{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:47:08Z","timestamp":1784306828545,"version":"3.55.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T00:00:00Z","timestamp":1613952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Zhoushan Municipal Science and Technology Project","award":["2020C31004"],"award-info":[{"award-number":["2020C31004"]}]},{"name":"Zhoushan Municipal Science and Technology Project","award":["2020C31005"],"award-info":[{"award-number":["2020C31005"]}]},{"name":"Zhoushan Municipal Science and Technology Project","award":["2020C31006"],"award-info":[{"award-number":["2020C31006"]}]},{"name":"China Spark Program","award":["2015GA700094"],"award-info":[{"award-number":["2015GA700094"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>This study aimed to identify the specimen type that has high positivity and its proper sampling time for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to promote diagnostic efficiency. All SARS-CoV-2-infected patients with a laboratory-confirmed diagnosis in Zhoushan City were followed up for viral shedding in respiratory tract specimens and faecal samples. Positivity was analysed both qualitatively and quantitatively by proper statistical approaches with strong testing power. Viral shedding in respiratory tract and faecal specimens was prolonged to 45 and 40 days after the last exposure, respectively. The overall positive rate in respiratory tract specimens was low and relatively unstable, being higher in the early-to-mid stage than in the mid-to-late stage of the disease course. Compared with respiratory tract specimens, faecal samples had a higher viral load, higher overall positive rate, and more stable positivity in different disease courses and varied symptomatic status. Faecal specimens have the potential ability to surpass respiratory tract specimens in virus detection. Testing of faecal specimens in diagnosis, especially for identifying asymptomatic carriers, is recommended. Simultaneously, testing respiratory tract specimens at the early-to-mid stage is better than testing at the mid-to-late stage of the disease course. A relatively small sample size was noted, and statistical approaches were used to address it. Information was missing for both specimen types at different stages of the disease course due to censored data. Our research extends the observed viral shedding in both specimen types and highlights the importance of faecal specimen testing in SARS-CoV-2 diagnosis. Healthcare workers, patients, and the general public may all benefit from our study findings. Disposal of sewage from hospitals and residential areas should be performed cautiously because the virus sheds in faeces and can last for a long time.<\/jats:p>","DOI":"10.1371\/journal.pone.0247367","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T18:25:33Z","timestamp":1614018333000},"page":"e0247367","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["SARS-CoV-2 viral shedding characteristics and potential evidence for the priority for faecal specimen testing in diagnosis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0031-0079","authenticated-orcid":true,"given":"Chen","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefeng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxin","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiabei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jienan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songye","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haodi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyu","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialu","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhendong","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,22]]},"reference":[{"key":"pone.0247367.ref001","unstructured":"WHO Coronavirus Disease (COVID-19) Dashboard. 2021. [Cited 2021 Jan 9]. In: World Health Organization. [Internet]. https:\/\/covid19.who.int\/"},{"key":"pone.0247367.ref002","unstructured":"Weekly epidemiological update\u20145 January 2021. 2021.[Cited 2021 Jan 9]. In: World Health Organization. [Internet]. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/situation-reports"},{"issue":"06","key":"pone.0247367.ref003","first-page":"380","article-title":"Characteristics of the third generation sequencing technology and its application in researching of viral genomes","volume":"11","author":"Y Yi","year":"2016","journal-title":"Journal of Microbes and Infection"},{"issue":"2","key":"pone.0247367.ref004","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3201\/eid1002.030610","article-title":"Detection of SARS coronavirus in patients with suspected SARS","volume":"10","author":"KH Chan","year":"2004","journal-title":"Emerg Infect Dis"},{"issue":"9371","key":"pone.0247367.ref005","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/S0140-6736(03)13412-5","article-title":"Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study","volume":"361","author":"JS Peiris","year":"2003","journal-title":"Lancet"},{"issue":"13","key":"pone.0247367.ref006","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1056\/NEJMc1511695","article-title":"Viral Load Kinetics of MERS Coronavirus Infection","volume":"375","author":"MD Oh","year":"2016","journal-title":"N Engl J Med"},{"key":"pone.0247367.ref007","first-page":"1","article-title":"Comparison of throat swab and sputum specimens for viral nucleic acid detection in four cases of 2019-nCoV infection","author":"C Wei","year":"2020","journal-title":"Chinese Journal of Zoonoses"},{"key":"pone.0247367.ref008","article-title":"SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients","author":"L Zou","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0247367.ref009","first-page":"1","article-title":"Detection of nucleic acid of SARS-CoV-2 in medical laboratory and its practice","author":"H Kuang","year":"2020","journal-title":"Chinese Journal of Nosocomiology"},{"key":"pone.0247367.ref010","unstructured":"Law of the People\u2019s Republic of China on prevention and control of infectious diseases. 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[Cited 2020 April 8]. In: World Health Organization. [Internet]. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/question-and-answers-hub"},{"key":"pone.0247367.ref020","article-title":"Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore","author":"BE Young","year":"2020","journal-title":"JAMA"},{"key":"pone.0247367.ref021","article-title":"Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding","author":"Y Xu","year":"2020","journal-title":"Nat Med"},{"issue":"9422","key":"pone.0247367.ref022","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/S0140-6736(04)16255-7","article-title":"Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome","volume":"363","author":"PK Cheng","year":"2004","journal-title":"Lancet"},{"key":"pone.0247367.ref023","article-title":"Viral load of SARS-CoV-2 in clinical samples","author":"Y Pan","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"pone.0247367.ref024","article-title":"Comparative analysis of primer-probe sets for the laboratory confirmation of SARS-CoV-2","author":"YJ Jung","year":"2020","journal-title":"bioRxiv"},{"key":"pone.0247367.ref025","article-title":"A familial cluster of COVID-19 indicating virus can be transmitted by asymptomatic carriers","author":"S Zhang","year":"2020","journal-title":"Bull World Health Organ"},{"key":"pone.0247367.ref026","unstructured":"The 2019 Statistical Yearbook of Zhoushan City.2019. [Cited 2020 March 8]. In: Zhoushan Municipal Statistics Bureau. [Internet]. http:\/\/zstj.zhoushan.gov.cn\/col\/col1228998393\/index.html"},{"key":"pone.0247367.ref027","first-page":"19","article-title":"Systematic autopsy of coronavirus disease: observation report","volume":"36","author":"L Qian","year":"2020","journal-title":"Journal of Forensic Medicine"},{"key":"pone.0247367.ref028","article-title":"Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer","author":"S Tian","year":"2020","journal-title":"J Thorac Oncol"},{"key":"pone.0247367.ref029","article-title":"Pathological findings of COVID-19 associated with acute respiratory distress syndrome","author":"Z Xu","year":"2020","journal-title":"Lancet Respir Med"},{"key":"pone.0247367.ref030","unstructured":"David CD Upper respiratory tract. 2020 April 15. [Cited 2020 April 16]. 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