How long can rhinovirus be shed?

Duration of Rhinovirus Shedding

Rhinovirus typically sheds for 7-10 days in immunocompetent individuals, with the highest contagiousness occurring during the first 3-5 days when viral shedding is most intense. 1

Shedding Duration by Population

Immunocompetent Individuals

• Children: Mean shedding duration of 11.4 days (95% CI: 8.2-14.7 days) 2
• Adults: Mean shedding duration of 10.1 days (95% CI: 7.4-12.9 days) 2
• The American Academy of Ophthalmology guidelines indicate that recovery of virus from infected cases is difficult after 7-10 days of infection 1

Special Populations

• Immunocompromised patients: Significantly longer shedding periods
  • Patients with hypogammaglobulinemia: Mean shedding duration of 40.9 days (95% CI: 26.4-55.4 days) 2
  • Prolonged shedding over 28 days is frequent in patients with hypogammaglobulinemia despite immunoglobulin replacement therapy 2
• HSCT patients: Prolonged shedding over 4 weeks is frequent, with asymptomatic shedding occurring in 13% of patients 3

Factors Affecting Shedding Duration

• Symptom severity: Duration of respiratory tract symptoms correlates with the duration of virus shedding (p=0.002) 2
• Viral load: Higher HRhV loads correlate with symptomatic presentations 3
• Age: Young children can be infectious before symptoms begin and for up to 10 days after symptom onset 1
• Immune status: Immunocompromised status significantly extends shedding duration 3, 2

Clinical Implications

Transmission Risk

• Highest contagiousness occurs during the first 3-5 days when viral shedding is most intense 1
• Young children in daycare settings may experience more protracted respiratory symptoms and potentially longer shedding periods 1
• Coinfections with other community-acquired respiratory viruses (CARVs) occur in approximately 19% of patients 3

Infection Control Considerations

• Healthcare settings: Consider patients potentially contagious for 7-10 days from symptom onset
• Household transmission: Rhinoviruses are frequently transmitted from children to other family members 4
• Asymptomatic shedding: Common in adults (secondary infections) and some immunocompromised populations 3, 4

Prevention of Transmission

• Hand hygiene through frequent handwashing with soap and water
• Isolation, especially for healthcare workers and childcare providers
• Environmental cleaning, as rhinovirus can remain infectious on surfaces for extended periods 1

The correlation between symptom duration and viral shedding suggests that clinical improvement can be a reasonable proxy for reduced contagiousness in immunocompetent individuals, though some shedding may continue after symptom resolution.