Elsevier

Journal of Infection

Volume 82, Issue 3, March 2021, Pages 399-406
Journal of Infection

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

https://doi.org/10.1016/j.jinf.2021.01.020Get rights and content
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open access

Highlights

  • We describe 33 patients with recurrent COVID19 and a positive PCR.

  • Recurrence is associated with working as a healthcare professional, blood-group A, and low IgG response to infection.

  • Evidence from differential virus sequencing between the first and second episode supports de novo reinfection.

  • Recurrent episodes tended to be more severe, with one fatal infection.

Summary

Background

There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term.

Methods

Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation >14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database.

Results

Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p <0.0001)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19  (2.4 ± 0.610; p<0.0001) and after recurrence (6.4 ± 11.34; p = 0.007).  Virus genome sequencing identified reinfection by a different isolate in one patient.

Conclusions

This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

Keywords

COVID-19
Recurrence
Reinfection
SARS-CoV-2
Antibodies

Cited by (0)

1

These authors contributed equally to this manuscript.

2

These authors are senior investigators and contributed equally to this manuscript.