Advanced Search

CN 34-1304/RISSN 1674-3679

Volume 25 Issue 4
May  2021
Turn off MathJax
Article Contents
LI Zi-shuai, LIN Jian-sheng, PU Rui, ZHAO Yue, CHEN Yi-fan, CAO Guang-wen. Asymptomatic transmission in the COVID-19 pandemic: a systematic review and Meta-analysis[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(4): 445-453. doi: 10.16462/j.cnki.zhjbkz.2021.04.014
Citation: LI Zi-shuai, LIN Jian-sheng, PU Rui, ZHAO Yue, CHEN Yi-fan, CAO Guang-wen. Asymptomatic transmission in the COVID-19 pandemic: a systematic review and Meta-analysis[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(4): 445-453. doi: 10.16462/j.cnki.zhjbkz.2021.04.014

Asymptomatic transmission in the COVID-19 pandemic: a systematic review and Meta-analysis

doi: 10.16462/j.cnki.zhjbkz.2021.04.014
LI Zi-shuai and LIN Jian-sheng contributed equally to this article
Funds:

National Natural Science Foundation of China 82041022

Research Foundation of Science and Technology Commission of Shanghai Municipality 20JC1410200

Research Foundation of Science and Technology Commission of Shanghai Municipality 20431900404

More Information
  • Corresponding author: CAO Guang-wen, E-mail: gcao@smmu.edu.cn
  • Received Date: 2020-07-16
  • Rev Recd Date: 2020-10-28
  • Available Online: 2021-05-11
  • Publish Date: 2021-04-10
  •   Objective  To determine the differences in the epidemiological characteristics of asymptomatic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) patients. Methods The relevant data of asymptomatic SARS-CoV-2 transmission literature in PubMed, Web of Science, CNKI, VIP medicine and Wanfang medical database were extracted as of August 1, 2020. Epidemiological information was screened and extracted according to pre-established inclusion and exclusion criteria. Age, gender, virus shedding duration and virual load of asymptomatic carriers were summarized and analyzed. Results A total of 38 articles met the criteria, 17 of which were asymptomatic case reports related to the virus shedding duration. Compared with symptomatic infected persons, asymptomatic individuals were younger [Weighted Mean Difference (WMD), WMD=-5.27, 95% CI: -9.78--0.76, P < 0.001] and the viral load was lower (WMD=2.36, 95% CI: 0.65-4.07, P=0.007). The virus shedding duration of asymptomatic individuals (median=11 days) was shorter than symptomatic patients (median=16 days). Conclusion Asymptomatic individuals with SARS-CoV-2 were younger, had a lower viral load and a shorter virus shedding duration than COVID-19 patients.
  • loading
  • [1]
    World Health Organization. Weekly operational update on COVID-19[EB/OL]. (2020-10-24)[2020-10-28]. https://www.who.int/publications/m/item/weekly-update-on-COVID-19---23-october.
    [2]
    Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern[J]. Lancet, 2020, 395(10223): 470-473. DOI: 10.1016/s0140-6736(20)30185-9.
    [3]
    Van DN, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1[J]. N Engl J Med, 2020, 382(16): 1564-1567. DOI: 10.1056/NEJMc2004973.
    [4]
    Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges[J]. Int J Antimicrob Agents, 2020, 55(3): 105924. DOI: 10.1016/j.ijantimicag.2020.105924.
    [5]
    Meng H, Xiong R, He RY, et al. CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan, China[J]. J Infect, 2020, 81(1): e33-e39. DOI: 10.1016/j.jinf.2020.04.004.
    [6]
    Long QX, Tang XJ, Shi QL, et al. Clinical and immunological assessment of asymptomatic SARS-CoV-2 infections[J]. Nat Med, 2020, 26(8): 1200-1204. DOI: 10.1038/s41591-020-0965-6.
    [7]
    Chau NVV, Thanh Lam V, Thanh Dung N, et al. The natural history and transmission potential of asymptomatic SARS-CoV-2 infection[J]. Clin Infect Dis, 2020, 71(10): 2679-2687. DOI: 10.1093/cid/ciaa711.
    [8]
    Han H, Xu ZC, Cheng XM, et al. Descriptive, retrospective study of the clinical characteristics of asymptomatic COVID-19 patients[J]. mSphere, 2020, 5(5): e00922-20. DOI: 10.1128/mSphere.00922-20.
    [9]
    Kong WF, Wang YT, Hu JL, et al. Comparison of clinical and epidemiological characteristics of asymptomatic and symptomatic SARS-CoV-2 infection: a multi-center study in Sichuan Province, China[J]. Travel Med Infect Dis, 2020, 37: 101754. DOI: 10.1016/j.tmaid.2020.101754.
    [10]
    Li Y, Shi J, Xia JB, et al. symptomatic and symptomatic patients with non-severe coronavirus disease (COVID-19) have similar clinical features and virological courses: a retrospective single center study[J]. Front Microbiol, 2020, 11: 1570. DOI: 10.3389/fmicb.2020.01570.
    [11]
    Ma Y, Xu QN, Wang FL, et al. Characteristics of asymptomatic patients with SARS-CoV-2 infection in Jinan, China[J]. Microbes Infect, 2020, 22(4-5): 212-217. DOI: 10.1016/j.micinf.2020.04.011.
    [12]
    Mei X, Zhang YY, Zhu H, et al. Observations about symptomatic and asymptomatic infections of 494 patients with COVID-19 in Shanghai, China[J]. Am J Infect Control, 2020, 48(9): 1045-1050. DOI: 10.1016/j.ajic.2020.06.221.
    [13]
    Samrah SM, AI-Mistarehi AW, Ibnian AM, et al. COVID-19 outbreak in Jordan: epidemiological features, clinical characteristics, and laboratory findings[J]. Ann Med Surg (Lond), 2020, 57: 103-108. DOI: 10.1016/j.amsu.2020.07.020.
    [14]
    Schwierzeck V, König JC, Kühn J, et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit[J]. Clin Infect Dis, 2021, 72(2): 265-270. DOI: 10.1093/cid/ciaa491.
    [15]
    Sohn Y, Jeong SJ, Chung WS, et al. Assessing viral shedding and infectivity of asymptomatic or mildly symptomatic patients with COVID-19 in a later phase[J]. J Clin Med, 2020, 9(9): 2924. DOI: 10.3390/jcm9092924.
    [16]
    Tabata S, Imai K, Kawano S, et al. Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the diamond princess cruise ship: a retrospective analysis[J]. Lancet Infect Dis, 2020, 20(9): 1043-1050. DOI: 10.1016/s1473-3099(20)30482-5.
    [17]
    Wellinghausen N, Plonné D, Voss M, et al. SARS-CoV-2-IgG response is different in COVID-19 outpatients and asymptomatic contact persons. [J] Clin Virol, 2020, 130: 104542. DOI: 10.1016/j.jcv.2020.104542.
    [18]
    Yang RR, Gui X, Xiong Y. Comparison of clinical characteristics of patients with asymptomatic vs symptomatic coronavirus disease 2019 in Wuhan, China[J]. JAMA Netw Open, 2020, 3(5): e2010182. DOI: 10.1001/jamanetworkopen.2020.10182.
    [19]
    Yu C, Zhou M, Liu Y, et al. Characteristics of asymptomatic COVID-19 infection and progression: a multicenter, retrospective study[J]. Virulence, 2020, 11(1): 1006-1014. DOI: 10.1080/21505594.2020.1802194.
    [20]
    Zhou R, Li FR, Chen FJ, et al. Viral dynamics in asymptomatic patients with COVID-19[J]. Int J Infect Dis, 2020, 96: 288-290. DOI: 10.1016/j.ijid.2020.05.030.
    [21]
    董玉颖, 范前东, 王月萍, 等. 江苏省扬州市新型冠状病毒肺炎患者核酸检测结果分析[J]. 实用临床医药杂志, 2020, 24(5): 6-9. DOI: 10.7619/jcmp.202005002.

    Dong YY, Fan QD, Wang YP, et al. Analysis in nucleic acid test results of patients with coronavirus disease 2019 in Yangzhou City of Jiangsu Province[J]. Journal of Clinical Medicine in Practice, 2020, 24(5): 6-9. DOI: 10.7619/jcmp.202005002.
    [22]
    胡世雄, 徐巧华, 罗垲炜, 等. 湖南省新型冠状病毒肺炎感染者流行病学特征分析[J]. 实用预防医学, 2020, 27(4): 385-388. DOI: 10.3969/j.issn.1006-3110.2020.04.001.

    Hu SX, Xu QH, Luo KW, et al. Epidemiological characteristics of patients with coronavirus disease 2019 in Hunan Province[J]. Practl Prev Med, 2020, 27(4): 385-388. DOI: 10.3969/j.issn.1006-3110.2020.04.001.
    [23]
    林君芬, 吴梦娜, 吴昊澄, 等. 浙江省新型冠状病毒肺炎病例流行特征分析[J]. 预防医学, 2020, 32(3): 217-221. DOI: 10.19485/j.cnki.issn2096-5087.2020.03.001.

    Lin JF, Wu MN, Wu HC, et al. Epidemiological characteristics of coronavirus disease 2019 in Zhejiang Province[J]. Prev Med, 2020, 32(3): 217-221. DOI: 10.19485/j.cnki.issn2096-5087.2020.03.001.
    [24]
    刘碧瑶, 戚小华, 江敏, 等. 浙江省境外输入新型冠状病毒肺炎病例流行特征分析[J]. 预防医学, 2020, 32(6): 550-554. DOI: 10.19485/j.cnki.issn2096-5087.2020.06.003.

    Liu BY, Qi XH, Jiang M, et al. Epidemiological characteristics of imported COVID-19 cases from abroad to Zhejiang Province[J]. Prev Med, 2020, 32(6): 550-554. DOI: 10.19485/j.cnki.issn2096-5087.2020.06.003.
    [25]
    王婉薇, 谢丹, 谭爱, 等. 内江市一起新型冠状病毒肺炎聚集性疫情流行病学分析[J]. 职业卫生与病伤, 2020, 35(3): 140-143. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWB202003004.htm

    Wang WW, Xie D, Tan A, et al. Epidemiological analysis of an outbreak of novel coronavirus pneumonia in Neijiang City[J]. Occupational Health and Damage, 2020, 35(3): 140-143. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWB202003004.htm
    [26]
    叶莹, 范威, 王文华, 等. 新型冠状病毒肺炎聚集性疫情中无症状感染者与确诊患者的流行差异[J]. 中国感染控制杂志, 2020, 19(6): 492-497. DOI: 10.12138/j.issn.1671-9638.20206755.

    Ye Y, Fan W, Wang WH, et al. Difference in epidemic characteristics between asymptomatic infected persons and confirmed cases in COVID-19 clustered epidemics[J]. Chin J Infec Contl, 2020, 19(6): 492-497. DOI: 10.12138/j.issn.1671-9638.20206755.
    [27]
    Shi JD, Luo DH, Weng H, et al. Optimally estimating the sample standard deviation from the five-number summary[J]. Res Synth Methods, 2020, 11(5): 641-654. DOI: 10.1002/jrsm.1429.
    [28]
    Luo DH, Wan X, Liu JM, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and / or mid-quartile range[J]. Stat Methods Med Res, 2018, 27(6): 1785-1805. DOI: 10.1177/0962280216669183.
    [29]
    Li W, Su YY, Zhi SS, et al. Virus shedding dynamics in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2[J]. Clin Microbiol Infect, 2020, 26(11): 1556. e1-1556. e6. DOI: 10.1016/j.cmi.2020.07.008.
    [30]
    Dong X, Cao YY, Lu XX, et al. Eleven faces of coronavirus disease 2019[J]. Allergy, 2020, 75(7): 1699-1709. DOI: 10.1111/all.14289.
    [31]
    Huang R, Zhao HY, Wang J, et al. A family cluster of COVID-19 involving an asymptomatic case with persistently positive SARS-CoV-2 in anal swabs[J]. Travel Med Infect Dis, 2020, 38: 101745. DOI: 10.1016/j.tmaid.2020.101745.
    [32]
    Luo Y, Trevathan E, Qian ZM, et al. Asymptomatic SARS-CoV-2 infection in household contacts of a healthcare provider, Wuhan, China[J]. Emerg Infect Dis, 2020, 26(8): 1930-1933. DOI: 10.3201/eid2608.201016.
    [33]
    Tong ZD, Tang A, Li KF, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020[J]. Emerg Infect Dis, 2020, 26(5): 1052-1054. DOI: 10.3201/eid2605.200198.
    [34]
    Yang MC, Hung PP, Wu YK, et al. A three-generation family cluster with COVID-19 infection: should quarantine be prolonged?[J]. Public Health, 2020, 185: 31-33. DOI: 10.1016/j.puhe.2020.05.043.
    [35]
    Hu ZL, Song C, Xu CJ, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China[J]. Sci China Life Sci, 2020, 63(5): 706-711. DOI: 10.1007/s11427-020-1661-4.
    [36]
    Jiang XL, Zhang XL, Zhao XN, et al. Transmission potential of asymptomatic and paucisymptomatic severe acute respiratory syndrome coronavirus 2 infections: a 3-family cluster study in China[J]. J Infect Dis, 2020, 221(12): 1948-1952. DOI: 10.1093/infdis/jiaa206.
    [37]
    Zhang HJ, Su YY, Xu SL, et al. Asymptomatic and symptomatic SARS-CoV-2 infections in close contacts of COVID-19 patients: a seroepidemiological study[J]. Clin Infect Dis, 2020: ciaa771. DOI: 10.1093/cid/ciaa771.
    [38]
    白红春, 陈世东, 刘永兴. 关于"新冠肺炎"无症状感染者鼻咽拭子和肛拭核酸检测分析报告[J]. 健康忠告, 2020, (3): 94-95.

    Bai CH, Chen SD, Liu YX. Analysis of nasopharyngeal swabs and anal swab nucleic acid tests of asymptomatic COVID-19 infected persons[J]. Health Advice, 2020, (3): 94-95.
    [39]
    晁湘琴, 沈晓晨, 姜利. 苏州市姑苏区1起家庭聚集性新型冠状病毒肺炎疫情的调查分析与处置[J]. 抗感染药学, 2020, 17(3): 453-455. DOI: 10.13493/j.issn.1672-7878.2020.03-050.

    Chao XQ, Shen XC, Jiang L. Investigation and analysis on a case of family-clustering coronavirus disease in Gusu District of Suzhou and its disposition[J]. Anti-Infec Pharm, 2020, 17(3): 453-455. DOI: 10.13493/j.issn.1672-7878.2020.03-050.
    [40]
    王蔚茹, 李新蕊, 王芳, 等. 济南市一起新型冠状病毒肺炎家庭聚集性疫情分析[J]. 山东大学学报(医学版), 2020, 58(4): 54-57. DOI: 10.6040/j.issn.1671-7554.0.2020.260.

    Wang WR, Li XR, Wang F, et al. Analysis of a family cluster outbreak of coronavirus disease 2019 in Jinan City[J]. Journal of Shandong University (Health Sciences), 2020, 58(4): 54-57. DOI: 10.6040/j.issn.1671-7554.0.2020.260.
    [41]
    魏伟, 袁成良, 刘晓, 等. 婴儿无症状感染新型冠状病毒伴粪便核酸检测持续阳性1例[J]. 解放军医学院学报, 2020, 41(3): 224-225, 228. DOI: 10.3969/j.issn.2095-5227.2020.03.006.

    Wei W, Yuan CL, Liu X, et al. Novel coronavirus accompanied by a continuous positive fecal nucleic acid test in one infant was asymptomatic[J]. Acad J Chin Pla Med Sch, 2020, 41(3): 224-225, 228. DOI: 10.3969/j.issn.2095-5227.2020.03.006.
    [42]
    杨丽丽, 叶佩佩, 葛怀志, 等. 多次血尿、反复肛拭子或粪便核酸检测阳性的轻型COVID-19患儿1例[J]. 温州医科大学学报, 2020, 50(5): 423-424. DOI: 10.3969/j.issn.2095-9400.2020.05.015.

    Yang LL, Ye PP, Ge HZ, et al. One child with mild COVID-19 tested positive for multiple hematuria, repeated anal swabs or fecal nucleic acid tests[J]. Journal of Wenzhou Medical University, 2020, 50(5): 423-424. DOI: 10.3969/j.issn.2095-9400.2020.05.015.
    [43]
    姚行艳, 赵雪芸, 王美丽, 等. 无症状COVID-19引起的家庭聚集性感染[J]. 国际呼吸杂志, 2020, 40(13): 982-987. DOI: 10.3760/cma.j.cn131368-20200318-00175.

    Yao XY, Zhao XY, Wang ML, et al. Asymptomatic family cluster infections caused by COVID-19[J]. Int J Respir, 2020, 40(13): 982-987. DOI: 10.3760/cma.j.cn131368-20200318-00175.
    [44]
    郑志林, 范正俊, 艾俊, 等. 无症状新型冠状病毒肺炎核酸检测35 d持续阳性1例[J]. 疑难病杂志, 2020, 19(7): 665-666. DOI: 10.3969/j.issn.1671-6450.2020.07.005.

    Zhen ZL, Fan ZJ, Ai J, et al. An asymptomatic COVID-19 case with sustained 35-day positive nucleic acid test[J]. Chinese Journal of Difficult and Complicated Cases, 2020, 19(7): 665-666. DOI: 10.3969/j.issn.1671-6450.2020.07.005.
    [45]
    周仁彬, 陈益香, 林创兴, 等. 无症状伴肺部影像学改变的新型冠状病毒感染孕妇一例[J]. 中华围产医学杂志, 2020, 23(3): 166-168. DOI: 10.3760/cma.j.cn113903-20200220-00134.

    Zhou RB, Chen YX, Lin CX, et al. A case of COVID-19 in a pregnant woman with no symptoms and pulmonary imaging changes[J]. Chinese Journal of Perinatal Medicine, 2020, 23(3): 166-168. DOI: 10.3760/cma.j.cn113903-20200220-00134.
    [46]
    Arons MM, Hatfield KM, Reddy SC, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility[J]. N Engl J Med, 2020, 382(22): 2081-2090. DOI: 10.1056/NEJMoa2008457.
    [47]
    Lavezzo E, Franchin E, Ciavarella C, et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo'[J]. Nature, 2020, 584(7821): 425-429. DOI: 10.1038/s41586-020-2488-1.
    [48]
    Varchetta S, Mele D, Oliviero B, et al. Unique immunological profile in patients with COVID-19[J]. Cell Mol Immunol, 2021, 18(3): 604-612. DOI: 10.1038/s41423-020-00557-9.
    [49]
    陈一凡, 曹广文. 全国新型冠状病毒肺炎发病趋势初步分析[J]. 上海预防医学, 2020, 32(2): 147-150. DOI: 10.19428/j.cnki.sjpm.2020.20053.

    Chen YF, Cao GW. Incidence trend of 2019 novel coronavirus diseases (COVID-19) in China[J]. Shanghai J Prevent Med, 2020, 32(2): 147-150. DOI: 10.19428/j.cnki.sjpm.2020.20053.
    [50]
    谭晓, 钱治军, 张宏伟. 全国新型冠状病毒肺炎疫情初期治愈和死亡情况分析[J]. 上海预防医学, 2020, 32(4): 309-313. DOI: 10.19428/j.cnki.sjpm.2020.20081.

    Tan XJ, Qian ZJ, Zhang HW. Cure and death situation in early outbreak of COVID-19 in China[J]. Shanghai J Prevent Med, 2020, 32(4): 309-313. DOI: 10.19428/j.cnki.sjpm.2020.20081.
    [51]
    俞文雅, 石建伟, 王慧. 重大传染病疫情下对基层医疗卫生机构职能的思考[J]. 上海预防医学, 2020, 32(7): 561-565. DOI: 10.19428/j.cnki.sjpm.2020.20125.

    Yu WY, Shi JW, Wang H. Function of primary health care institutions in pandemics[J]. Shanghai J Prevent Med, 2020, 32(7): 561-565. DOI: 10.19428/j.cnki.sjpm.2020.20125.
    [52]
    庄华东, 宿飞, 陆蕴慧, 等. 上海市黄浦区防控新型冠状病毒肺炎工作模式实践与思考[J]. 上海预防医学, 2020, 32(5): 397-400. DOI: 10.19428/j.cnki.sjpm.2020.20129.

    Zhuang HD, Su F, Lu YH, et al. Practical experience and lessons learnt on COVID-19 prevention and control in Huangpu District, Shanghai[J]. Shanghai J Prevent Med, 2020, 32(5): 397-400. DOI: 10.19428/j.cnki.sjpm.2020.20129.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(5)

    Article Metrics

    Article views (679) PDF downloads(118) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return