Risk and severity of SARS-CoV-2 reinfections during 2020–2022 in Vojvodina, Serbia: A population-level observational study

Medić, Snežana; Anastassopoulou, Cleo; Lozanov-Crvenković, Zagorka; Vuković, Vladimir; Dragnić, Nataša; Petrović, Vladimir; Ristić, Mioljub; Pustahija, Tatjana; Gojković, Zoran; Tsakris, Athanasios; Ioannidis, John P. A.

doi:10.1016/j.lanepe.2022.100453

Cited by 69 publications

(92 citation statements)

References 31 publications

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“…Sixteen unique articles reporting data for 26 studies were included for analysis. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Seven articles reported data for multiple studies, defined by multiple sets of study methods and independent populations with unique estimates of protection. Eleven studies reported on prior infection and 15 studies reported on hybrid immunity, which included six reporting on both.…”

Section: Resultsmentioning

confidence: 99%

Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression

Bobrovitz

Ware

et al. 2022

Preprint

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Background We aimed to systematically review the magnitude and duration of the protective effectiveness of prior infection (PE) and hybrid immunity (HE) against Omicron infection and severe disease. Methods We searched pre-print and peer-reviewed electronic databases for controlled studies from January 1, 2020, to June 1, 2022. Risk of bias (RoB) was assessed using the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I)-Tool. We used random-effects meta-regression to estimate the magnitude of protection at 1-month intervals and the average change in protection since the last vaccine dose or infection from 3 months to 6 or 12 months. We compared our estimates of PE and HE to previously published estimates of the magnitude and durability of vaccine effectiveness (VE) against Omicron. Findings Eleven studies of prior infection and 15 studies of hybrid immunity were included. For prior infection, there were 97 estimates (27 at moderate RoB and 70 at serious RoB), with the longest follow up at 15 months. PE against hospitalization or severe disease was 82.5% [71.8-89.7%] at 3 months, and 74.6% [63.1-83.5%] at 12 months. PE against reinfection was 65.2% [52.9-75.9%] at 3 months, and 24.7% [16.4-35.5%] at 12 months. For HE, there were 153 estimates (78 at moderate RoB and 75 at serious RoB), with the longest follow up at 11 months for primary series vaccination and 4 months for first booster vaccination. Against hospitalization or severe disease, HE involving either primary series vaccination or first booster vaccination was consistently >95% for the available follow up. Against reinfection, HE involving primary series vaccination was 69.0% [58.9-77.5%] at 3 months after the most recent infection or vaccination, and 41.8% [31.5-52.8%] at 12 months, while HE involving first booster vaccination was 68.6% [58.8-76.9%] at 3 months, and 46.5% [36.0-57.3%] at 6 months. Against hospitalization or severe disease at 6 months, hybrid immunity with first booster vaccination (effectiveness 95.3% [81.9-98.9%]) or with primary series alone (96.5% [90.2-98.8%]) provided significantly greater protection than prior infection alone (80.1% [70.3-87.2%]), first booster vaccination alone (76.7% [72.5-80.4%]), or primary series alone (64.6% [54.5-73.6%]). Results for protection against reinfection were similar. Interpretation Prior infection and hybrid immunity both provided greater and more sustained protection against Omicron than vaccination alone. All protection estimates waned quickly against infection but remained high for hospitalisation or severe disease. Individuals with hybrid immunity had the highest magnitude and durability of protection against all outcomes, reinforcing the global imperative for vaccination.

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Section: Resultsmentioning

confidence: 99%

Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression

Bobrovitz

Ware

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Previous infections in our cohort were unlikely to contribute to these observations as evidenced by a lack of IgG responses to N in all those participants tested at enrolment. Participants not screened for anti N responses were recruited early in the study when reinfection was rare phenomenon [33,34]. Therefore, the mechanisms that underpin heterogeneity of viral shedding of SARS-CoV-2, are unclear, may involve infectious dose, pre-existing adaptive immunity [35], host genetics [36] and innate immune responses [37], among others, and merit targeted studies.…”

Section: Plos Pathogensmentioning

confidence: 99%

Infectious viral shedding of SARS-CoV-2 Delta following vaccination: A longitudinal cohort study

et al. 2022

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The impact of vaccination on SARS-CoV-2 infectiousness is not well understood. We compared longitudinal viral shedding dynamics in unvaccinated and fully vaccinated adults. SARS-CoV-2-infected adults were enrolled within 5 days of symptom onset and nasal specimens were self-collected daily for two weeks and intermittently for an additional two weeks. SARS-CoV-2 RNA load and infectious virus were analyzed relative to symptom onset stratified by vaccination status. We tested 1080 nasal specimens from 52 unvaccinated adults enrolled in the pre-Delta period and 32 fully vaccinated adults with predominantly Delta infections. While we observed no differences by vaccination status in maximum RNA levels, maximum infectious titers and the median duration of viral RNA shedding, the rate of decay from the maximum RNA load was faster among vaccinated; maximum infectious titers and maximum RNA levels were highly correlated. Furthermore, amongst participants with infectious virus, median duration of infectious virus detection was reduced from 7.5 days (IQR: 6.0–9.0) in unvaccinated participants to 6 days (IQR: 5.0–8.0) in those vaccinated (P = 0.02). Accordingly, the odds of shedding infectious virus from days 6 to 12 post-onset were lower among vaccinated participants than unvaccinated participants (OR 0.42 95% CI 0.19–0.89). These results indicate that vaccination had reduced the probability of shedding infectious virus after 5 days from symptom onset.

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“…Other population studies, e.g. in Vojvodina, Serbia (74), suggest that fatality rates may be ten times lower in re-infections versus primary infections. The relative contributions of vaccination, prior infection and new variants in the IFR decline needs careful study and continued monitoring.…”

Section: Discussionmentioning

confidence: 94%

Age-stratified infection fatality rate of COVID-19 in the non-elderly informed from pre-vaccination national seroprevalence studies

Pezzullo

Axfors

Contopoulos‐Ioannidis

et al. 2022

Preprint

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The infection fatality rate (IFR) of COVID-19 among non-elderly people in the absence of vaccination or prior infection is important to estimate accurately, since 94% of the global population is younger than 70 years and 86% is younger than 60 years. In systematic searches in SeroTracker and PubMed (protocol: https://osf.io/xvupr), we identified 40 eligible national seroprevalence studies covering 38 countries with pre-vaccination seroprevalence data. For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.035% (interquartile range (IQR) 0.013 - 0.056%) for the 0-59 years old population, and 0.095% (IQR 0.036 - 0.125%,) for the 0-69 years old. The median IFR was 0.0003% at 0-19 years, 0.003% at 20-29 years, 0.011% at 30-39 years, 0.035% at 40-49 years, 0.129% at 50-59 years, and 0.501% at 60-69 years. Including data from another 9 countries with imputed age distribution of COVID-19 deaths yielded median IFR of 0.025-0.032% for 0-59 years and 0.063-0.082% for 0-69 years. Meta-regression analyses also suggested global IFR of 0.03% and 0.07%, respectively in these age groups. The current analysis suggests a much lower pre-vaccination IFR in non-elderly populations than previously suggested. Large differences did exist between countries and may reflect differences in comorbidities and other factors. These estimates provide a baseline from which to fathom further IFR declines with the widespread use of vaccination, prior infections, and evolution of new variants.

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Risk and severity of SARS-CoV-2 reinfections during 2020–2022 in Vojvodina, Serbia: A population-level observational study

Cited by 69 publications

References 31 publications

Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression

Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression

Infectious viral shedding of SARS-CoV-2 Delta following vaccination: A longitudinal cohort study

Age-stratified infection fatality rate of COVID-19 in the non-elderly informed from pre-vaccination national seroprevalence studies

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