Infection and reinfection with SARS‑CoV‑2 in cancer patients: A cohort study

Abstract

COVID-19 reinfection, although a controversial issue, is an important clinical problem in cancer patients and beyond. The present study aimed to identify the risk factors associated with worse outcomes in cancer patients with Covid-19 in both first infection and reinfection and to describe the involvement of vaccines in reinfection outcome. The present study enrolled 85 patients with solid tumors who had Covid-19 infection and had not been previously vaccinated. Classical risk factors associated with worse outcomes in cancer patients with second SARS-Cov infection were considered. The patients were followed up retrospectively, measuring mortality at the first and second infection and the vaccination rate after the first infection. The factors associated with the highest risk of mortality at the first infection were, in order of importance: intensive care unit (ICU) admission, unfavorable performance status, radiologically quantifiable presence of oncological disease, and administration of cytotoxic chemotherapy in the period immediately before infection. The risk factors associated with higher mortality from reinfection were ECOG 3-4 performance status and administration of cytotoxic chemotherapy in the period immediately before infection. In the studied patients, mortality from reinfection was not affected by prior vaccination. Thus, bearing in mind all of these risk factors for poor outcomes in cancer patients with solid tumors presenting with Covid-19 can help the treating oncologists make personalized decisions about patient care during the pandemic.

Risk of reinfection and disease after SARS‐CoV‐2 primary infection: Meta‐analysis

“…Of the 3282 papers initially retrieved, we included 91 cohort studies evaluating the onset of reinfection, severe and very severe/lethal COVID‐19 among 15,034,624 previously infected subjects (Figure 1), either among health care workers (27 publications; n = 37,598 2,8,9,15,17,24,36,38,42–59 ) or in the general population (67 publications; n = 14,997,026 3–7,10,12,16–23,25–27,43,49,60–106 ).…”

“…Overall, a total of 158,478 reinfections were recorded among the 15,034,624 subjects with a previous infection, 2–10,12,13,15–27,36,38,42–107 corresponding to a pooled rate of 0.97% (95% CI: 0.71%–1.27%—Table 1; Figure 2). The summary rate of reinfection rose to 1.07% (95% CI: 0.73%–1.46%) when only the 69 datasets with a more conservative time lag of ≥90 days between the two episodes were considered 3–6,8–10,12,18–23,25,26,36,42–44,46–50,52–56,59,61–65,67–69,72–84,86,87,89,91–96,98,101,103,105–107 and it slightly varied by reinfection definition criteria (0.93% vs 1.01% when considering studies with high vs low risk of misclassification). The risk of reinfection was higher among health care workers as compared to the general population (1.20% vs 0.90), and among females (0.79% vs 0.55% among males), although these estimates showed largely overlapping confidence intervals.…”

“…Finally, in the 54 datasets that provided data for the analysis of very severe/lethal COVID‐19, 2,3,5,6,10,16–22,25–27,44,47–59,64–66,69,71–73,79,81,82,84–87,92,94,95,99–104 a total of 199 events were recorded among 3,574,793 previously infected individuals, corresponding to a pooled rate of 0.02% (0.01%–0.03%), which did not differ by time lag or definition criteria.…”

“…As shown in Table S1, most of the included studies ( n = 43) were carried out in Europe, 2,4–10,12,15,17,18,21,24,26,36,38,44,46–51,58,66,69,71,72,75,81,85–88,91–93,95,99,102 24 in the USA, 20,22,23,25,42,43,57,59,63,67,77,79,82–84,89,90,97,98,103,105–107 18 in Asia 3,16,19,27,45,52–54,56,60,62,64,65,70,73,74,100,101 and the remaining six in South America or South Africa 61,68,80,94,96,104 . The mean age of the participants ranged from 15 to 87 years, and the average follow‐up ranged from 29 to 371 days.…”

Clinical Characteristics and Outcomes of Kidney Transplant Recipients With SARS-CoV-2 Reinfections

“…3 Letter to the Editor In cancer patients, prior vaccination did not affect mortality from reinfection. 4 In the study by Morris et al, 2.4% of organ transplant recipients developed reinfection. Two of them were fully vaccinated.…”