Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)
Identifieur interne : 000738 ( Pmc/Corpus ); précédent : 000737; suivant : 000739Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)
Auteurs : Jaffar A. Al-TawfiqSource :
- Travel Medicine and Infectious Disease [ 1477-8939 ] ; 2020.
Url:
DOI: 10.1016/j.tmaid.2020.101608
PubMed: 32114075
PubMed Central: 7102602
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)</title><author><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><affiliation><nlm:aff id="aff1">Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, Indiana, USA</nlm:aff></affiliation><affiliation><nlm:aff id="aff3">Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32114075</idno><idno type="pmc">7102602</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102602</idno><idno type="RBID">PMC:7102602</idno><idno type="doi">10.1016/j.tmaid.2020.101608</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000738</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000738</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)</title><author><name sortKey="Al Tawfiq, Jaffar A" sort="Al Tawfiq, Jaffar A" uniqKey="Al Tawfiq J" first="Jaffar A." last="Al-Tawfiq">Jaffar A. Al-Tawfiq</name><affiliation><nlm:aff id="aff1">Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">Indiana University School of Medicine, Indiana, USA</nlm:aff></affiliation><affiliation><nlm:aff id="aff3">Johns Hopkins University School of Medicine, Baltimore, MD, USA</nlm:aff></affiliation></author></analytic><series><title level="j">Travel Medicine and Infectious Disease</title><idno type="ISSN">1477-8939</idno><idno type="eISSN">1873-0442</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Al Tawfiq, J A" uniqKey="Al Tawfiq J">J.A. Al-Tawfiq</name></author><author><name sortKey="Gautret, P" uniqKey="Gautret P">P. Gautret</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Granados, A" uniqKey="Granados A">A. Granados</name></author><author><name sortKey="Goodall, E C" uniqKey="Goodall E">E.C. Goodall</name></author><author><name sortKey="Luinstra, K" uniqKey="Luinstra K">K. Luinstra</name></author><author><name sortKey="Smieja, M" uniqKey="Smieja M">M. Smieja</name></author><author><name sortKey="Mahony, J" uniqKey="Mahony J">J. Mahony</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Camargo, C N" uniqKey="Camargo C">C.N. Camargo</name></author><author><name sortKey="Carraro, E" uniqKey="Carraro E">E. Carraro</name></author><author><name sortKey="Granato, C F" uniqKey="Granato C">C.F. Granato</name></author><author><name sortKey="Bellei, N" uniqKey="Bellei N">N. Bellei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Furuya Kanamori, L" uniqKey="Furuya Kanamori L">L. Furuya-Kanamori</name></author><author><name sortKey="Cox, M" uniqKey="Cox M">M. Cox</name></author><author><name sortKey="Milinovich, G J" uniqKey="Milinovich G">G.J. Milinovich</name></author><author><name sortKey="Magalhaes, R J S" uniqKey="Magalhaes R">R.J.S. Magalhaes</name></author><author><name sortKey="Mackay, I M" uniqKey="Mackay I">I.M. Mackay</name></author><author><name sortKey="Yakob, L" uniqKey="Yakob L">L. Yakob</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilder Smith, A" uniqKey="Wilder Smith A">A. Wilder-Smith</name></author><author><name sortKey="Teleman, M D" uniqKey="Teleman M">M.D. Teleman</name></author><author><name sortKey="Heng, B H" uniqKey="Heng B">B.H. Heng</name></author><author><name sortKey="Earnest, A" uniqKey="Earnest A">A. Earnest</name></author><author><name sortKey="Ling, A E" uniqKey="Ling A">A.E. Ling</name></author><author><name sortKey="Leo, Y S" uniqKey="Leo Y">Y.S. Leo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rothe, C" uniqKey="Rothe C">C. Rothe</name></author><author><name sortKey="Schunk, M" uniqKey="Schunk M">M. Schunk</name></author><author><name sortKey="Sothmann, P" uniqKey="Sothmann P">P. Sothmann</name></author><author><name sortKey="Bretzel, G" uniqKey="Bretzel G">G. Bretzel</name></author><author><name sortKey="Froeschl, G" uniqKey="Froeschl G">G. Froeschl</name></author><author><name sortKey="Wallrauch, C" uniqKey="Wallrauch C">C. Wallrauch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, J F W" uniqKey="Chan J">J.F.-W. Chan</name></author><author><name sortKey="Yuan, S" uniqKey="Yuan S">S. Yuan</name></author><author><name sortKey="Kok, K H" uniqKey="Kok K">K.-H. Kok</name></author><author><name sortKey="To, K K W" uniqKey="To K">K.K.-W. To</name></author><author><name sortKey="Chu, H" uniqKey="Chu H">H. Chu</name></author><author><name sortKey="Yang, J" uniqKey="Yang J">J. Yang</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="brief-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Travel Med Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Travel Med Infect Dis</journal-id><journal-title-group><journal-title>Travel Medicine and Infectious Disease</journal-title></journal-title-group><issn pub-type="ppub">1477-8939</issn><issn pub-type="epub">1873-0442</issn><publisher><publisher-name>Elsevier Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32114075</article-id><article-id pub-id-type="pmc">7102602</article-id><article-id pub-id-type="publisher-id">S1477-8939(20)30075-2</article-id><article-id pub-id-type="doi">10.1016/j.tmaid.2020.101608</article-id><article-id pub-id-type="publisher-id">101608</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19)</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Al-Tawfiq</surname><given-names>Jaffar A.</given-names></name><email>jaffar.tawfiq@jhah.com</email><email>jaffar.tawfiq@jhah.com</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref><xref rid="aff3" ref-type="aff">c</xref><xref rid="cor1" ref-type="corresp">∗</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia</aff><aff id="aff2"><label>b</label>Indiana University School of Medicine, Indiana, USA</aff><aff id="aff3"><label>c</label>Johns Hopkins University School of Medicine, Baltimore, MD, USA</aff><author-notes><corresp id="cor1"><label>∗</label>Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia <email>jaffar.tawfiq@jhah.com</email><email>jaffar.tawfiq@jhah.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>27</day><month>2</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>27</day><month>2</month><year>2020</year></pub-date><elocation-id>101608</elocation-id><history><date date-type="received"><day>12</day><month>2</month><year>2020</year></date><date date-type="rev-recd"><day>19</day><month>2</month><year>2020</year></date><date date-type="accepted"><day>24</day><month>2</month><year>2020</year></date></history><permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions></article-meta></front><body><p content-type="salutation">To the editor,</p><p id="p0010">The occurrence of asymptomatic individuals with coronaviruses or other viruses may pose a significant public health issue. A recent review in this journal showed that an increase in the rate of asymptomatic individuals with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) increased from 0% to 28.6% [<xref rid="bib1" ref-type="bibr">1</xref>]. Actually, as the MERS-CoV progressed overtime there was more identification of asymptomatic individuals due to increased surviellance and contacts testing. This increase had proportionally but inversely affected the case fatality rate. It is expected that early on the course of any outbreak that severe cases are recognized first and then less severe (mildly or asymptomatic) cases are detected with increasing frequency. The extent of asymptomatic MERS-CoV cases is about 9.8% from different studies, <xref rid="tbl1" ref-type="table">Table 1</xref>[<xref rid="bib1" ref-type="bibr">1</xref>].<table-wrap position="float" id="tbl1"><label>Table 1</label><caption><p>Extent of Asymptomatic MERS-CoV among tested individuals based on Reverse Transcriptase PCR, data are from Ref. [<xref rid="bib1" ref-type="bibr">1</xref>].</p></caption><alt-text id="alttext0010">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th>Setting</th><th>Proportion of asymptomatic cases (%)</th></tr></thead><tbody><tr><td align="left">laboratory-confirmed and probable MERS-CoV cases from 9 countries</td><td align="left">18/144 (12.5%)</td></tr></tbody></table><table frame="hsides" rules="groups"><tbody><tr><td align="left">HCWs contacts</td><td align="left">4/520 (1%)</td></tr><tr><td align="left">South Korea contacts</td><td align="left">3/186 (1.6%)</td></tr><tr><td align="left">Jeddah Outbreak</td><td align="left">64/255 (25%)</td></tr><tr><td align="left">Pediatric patients</td><td align="left">9/11 (82)</td></tr><tr><td align="left">Pediatric patients</td><td align="left">13/31 (42%)</td></tr><tr><td align="left">Hospital admission</td><td align="left">3/7 (42.8%)</td></tr></tbody></table></table-wrap></p><p id="p0015">A study of human rhinovirus showed that asymptomatic infection was four times as common as symptomatic infection [<xref rid="bib2" ref-type="bibr">2</xref>] and another study showed that the rate of rhinovirus infection among a pair of asymptomatic parents of a rhinovirus symptomatic child was one of 36 (2.8%) with an overall positivity of 23.5% among symptomatic subjects and 3.6% of asymptomatic subjects [<xref rid="bib3" ref-type="bibr">3</xref>]. Asymptomatic carriage of influenza virus was estimated to be 5.2%–35.5% [<xref rid="bib4" ref-type="bibr">4</xref>] Based on serology, the positivity rate was 13% in asymptomatic SARS 4% in those with mild symptoms, and 82% in those with severe disease [<xref rid="bib5" ref-type="bibr">5</xref>].</p><p id="p0020">Since the emergence of SARS-COV-2, (known initially as 2019-nCoV), in Wuhan, China, in December 2019, the number of global cases had increased significantly. The increase in the number of cases is alarming and brought the fear of having viral transmission from asymptomatic individuals. One report indicated that an asymptomatic person was able to transmit the virus to another patient in Germany [<xref rid="bib6" ref-type="bibr">6</xref>]. In addition, in a family cluster of cases who went to Wuhan from Shenzen, the parents and the grandparents who visited a family member in a hospital had symptoms and they tested positive for SARS-CoV-2 (2019-nCoV). The family insisted in testing a 10-year-old asymptomatic boy and the tests were positive as tested by RT-PCR in nasopharyngeal and throat swab samples and the CT-scan showed mild infiltrate [<xref rid="bib7" ref-type="bibr">7</xref>].</p><p id="p0025">The contribution of asymptomatic persons with MERS-CoV or SARS-CoV-2 to the transmission is not well characterized. Those asymptomatic cases may play a role in the transmission and thus pose a significant infection control challenge. However, the contribution of asymptomatic cases in the transmission of these viruses is not well known and deserve further studies to examine the extent of occurrence and the role in transmission. These studies should examine the clinical course of those individuals, viral dynamics, viral loads and contribution to the transmission. It is crucial to evaluate the burden of asymptomatic individuals. Such studies will enhance the understanding of the pathogenesis of these emerging viruses and will inform policy makers to make scientifically sound recommendations.</p><sec id="sec1"><title>Funding source</title><p id="p0030">None.</p></sec><sec id="sec2"><title>CRediT authorship contribution statement</title><p id="p0035"><bold>Jaffar A. Al-Tawfiq:</bold> Conceptualization, Writing - original draft.</p></sec><sec sec-type="COI-statement"><title>Declaration of competing interest</title><p id="p0040">None.</p></sec></body><back><ref-list id="cebib0010"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="journal" id="sref1"><person-group person-group-type="author"><name><surname>Al-Tawfiq</surname><given-names>J.A.</given-names></name><name><surname>Gautret</surname><given-names>P.</given-names></name></person-group><article-title>Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: extent and implications for infection control: a systematic review</article-title><source>Trav Med Infect Dis</source><volume>27</volume><year>2019</year><fpage>27</fpage><lpage>32</lpage></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="sref2"><person-group 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