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Rational Vaxxer

Attached is a scientific commentary which outlines information on asymptomatic shedding and also gives the citations for the direct studies.

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Rational Vaxxer

Attached is a scientific commentary which outlines information on asymptomatic shedding and also gives the citations for the direct studies.

 To put it in layman's terms even people who are asymptomatic can still shed 10% of the time which is an average of 18 times a year. The actual act of shedding is considered an outbreak, ulcers and sores are considered the secondary.  Another interesting point is the tingling sensation that you get otherwise known as prodrome is actually the immune system attacking the virus.  A day or so prior to actually getting prodrome is when the virus started reemerging and replicating. 

http://m.jid.oxfordjournals.org/content/198/8/1098.full

Edited by Rational Vaxxer
Misspelling add info

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WilsoInAus

There are several things that are not known.

The main issue is the vexed question of what proportion of shedding instances involve a transmission quantity of shedding. The testing noted in the articles is usually daily. It is more likely for example that people shed at least one copy of the virus each and every single day. What is more important is whether there is a sufficient quantity of live virus to infect. This occurs on very occasions during a year.

Even post a vaccine, people may shed the virus daily, but the transmission quantity occasions could be dramatically cut.

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Rational Vaxxer

 The study does not state  that people shed the virus daily,  curious...where did you get that information from ? 

Edited by Rational Vaxxer

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WilsoInAus

Studies that test for shedding multiple times a day detect more shedding instances, what is the asymptotic level if you measured each second say? 

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Rational Vaxxer

 That's an interesting statement but where is that study? What study did that and where are the findings?

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WilsoInAus

Have a look at this paper:

http://pubmedcentralcanada.ca/pmcc/articles/PMC3563330/

It shows that the shorter the timeframe between swabs, the more the virus is detected. Look at the increase from moving from 24 hourly to 6 hourly. As I say, a very open question as to what would be discovered if the sampling was continuous!

All this detracts from the point, what is important is transmission, it matters not if we discover the true frequency of 'shedding' as this will not change the current transmission rates from a person that is asymptomatic.

Recent studies have illustrated that the major burden of HSV-2 infection lies in frequent recurrences – ≥80% of which are asymptomatic or unrecognized. Studies that use daily self-collected anogenital swabs to detect HSV-2 reactivation demonstrated that the median shedding rate was 25% of days (range 2% to 75% of days) (12). A study that used six hourly swabbing found that 49% of episodes lasted less than 12 hours and 29% lasted less than 6 hours (13). Even these short bursts of HSV-2 replication have viral copy numbers sufficient for HSV-2 transmission. An intra-host model of HSV-2 pathogenesis estimated that the dorsal root ganglion releases small amounts of virus in a near constant pattern to replicate the shedding patterns seen in clinical studies (14). A key characteristic of HSV-2 infection is now understood to be near-constant viral shedding--not at all the quiescent latent phase previously ascribed to HSV-2 between episodes of symptomatic genital ulcer disease, which were described to be infrequent (11).

 

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Rational Vaxxer
9 hours ago, WilsoInAus said:

Have a look at this paper:

http://pubmedcentralcanada.ca/pmcc/articles/PMC3563330/

It shows that the shorter the timeframe between swabs, the more the virus is detected. Look at the increase from moving from 24 hourly to 6 hourly. As I say, a very open question as to what would be discovered if the sampling was continuous!

All this detracts from the point, what is important is transmission, it matters not if we discover the true frequency of 'shedding' as this will not change the current transmission rates from a person that is asymptomatic.

Recent studies have illustrated that the major burden of HSV-2 infection lies in frequent recurrences – ≥80% of which are asymptomatic or unrecognized. Studies that use daily self-collected anogenital swabs to detect HSV-2 reactivation demonstrated that the median shedding rate was 25% of days (range 2% to 75% of days) (12). A study that used six hourly swabbing found that 49% of episodes lasted less than 12 hours and 29% lasted less than 6 hours (13). Even these short bursts of HSV-2 replication have viral copy numbers sufficient for HSV-2 transmission. An intra-host model of HSV-2 pathogenesis estimated that the dorsal root ganglion releases small amounts of virus in a near constant pattern to replicate the shedding patterns seen in clinical studies (14). A key characteristic of HSV-2 infection is now understood to be near-constant viral shedding--not at all the quiescent latent phase previously ascribed to HSV-2 between episodes of symptomatic genital ulcer disease, which were described to be infrequent (11).

 

 While this is very interesting it's only dealing with a 25%-75% of shedding in a 6 hour period.  This is pretty common during an outbreak period to be shedding quite a bit during that time.  The numbers do not mean you are shedding every day,  throughout the entire year.  Also the study is from 2012. 

Edited by Rational Vaxxer

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Rational Vaxxer

 I'm not seeing anywhere in the article where it states that you would shed every day 

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WilsoInAus

I didn't say it did. I pointed out that the more often a day you test, the more shedding you discover. I posed the question as to what is the asymptotic level of shedding if you could test each second of the day?

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Constant Diplomat

I think Wilso is making a pretty clear point here. More data points, more clarity.

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Rational Vaxxer
3 hours ago, WilsoInAus said:

I didn't say it did. I pointed out that the more often a day you test, the more shedding you discover. I posed the question as to what is the asymptotic level of shedding if you could test each second of the day?

 

First I would ask, Who told you the more often a day you test the more shedding you discover ? Or is this just a brain teaser  hypothetical question?

It is not possible to say without actually doing the test.  There are too many variables in this equation.  For one, not everyone has the same immune response, so everyone is going to react differently.  Who is the person being tested?  How symptomatic are they?  How asymptomatic are they?  How often are they getting OBs?  How Healthy are they? 

 I doubt very highly that a person would be shedding every day. Even someone who is showing signs of constant neuralgia from HSV and suffering in a terrible way, then...maybe then, it would be possible to shed a lot, but who really knows.  A proper shedding test cost $12,000+  I couldn't even imagine how much it would cost to test someone for shedding every day for an entire month, let alone every day  

However to answer your question "What is the asymptomatic level of shedding if you could test every second of the day?" 

 More than likely...a level of zero. If someone is truly "asymptomatic" with no signs neuralgia or prodrome, the chances of them shedding are probable to 10% of the time.  Which means 18 times a year, so shedding "every day"  it's not impossible...just not probable.  In the end without actually doing the test, it's hard to say. 

 I hope that answers your question. 

Edited by Rational Vaxxer

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WilsoInAus

We cannot look at individuals, individuals will vary, what is relevant is the population distribution or profile. This can be summarised in such ways as showing the average or quartiles or even deciles. Yes there could be people that shed every day and some that do not shed at all. What is more important is to understand the full profile, which can be done by sampling enough individuals.

What is fact is that if you conduct 6 hourly testing versus 24 hourly testing, then you identify more days on which shedding occurs. This is because a proportion of shedding blooms last less than 6 hours. Hence 24 hour testing will miss a portion of blooms that last less than 24 hours in proportion to how long the blooms last. For example, there is a 50% chance a daily test will pick up a 12 hour bloom, but only 25% chance it will pick up a 6 hour bloom and so on.

We know 6 hour and less blooms exist and hence 75% of these are missed with daily testing. The question comes down to do 3 hour blooms exist, 2 hour? 1 hour? 1 minute?

So I do disagree with you. If daily testing has identified shedding as, say, 10% of days then the true level of shedding at least one copy of the virus per day will be multiples of this on the basis of what we know now. What we may know in future can only add to this.

Again not terribly relevant as the transmission rates do not change regardless of how much we understand shedding.

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