Symptomatic SARS-CoV-2 re-infection of a health care worker in a Belgian nosocomial outbreak despite primary neutralizing antibody response

Selhorst, Philippe; Ierssel, Sabrina Van; Michiels, Jo; Mariën, Joachim; Bartholomeeusen, Koen; Dirinck, Eveline; Vandamme, Sarah; Jansens, Hilde; Ariën, Kevin K.

doi:10.1101/2020.11.05.20225052

Cited by 38 publications

(47 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A longitudinal study in health care workers suggests that post-infection anti-SARS-CoV-2 IgG antibodies are associated with protection from reinfection for most people for at least six months 23 . We may speculate that the patients described here developed a transient protective immunity after primoinfection, but the anti-SARS-CoV-2 antibodies substantially decayed by the time of reinfection 24 . Alternatively, the positive IgG rapid tests obtained only eight days (case 1) and two months (case 2) before the second episode suggest that reinfection in those cases might have occurred in the face of preexisting anti-SARS-CoV-2 antibodies, although this nding should be interpreted with caution due to the limitations of rapid tests.…”

Section: Discussionmentioning

confidence: 84%

Three SARS-CoV-2 reinfection cases by the new Variant of Concern (VOC) P.1/501Y.V3

Naveca

Costa²,

Nascimento

et al. 2021

Preprint

View full text Add to dashboard Cite

The SARS-CoV-2 lineage B.1.1.28 has been evolving in Brazil since February 2020 giving origin to multiple local clades including the new Variant of Concern (VOC) designated P.1 or 501Y.V3. The recent emergence of sub-lineages with convergent mutations in the spike (S) protein raises concern about the potential impact on viral infectivity and immune escape. We describe here the first three confirmed SARS-CoV-2 reinfections cases with the new VOC P.1 in residents of the Amazonas state, Brazil. Three female patients, 29, 40, and 50-year-old, were RT-PCR confirmed for SARS-CoV-2 on two occasions, with at least 92 days apart. Next-generation sequencing and phylogenetic analysis were conducted to precisely access the SARS-CoV-2 lineages of each infection event. SARS-CoV-2 genomic analysis confirmed three cases of reinfections caused by the VOC P.1 in patients that were primo-infected by distinct viral lineages 3–9 months earlier. Case 1 (29-year-old) was positive on March 24, 2020 (lineage B.1.195) and then on December 30, 2020 (lineage P.1); case 2 (50-year-old) was positive on October 19, 2020 (lineage B.1.1.33) and on January 19, 2021 (lineage P.1); case 3 (40-year-old) was positive on April 22, 2020 (lineage B.1.195) and on January 29, 2021 (lineage P.1). The three patients displayed low mean Ct values (< 22) at nasopharyngeal samples and reported less severe illness during reinfection. The present study provides the first evidence of the new VOC P.1 causing multiple reinfections during the second epidemic peak in the Amazonas state. Our findings suggest that reinfected individuals may have been infectious. Although immune responses induced by natural infections do not necessarily prevent subsequent infections by the VOC P.1, they may still protect from severe disease.

show abstract

Section: Discussionmentioning

confidence: 84%

Three SARS-CoV-2 reinfection cases by the new Variant of Concern (VOC) P.1/501Y.V3

Naveca

Costa²,

Nascimento

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Importantly, even among all seronegative participants who had evidence of a previous SARS-CoV-2 infection, a single vaccine dose induced higher titer levels compared to the infection naïve cohort, suggesting immune memory persistence. With the risk of reinfection increasing with time, several COVID-19 reinfection cases have already been documented [22][23][24][25][26][27][28][29]. The fact that most reinfected patients are asymptomatic or mildly symptomatic, raises the possibility that immunity is maintained and reduces the disease symptom severity even in cases of undetectable antibody levels at the time of reinfection.…”

Section: Discussionmentioning

confidence: 99%

Safety and Humoral Responses to SARS-CoV-2 mRNA Vaccination of Previously Infected and Naive Populations

Efrati¹,

Catalogna²,

Hamed³

et al. 2021

Preprint

View full text Add to dashboard Cite

Since COVID-19 risk of reinfection is of great concern, the safety and efficacy of the mRNA-based vaccines in previously infected populations should be assessed. We studied 78 individuals previously infected with SARS-CoV-19, who received a single dose of BNT162b2 mRNA COVID-19 vaccine, and 1:2 ratio matched infection-naïve cohort who received two injections. The evaluation procedure included symptom monitoring, and serological tests. Among the post-infected population, the median IgG-S response after the first vaccine dose was 2260 AU/ml, compared to 238 AU/ml after the second vaccine injection in the infection naive group. A strong correlation was demonstrated between IgG-S level before vaccination, and the corresponding responses after a single vaccine dose (r = 0.8, p < 0.001) in the post infected population. Short-term severe symptoms that required medical attention were found in 6.8% among the post-infected individuals, while none were found in the infection naïve population. Our data suggest that a single vaccine dose is sufficient to induce an intense immune response in post-infected population regardless of seropositivity. Although some short-term safety issues were observed compared to the infection naïve population, a single dose regimen can be considered safe in post-infected populations.

show abstract

“…Taken together, these data unambiguously demonstrate that adaptive immunity confers protection against SARS-CoV-2 infection in the majority of cases. However, rare case reports of SARS-CoV-2 reinfection by antigenically similar variants have also been documented as soon as 48 days from primary symptom onset [11][12][13][14][15][16][17][18] (Extended Data Table 1). Whether these reinfections are the direct result of deficient adaptive immune responses to the primary infection, or are the result of waning adaptive immunity, is currently unknown.…”

Section: Introductionmentioning

confidence: 99%

Case Study: Longitudinal immune profiling of a SARS-CoV-2 reinfection in a solid organ transplant recipient

Klein

Trubin

et al. 2021

Preprint

View full text Add to dashboard Cite

Prior to the emergence of antigenically distinct SARS-CoV-2 variants, reinfections were reported infrequently - presumably due to the generation of durable and protective immune responses. However, case reports also suggested that rare, repeated infections may occur as soon as 48 days following initial disease onset. The underlying immunologic deficiencies enabling SARS-CoV-2 reinfections are currently unknown. Here we describe a renal transplant recipient who developed recurrent, symptomatic SARS-CoV-2 infection - confirmed by whole virus genome sequencing - 7 months after primary infection. To elucidate the immunological mechanisms responsible for SARS-CoV-2 reinfection, we performed longitudinal profiling of cellular and humoral responses during both primary and recurrent SARS-CoV-2 infection. We found that the patient responded to the primary infection with transient, poor-quality adaptive immune responses. The patients immune system was further compromised by intervening treatment for acute rejection of the renal allograft prior to reinfection. Importantly, we also identified the development of neutralizing antibodies and the formation of humoral memory responses prior to SARS-CoV-2 reinfection. However, these neutralizing antibodies failed to confer protection against reinfection, suggesting that additional factors are required for efficient prevention of SARS-CoV-2 reinfection. Further, we found no evidence supporting viral evasion of primary adaptive immune responses, suggesting that susceptibility to reinfection may be determined by host factors rather than pathogen adaptation in this patient. In summary, our study suggests that a low neutralizing antibody presence alone is not sufficient to confer resistance against reinfection. Thus, patients with solid organ transplantation, or patients who are otherwise immunosuppressed, who recover from infection with SARS-CoV-2 may not develop sufficient protective immunity and are at risk of reinfection.

show abstract

Symptomatic SARS-CoV-2 re-infection of a health care worker in a Belgian nosocomial outbreak despite primary neutralizing antibody response

Cited by 38 publications

References 32 publications

Three SARS-CoV-2 reinfection cases by the new Variant of Concern (VOC) P.1/501Y.V3

Three SARS-CoV-2 reinfection cases by the new Variant of Concern (VOC) P.1/501Y.V3

Safety and Humoral Responses to SARS-CoV-2 mRNA Vaccination of Previously Infected and Naive Populations

Case Study: Longitudinal immune profiling of a SARS-CoV-2 reinfection in a solid organ transplant recipient

Contact Info

Product

Resources

About