Reliability of self-sampling for accurate assessment of respiratory virus viral and immunologic kinetics

Alpana Waghmare; Elizabeth M Krantz; Subhasish Baral; Emma Vasquez; Tillie Loeffelholz; E. Lisa Chung; Urvashi Pandey; Jane Kuypers; Elizabeth R Duke; Keith R Jerome; Alexander L Greninger; Daniel B Reeves; Florian Hladik; E Fabian Cardozo-Ojeda; Michael Boeckh; Joshua T Schiffer

is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/2020.04.03.20051706 doi: medRxiv preprint instructions were easy to follow, and 90% agreed or strongly agreed that the collection kit return 113 process was easy. Serial home-based testing appears to be a well-accepted methodology. 114 115 Steady-state nasal passage viral load kinetics during respiratory virus infections. In the 116 longitudinal sampling portion of our study, we were able to detect 14 viruses including seven 117 human rhinovirus (HRV), two coronavirus (CoV), one bocavirus (BoV), two adenovirus (ADV), 118 one human metapneumovirus (MPV) and one respiratory syncytial virus (RSV) cases. There 119 were four instances of viral co-infection, though in each case a dominant virus was evident 120 based on greater duration of shedding and higher viral load (Fig 2a) . 121 122 Duration of shedding was heterogeneous. In 5 cases, HRV shedding lasted more than a week 123 with one instance of 5-day shedding and one short single-day blip. RSV and MPV episodes 124 were both prolonged. ADV, BoV and CoV shedding was short-lived, though in one case low-125 level ADV shedding was evident throughout the sampling period (Fig 2a) . 126 127 During most extended periods of HRV, RSV and HMPV shedding, viral loads were remarkably 128 stable from sample to sample (Fig 2a) . For HRV, a generalized pattern of viral load steady state 129 or slight gradual decline, followed by rapid elimination was noted. The single case of RSV had a 130 similar profile but with an initial high viral load peak and shorter duration of shedding. The single 131 case of MPV had a more protracted decline with a single re-expansion phase. These transiently 132 observed periods of steady state viral loads are highly unlikely to occur by chance if true viral 133 loads fluctuated or exhibited stochastic noise. Thus, the sampling method appears highly 134 reliable. These data also suggest a brief period of equilibrium between the virus and local 135 immune system before viral elimination. 136 137 . CC-BY-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.