TY - JOUR AU - Andersson, Monique AU - Arancibia-Cárcamo, Carolina V. AU - Auckland, Kathryn AU - Baillie, J. Kenneth AU - Barnes, Eleanor AU - Beneke, Tom AU - Bibi, Sagida AU - Brooks, Tim AU - Carroll, Miles W. AU - Crook, Derrick W. AU - Dingle, Kate AU - Dold, Christina AU - Downs, Louise O AU - Dunn, Laura AU - Eyre, David W. AU - Gilbert Jaramillo, Javier AU - Harvala, Heli AU - Hoosdally, Sarah AU - Ijaz, Samreen AU - James, Tim AU - James, William AU - Jeffery, Katie AU - Justice, Anita AU - Klenerman, Paul AU - Knight, Julian C. AU - Knight, Michael L. AU - Liu, Xu AU - Lumley, Sheila F AU - Matthews, Philippa C. AU - McNaughton, Anna L AU - Mentzer, Alexander J. AU - Mongkolsapaya, Juthathip AU - Oakley, Sarah AU - Oliveira, Marta S. AU - Peto, Timothy E.A. AU - Ploeg, Rutger J. AU - Ratcliff, Jeremy AU - Robbins, Melanie J AU - Roberts, David J. AU - Rudkin, Justine AU - Russell, Rebecca A AU - Screaton, Gavin AU - Semple, Malcolm G. AU - Skelly, Donal AU - Simmonds, Peter AU - Stoesser, Nicole AU - Turtle, Lance C.W. AU - Wareing, Susan AU - Zambon, Maria PY - 2020 DA - October TI - SARS-CoV-2 RNA detected in blood products from patients with COVID-19 is not associated with infectious virus JO - Wellcome Open Research VL - 5 IS - 181 DO - https://doi.org/10.12688/wellcomeopenres.16002.2 AB - Background: Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood. Methods: We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=462 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples. Results: We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/494 (0%, 95%CI 0-0.7%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA. There was a relationship between RT-PCR negativity and the presence of total SARS-CoV-2 antibody (p=0.02). Conclusions: vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19. PB - Wellcome Open Research UR - https://www.research.ed.ac.uk/portal/en/publications/sarscov2-rna-detected-in-blood-products-from-patients-with-covid19-is-not-associated-with-infectious-virus(e2e21492-1602-44fa-8248-3a9b8525d121).html KW - Coronavirus (COVID-19) ER