COVID-19 Reinfection in An Immunosuppressed Patient Without An Antibody Response

Hunsinger, Hillary P; Sridharan, Gurusaravanan Kutti; Rokkam, Venkata Ram Pradeep; Fantry, Lori E.

doi:10.1016/j.amjms.2021.02.003

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…Furthermore, none could define which characteristics are associated with reinfection. For example, there is evidence to suggest immune responses are weaker following asymptomatic SARS‐CoV‐2 infections 20 and in immunocompromised patients, 21 which may increase susceptibility to repeat infection. Mucosal immunity and neutralising antibodies present in respiratory secretions may be more important for sterilising immunity than circulating IgG levels.…”

Section: Discussionmentioning

confidence: 99%

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Quantifying the risk of SARS‐CoV‐2 reinfection over time

Murchu

Byrne

Carty

et al. 2021

Reviews in Medical Virology

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Summary Despite over 140 million SARS‐CoV‐2 infections worldwide since the beginning of the pandemic, relatively few confirmed cases of SARS‐CoV‐2 reinfection have been reported. While immunity from SARS‐CoV‐2 infection is probable, at least in the short term, few studies have quantified the reinfection risk. To our knowledge, this is the first systematic review to synthesise the evidence on the risk of SARS‐CoV‐2 reinfection over time. A standardised protocol was employed, based on Cochrane methodology. Electronic databases and preprint servers were searched from 1 January 2020 to 19 February 2021. Eleven large cohort studies were identified that estimated the risk of SARS‐CoV‐2 reinfection over time, including three that enrolled healthcare workers and two that enrolled residents and staff of elderly care homes. Across studies, the total number of PCR‐positive or antibody‐positive participants at baseline was 615,777, and the maximum duration of follow‐up was more than 10 months in three studies. Reinfection was an uncommon event (absolute rate 0%–1.1%), with no study reporting an increase in the risk of reinfection over time. Only one study estimated the population‐level risk of reinfection based on whole genome sequencing in a subset of patients; the estimated risk was low (0.1% [95% CI: 0.08–0.11%]) with no evidence of waning immunity for up to 7 months following primary infection. These data suggest that naturally acquired SARS‐CoV‐2 immunity does not wane for at least 10 months post‐infection. However, the applicability of these studies to new variants or to vaccine‐induced immunity remains uncertain.

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Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Quantifying the risk of SARS‐CoV‐2 reinfection over time

Murchu

Byrne

Carty

et al. 2021

Reviews in Medical Virology

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“…According to published studies, the possible explanations for reinfection would be: infection by a different strain that can avoid, at least in part, the immune response [6–8, 11, 22, 30]; intensive re-exposure to the virus [11, 13, 25]; or a poor immune response [10–12]. The latter might be due to age [13], previous immunological involvement [19, 31] or, as previously indicated, in relation to a first non-severe infection [20–22, 29]. In our series there was re-exposure and circumstances that might imply a weak response (a third were older than 65 years, 12.5 % had a previous immunosuppressive comorbidity, there were no severe cases, 87.5 % were either asymptomatic or mild, and only 38 % for whom serology was performed in the first episode were positive).…”

Section: Discussionmentioning

confidence: 99%

A retrospective cross-sectional observational study of SARS-CoV-2 reinfection in La Ribera Health Department, Valencia, Spain

García

2022

Journal of Medical Microbiology

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Introduction. The possibility of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a widely proven fact and may have clinical implications. Hypothesis /Gap Statement. It is not known whether there have been cases of reinfection by SARS-CoV-2 in La Ribera Health Department. Aim. To determine whether there have been cases of reinfection by SARS-CoV-2 in La Ribera Health Department and to identify their characteristics. Methodology. Retrospective cross-sectional observational study of cases of reinfection by SARS-CoV-2 in the population of La Ribera Department between March 2020 and February 2021. The positive baseline cohort includes all cases positive by RT-PCR for SARS-CoV-2, with reinfection cases being those that, after resolution of the first episode according to the World Health Organization (WHO) criteria, presented a new positive RT-PCR result. Results. Out of a total of 15 687 cases with positive RT-PCR, 40 were considered to be reinfections, which meant a cumulative incidence of 0.255 % and an incidence density of 5.05 cases per 100 000 person-days. Most of the cases occurred during the highest incidence peaks of the pandemic in the department. Seventy-five per cent of the patients in these cases were older than 40 years, 42.5 % were healthcare professionals or nursing home residents and 12.5 % had an immunosuppressive comorbidity. There were no severe, critical or death cases. In the reinfection episodes, with respect to the first episode, there was a tendency to be milder, they required fewer days of hospitalization, their RT-PCR became negative earlier, they developed a greater humoral response and the sick leave period was shorter. The median period between the RT-PCR in the first episode and the RT-PCR in the second episode was 127.5 days (range: 48–301; IQR: 89.5–256.25) Conclusions. SARS-CoV-2 reinfection cases are rare, tend to be mild and can occur within a median period of 127.5 days.

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“…While most cases of re‐infection have a mild clinical course, 5,6 in our case, the repeat episode also presented as a severe disease with a new‐onset GGOs—classical lung features of COVID‐19. There is growing evidence of repeat infections occurring in immunocompromised who do not mount an antibody response, being more severe than the primary infection 8,9 . This is an important consideration for special populations with significant co‐morbidity and/or immunodeficiency, where natural infection or vaccination may not provide sufficient immunity to re‐infection.…”

Section: Discussionmentioning

confidence: 99%

Recurrent COVID‐19 infection in a case of rituximab‐induced hypogammaglobulinaemia

Daniel

Thangakunam

Isaac

et al. 2021

Respirology Case Reports

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Patients with immunodeficiency are at an increased risk of recurrent COVID‐19 infection. They may lack the natural immune response that usually confers long‐lasting immunity. Here, we present our experience managing one such patient, who had a COVID‐19 infection twice, 5 months apart. He had a positive SARS‐CoV‐2 real‐time reverse transcription polymerase chain reaction (RT‐PCR) and computed tomography (CT) thorax with classical findings of COVID‐19 on both occasions. He had multiple negative RT‐PCR tests and two CT scans without COVID‐19 features between these two infections. While the antibody response to the first infection was not detectable, the response to the second infection was robust. Live attenuated vaccines are contraindicated in patients with immunodeficiency, and other vaccines may not elicit an adequate immune response. A high index of suspicion for recurrent COVID‐19 is warranted in this group of patients.

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COVID-19 Reinfection in An Immunosuppressed Patient Without An Antibody Response

Cited by 7 publications

References 5 publications

Quantifying the risk of SARS‐CoV‐2 reinfection over time

Quantifying the risk of SARS‐CoV‐2 reinfection over time

A retrospective cross-sectional observational study of SARS-CoV-2 reinfection in La Ribera Health Department, Valencia, Spain

Recurrent COVID‐19 infection in a case of rituximab‐induced hypogammaglobulinaemia

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