Source CDC PHIL
#18,451
As we've discussed previously (see WHO: Dead Bodies from Natural Disasters and Conflict Do Not Generally Pose Health Risks), decaying bodies from trauma or natural disasters (as opposed to epidemics) usually do not pose a serious threat of spreading disease.
But during certain infectious disease outbreaks, we have seen the post-mortem spread of diseases; particularly with Ebola, Marburg, and Lassa fever, but other concerns include TB, HIV, and Prion disease. A few (of many) examples:
- Burial rites in Africa often involve family members cleaning the bodies, and are a common source of new infections in the community (see WHO AFRO: New Ebola outbreak declared in Guinea).
- Last year, in Japan Case Report: 1st Human-to-Human Transmission of SFTS in Japan, Japan's Institute for Infectious Diseases noted that `. . . report examining SFTS cluster infections found that contact with blood from dead bodies has a higher risk of infection.'
- Very early in the COVID outbreak in China, their National Health Commission ordered mandatory cremation of dead bodies due to concerns over infection control.
- In 2016's Germany's RKI Statement On Lassa Fever Cluster In Cologne, a medical director who had been transferred from Togo to Germany for treatment died, and 3 contacts - including the mortician who prepared his body - contracted the virus.
- In 2014, when several case of Ebola were detected in the United States, we looked at the CDC's Interim Ebola Guidance: Mortuary Removal and Handling.
In contrast to China's strict cremation policy, a 2021 report in Forensic Sci Med Pathology (see The handling of SARS-CoV-2 associated deaths - infectivity of the body) reassuringly found that, with adequate management of general safety precautions, transmission of SARS-CoV-2 through autopsies and handling of bodies is unlikely.
Last fall, however, in Post-mortem transmission risk of infectious disease: A systematic review by Geoffray, Tuchtan Piercecchi-Marti, &. Delteil, the authors wrote about a lack of solid scientific data on the risk of post-mortem disease transmission, although they cited the longest post-mortem interval for positive cultures was 21 h for HIV, 6 days for HBV, 36 days for MBT, 17 days for SARS-CoV2.Since another influenza pandemic is inevitable, another coronavirus (e.g. MERS-CoV, WIV-1, SARS-CoV-x) is certainly possible, and there are many other infectious diseases with epidemic potential, understanding the risks of post-mortem transmission of various pathogens could be critical.
All of which brings us to a detailed report, published earlier this week in the Journal of Infection, where Chinese researchers used infected mouse cadavers to determine the duration of post-mortem infectivity of IAV, RSV, and SARS-CoV at different storage temperatures.
While IAV (Influenza A Virus) showed the lowest duration (a matter of hours), this was based on one specific subtype (A/Xi’an/07/2023 (H3N2)), which may not necessarily reflect what we might see with a novel virus like HPAI H5 (see Viruses: Assessment of Survival Kinetics for Emergent Highly Pathogenic Clade 2.3.4.4 H5Nx Avian Influenza Viruses).
The big takeaway, however, is that the SARS-CoV-2 virus remained infectious in mouse cadavers far longer (up to 5 days at room temperature and for more than 7 days at 4℃) than IAV or RSV (24-48 hours).
Although mice may not be the ideal analog for a human cadaver, they likely provide reasonably reliable data. The authors wrote:
By providing a comprehensive analysis of post-mortem viral kinetics, this study offers crucial insights for refining forensic, autopsy, and biosafety protocols. The findings will inform infection control measures, enhance occupational safety, and contribute to the development of evidence-based guidelines for the safe handling of infectious cadavers. Ultimately, this research addresses a critical knowledge gap in post-mortem virology, advancing the understanding of viral behavior in deceased hosts while strengthening global preparedness for future infectious disease outbreaks.
I've only reproduced the abstract below. Follow the link to read the report in its entirety.
Run Chena,1 ∙ Zeyi Haoa,1 ∙ Jian Yeb ∙ … ∙ Qinru Suna qinrusun@xjtu.edu.cn ∙ Hongping Weic hongpingwei2000@aliyun.com ∙ Zhenyuan Wanga wzy218@xjtu.edu.cn … Show more
Published online April 21, 2025DOI: 10.1016/j.jinf.2025.106489Highlights
• SARS-CoV-2 exhibits extended post-mortem infectivity, persisting for 5 days at RT/37℃ and exceeding 7 days at 4℃.
• Comparative virological analysis reveals that RSV remains infectious for 24-48 hours, while IAV becomes undetectable within hours.
• The highest transmission risk from cadaveric SARS-CoV-2 occurs within the first 72 hours at RT and the initial 24 hours at 37℃.
• Post-mortem viral persistence is modulated by temperature, tissue tropism, and pre-mortem viral load.
Graphical AbstractSummaryObjectivesThe persistence and infectivity of respiratory viruses in cadavers remain poorly characterized, posing significant biosafety risks for forensic and healthcare professionals. This study systematically evaluates the post-mortem stability and transmission potential of SARS-CoV-2, influenza A virus (IAV), and respiratory syncytial virus (RSV) under varying environmental conditions, providing critical insights into viral kinetics.MethodsTo assess the post-mortem stability of SARS-CoV-2, tissue samples were collected from infected cadavers at 4℃, room temperature (RT, 20-22℃), and 37℃ over a predetermined timeframe. Viral kinetics were analyzed using quantitative assays, while histopathology and immunohistochemistry characterized tissue-specific distribution. Additionally, comparative analyses were conducted both in vitro and in cadaveric tissues to characterize the survival dynamics of IAV and RSV under identical conditions.ResultsSARS-CoV-2 exhibited prolonged post-mortem infectivity, persisting for up to 5 days at RT and 37℃ and over 7 days at 4℃, with the highest risk of transmission occurring within the first 72hours at RT and 24hours at 37℃. In contrast, RSV remained viable for 1-2 days, while IAV persisted for only a few hours post-mortem. Viral decay rates were temperature-dependent and varied across tissues, demonstrating distinct post-mortem survival kinetics.ConclusionsThis study presents the first comprehensive analysis of viral persistence in cadavers, revealing prolonged SARS-CoV-2 stability compared to IAV and RSV. These findings underscore the need for enhanced post-mortem biosafety protocols to mitigate occupational exposure risks in forensic and clinical settings. By elucidating viral decay dynamics across environmental conditions, this research estabishes a critical foundation for infection control strategies, informing biosafety policies for emerging respiratory pathogens.
