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Review
. 2025 Feb 24;46(3):1-9.
doi: 10.1017/ice.2025.11. Online ahead of print.

Risk period for transmission of SARS-CoV-2 and seasonal influenza: a rapid review

Erin C Stone  1   2 , Devon L Okasako-Schmucker  2 , Joanna Taliano  3 , Melissa Schaefer  2 , David T Kuhar  1
Affiliations
Review

Risk period for transmission of SARS-CoV-2 and seasonal influenza: a rapid review

Erin C Stone et al. Infect Control Hosp Epidemiol. .

Abstract

Background: Restricting infectious healthcare workers (HCWs) from the workplace is an important infection prevention strategy. The duration of viral shedding or symptoms are often used as proxies for the infectious period in adults but may not accurately estimate it.

Objective: To determine the risk period for transmission among previously healthy adults infected with SARS-CoV-2 omicron variant (omicron) or influenza A (influenza) by examining the duration of shedding and symptoms, and day of symptom onset in secondary cases of transmission pairs.

Design: Rapid review.

Methods: This rapid review adhered to PRISMA-ScR; five databases were searched. The cumulative daily proportion of participants with an outcome of interest was calculated for each study and summarized.

Results: Forty-three studies were included. Shedding resolved among ≥ 70% of participants by the end of day nine post symptom onset for omicron, and day seven for influenza; and for ≥ 90% of participants, by the end of day 10 for omicron and day nine for influenza. Two studies suggested shedding continues > 24 hours post-fever resolution for both viruses. Symptom onset occurred in ≥ 80% of secondary cases by the end of day seven post-primary case symptom onset for omicron and day six for influenza.

Conclusions: Omicron shedding is consistent with previous recommendations to exclude infected HCWs from work for 10 days; and influenza follows a similar trend. Earlier symptom onset in most secondary cases for both pathogens indicates that, despite persistent viral shedding, most transmission occurs earlier; and the cumulative serial interval might better approximate the duration of infectiousness.

Keywords: Influenza; Omicron; Rapid review; Respiratory illness; Serial interval; Shedding; Symptomatic infectious period; Symptoms; Viral.

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Conflict of interest statement

The authors report that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Transmission parameters (adapted from Kim et.al. 2023).
Figure 2.
Figure 2.
Flow chart of all studies.
Figure 3.
Figure 3.
The cumulative proportion (%) of participants whose shedding resolved, measured in days from symptom onset, diagnosis, or inoculation. A. Studies reporting omicron. B. Studies reporting influenza.
Figure 4.
Figure 4.
The cumulative proportion (%) of symptom onset in secondary cases measured in days from symptom onset in the primary case. A. Studies reporting omicron. B. Studies reporting influenza.
See this image and copyright information in PMC

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