Prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of case-ascertained household cohort

Matthew So; Sarah A Goldberg; Scott Lu; Miguel Garcia-Knight; Michelle C Davidson; Michel Tassetto; Victoria Wong Murray; Khamal Anglin; Jesus Pineda-Ramirez; Jessica Y Chen; Paulina R Rugart; Eugene T Richardson; Melissa Briggs Hagen; Claire M Midgley; Raul Andino; Gerami D Seitzman; John Gonzales; Michael J Peluso; Jeffrey N Martin; J Daniel Kelly

doi:10.1016/j.ajo.2024.04.008

Prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of case-ascertained household cohort

Am J Ophthalmol. 2024 Apr 23:S0002-9394(24)00149-1. doi: 10.1016/j.ajo.2024.04.008. Online ahead of print.

Authors

Matthew So¹, Sarah A Goldberg², Scott Lu², Miguel Garcia-Knight³, Michelle C Davidson⁴, Michel Tassetto³, Victoria Wong Murray⁵, Khamal Anglin⁶, Jesus Pineda-Ramirez⁶, Jessica Y Chen⁶, Paulina R Rugart⁷, Eugene T Richardson⁸, Melissa Briggs Hagen⁹, Claire M Midgley⁹, Raul Andino³, Gerami D Seitzman¹⁰, John Gonzales¹⁰, Michael J Peluso¹¹, Jeffrey N Martin⁷, J Daniel Kelly¹²

Affiliations

¹ Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA. Electronic address: matt.so@ucsf.edu.
² Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
³ Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA.
⁴ School of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁵ School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA.
⁶ Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA.
⁷ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹⁰ F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, California.
¹¹ Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
¹² Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA; F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA. Electronic address: Dan.Kelly@ucsf.edu.

PMID: 38663502
DOI: 10.1016/j.ajo.2024.04.008

Abstract

Purpose: To investigate the prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of case-ascertained household cohort.

Design: Prospective, longitudinal case-ascertained household cohort identified through convenience sampling.

Methods: This analysis was restricted to individuals who were non-hospitalized, symptomatic, and tested positive for SARS-CoV-2 by nasal RT-PCR. Tears and anterior nasal biospecimens were serially collected throughout the acute period. Tears specimens were collected by the study staff using Schirmer test strips, and nasal specimens were self-collected. For both, SARS-CoV-2 RNA was quantified using qRT-PCR and culturable virus was detected using presence of cytopathic effect (CPE) in tissue culture; positive CPE was confirmed by a qRT-PCR step. A series of cross-sectional unadjusted analyses were performed investigating the relationship between different sociodemographic determinants and biological factors associated with tears RNA positivity.

Results: Among the 83 SARS-CoV-2 infected participants, ten (12%) had at least one RNA positive tears specimen. Amongst these ten, five (50%) had concurrent presence of culturable virus, at a median of 7 days post symptom onset (IQR: 4-7 days) (absolute range: 4-8 days).

Conclusions: In this longitudinal cohort, we found evidence of culturable virus in the tears of a small proportion of non-hospitalized SARS-CoV-2 infected individuals. Current public health infection precautions do not account for transmission via tears, so these findings may improve our understanding of potential sources of SARS-CoV-2 transmission and contribute to developing future guidelines.

Keywords: COVID-19; Culturable; Non-hospitalized; RNA Detection; SARS-CoV-2; Tears.