Predictors of severe symptomatic laboratory-confirmed SARS-CoV-2 reinfection

Abstract

Objective To evaluate factors predicting severe symptomatic laboratory-confirmed (reverse transcription-quantitative polymerase chain reaction, RT-qPCR) SARS-COV-2 (severe acute coronavirus-2) reinfection. Study design A nationwide retrospective cohort study was conducted in Mexico. Method Data from 258 reinfection cases (at least 28 days between both episodes onset) were analyzed. We used risk ratios (RR) and 95% confidence intervals (CI) to evaluate predictors of severe (dyspnea requiring hospital admission) secondary SARS-COV-2 infection. Results The risk of severe disease was 14.7% and the observed overall fatality rate was 4.3%. Patients with more serious primary disease were more likely to develop severe symptoms (39.5% vs. 5.5%, p < 0.001) during reinfection. In multiple analysis, factors associated with an increased risk of severe symptomatic SARS-COV-2 reinfection were increasing age (RR per year = 1.007, 95% CI 1.003-1.010), comorbidities (namely obesity [RR = 1.12, 95% CI 1.01-1.24], asthma [RR = 1.26, 95% CI 1.06-1.50], type 2 diabetes mellitus [RR = 1.22, 95% CI 1.07 - 1.38] and previous severe laboratory-confirmed COVID-19 (RR = 1.20, 95% CI 1.03-1.39). Conclusions To the best of our knowledge this is the first study evaluating disease outcomes in a large set of laboratory-positive cases of symptomatic SARS-COV-2 reinfection and factors associated with illness severity was characterized. Our results may contribute to the current knowledge of SARS-COV-2 pathogenicity and to identify populations at increased risk of a poorer outcome after reinfection.

Reinfection or Reactivation of Severe Acute Respiratory Syndrome Coronavirus 2: A Systematic Review

“…However, some studies reported that a small proportion (about 1%) of the population can be RP for SARS-CoV-2, and possibly due to reactivation or reinfection (16,17). Furthermore, previous reports (7,34,35) highlighted that RP-SARS-CoV-2 is less likely to cause serious problems to public health since the rate of RP seems low (about 1%), and new infections declining after recovery from the first episode of the infection (16,35), which is likely due to the suspected herd immunity (97,98). This suggests that previously infected individuals have a significantly lower risk of being infected for the second time.…”

“…According to previous studies (9)(10)(11), some COVID-19 patients were found positive from RT-PCR results for the second time (usually) within 5-13 days after discharge from the isolation before confirmation of reactivation or relapse (5,29,30), while some patients were found to be RP-SAR-CoV-2 at least 4 weeks from the first episode of the infection, indicating the possibility of reinfection (6,7). Therefore, urgent research is needed to disentangle possible reasons of RP-SAR-CoV-2 after recovery from primary infection to guide policy-making and help in controlling further spared of the virus (9,(31)(32)(33)(34).…”

“…Following previous reports (6,7,12,32), we re-examined some of the clinical features, infection ratios, recovery, and potential reasons of possible reactivation and/or reinfection of SARS-CoV-2 to shade more light on the current issue of RP-SARS-CoV-2 in recovered patients, and provide suggestions for public health policy-makers to guide effective control of SARS-CoV-2 transmission. Our study would be valuable to policy-makers since there was until recently no clear epidemiological underpinning explanation for the resurgence of COVID-19 infection among patients that tested positive on a retest.…”

“…Here, we reported some scenarios that analyze possible reinfection of SARS-CoV-2 in recovered patients. A recent retrospective cohort study in Mexico by Murillo-Zamora et al (7) revealed some possible factors that predict severe symptomatic SARS-COV-2 reinfection, which suggested that reinfection occurs when the time lag between discharge and RP is at least 28 days (that is, a second-time infection after a patient satisfied the standard discharge criteria). Moreover, they found that the risk of previously infected patients being infected for the second time was 258/100,432 = 0.26%, with a case fatality rate of 11/258 (3,95).…”

“…Recently, the issue of reinfection (SARS-CoV-2 subsequent infection after recovery from previous episode of the infection) and reactivation (also known as relapse, a re-detectable positive SARS-CoV-2 viral RNA in recovered patient which occurs within the first 4 weeks of previous infection) have been reported in several studies [see for instance (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), and the references therein]. These studies highlighted the possibility of reactivation and reinfection of SARS-CoV-2 which needs urgent attention from the researchers as well the public health policymakers.…”