017201:Virus Shedding; D055815:Young Adult