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Medline, Scopus, and Web of Science databases were searched using a combination of search terms to identify articles that tested exhaled material from SARS-CoV-2 infected patients. Records were systematically screened and assessed for eligibility, following which reference lists of eligible articles were hand-searched to identify further relevant studies. Data extraction and quality assessment of individual studies were conducted prior to synthesizing the evidence. Forty-five articles that sampled exhaled breath, exhaled breath condensate, face masks, and cough samples were reviewed. The variation in the SARS-CoV-2 viral load in these materials was considerable with the detection of viral RNA shed during breathing as far as 43\u00a0days after symptom onset. The replication-competent virus was present in all four sample types, with the majority isolated during the first week of symptoms onset. Variations in the sample types and testing protocols precluded meta-analysis. High heterogeneity in exhaled SARS-CoV-2 viral load is likely due to host and viral factors as well as variations in sampling and diagnostic methodologies. Evidence on SARS-CoV-2 shedding in exhaled material is scarce and more controlled fundamental studies are needed to assess this important route of viral shedding.<\/jats:p>","DOI":"10.1017\/s0950268825100174","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T01:35:51Z","timestamp":1750383351000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Severe acute respiratory syndrome coronavirus-2 shedding in exhaled material: a systematic review"],"prefix":"10.1017","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-9573","authenticated-orcid":false,"given":"A. M. 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