Severity of COVID-19 reinfection and associated risk factors: findings of a cross-sectional study in Bangladesh

Abstract

Background: COVID-19 reinfected patients suffer from diverse health consequences. Information on the severity of COVID-19 reinfection is scarce. The current study aimed to determine the proportion of COVID-19 reinfection and risk factors associated with its severity. Methods: This cross-sectional study targeted all COVID-19 patients reported in May 2021 at the Health Information Unit (HIU) of the Directorate General of Health Services (DGHS) of Bangladesh. We identified 473 (1.14%) reinfected patients out of 41408 diagnosed cases by reviewing their medical records. Considering the selection criteria and informed consent, we enrolled 404 reinfected patients. Data were collected through telephone interviews and reviewing medical records using a semi-structured questionnaire and a checklist. Results: The majority of the reinfected patients were urban residents (98.0%). Around 13.0% of reinfected patients had <90% oxygen saturation, and 64.0% had an interval of 3-6 months between two attacks. The severity of reinfection included asymptomatic (12.9%), mild (8.9%), moderate (66.3%), and severe (11.9%) forms of infection. An interval of 3-6 months between two attacks had less chance of having mild (AOR=0.031, ρ=0.000), moderate (AOR=0.132, ρ=0.017), and severe (AOR=0.059, ρ=0.002) infections. Patients who maintained physical distance had less chance of moderate-intensity reinfection (AOR=0.137, ρ=0.013), while the vaccinated patients had a higher chance of moderate (AOR=16.127, ρ=0.001) and severe (AOR=3.894, ρ=0.047) intensity reinfection. Conclusion: To avert COVID-19 reinfection and its severity, patients should be vigilant about preventive practices even after recovery. The study suggests vibrant interventions aligned with exposure, physical distancing, vaccination, and comorbidities for mitigating reinfection.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

“…COVID-19 disease severity is modulated by additional factors even in the presence of immunological protection resulting from previous SARS-CoV-2 infection(s). Advanced age [ 668 , 676 , 677 ], the presence of comorbidities [ 676 , 677 , 678 , 679 ] and male sex [ 668 ] have an exacerbating effect on re-infections similar to first infections. Severe primary infection predicts higher risk of severe symptoms in re-infections [ 676 , 677 ], even though more severe primary infection appears to elicit higher levels of memory B cells [ 680 ] and antibodies [ 680 , 681 , 682 , 683 ], and stronger T cell responses [ 650 ].…”

Re‐infection in COVID‐19: Do we exaggerate our worries?

“…Similarly, in one study, the severity of COVID‐19 re‐infection was significantly associated with patients’ age, comorbidity, and COVID‐19 vaccine status. 25 In the meta‐analysis 22 mentioned above, all patients who died had comorbidities and were elderly, but the vaccination information was not defined. It has been shown that the substantial comorbidities that determine the prognosis in COVID‐19 are diabetes mellitus and hypertension.…”

“…In our literature search, we noticed that the studies addressing this issue are quite limited. In one study, 25 it was shown that 37.1% of re‐infected cases were healthcare workers. In the present study, we found that 17.6% (72 cases) of re‐infected ones were healthcare workers.…”

“…Vaccination has been shown to be beneficial for people who have been previously infected. 25 , 27 In one study, it was shown that full vaccination provides additional protection against re‐infection in people infected with SARS‐CoV‐2. In the present study, it was found that the risk of re‐infection was 2.34 times higher in the previously infected people who were not vaccinated than those who were fully vaccinated.…”

“…It was remarkable that none of our patients with a mortal course did not have a completed vaccination schedule and all of them were aged and had at least two chronic diseases. Similarly, in one study, the severity of COVID‐19 re‐infection was significantly associated with patients’ age, comorbidity, and COVID‐19 vaccine status 25 . In the meta‐analysis 22 mentioned above, all patients who died had comorbidities and were elderly, but the vaccination information was not defined.…”