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

• DOI: 10.1016/j.jinf.2021.01.020
• Publication Date: 2021-02-15T07:37:07Z
• Authors: Letícia Adrielle ...; Pedro Germano de ...; Ana Maria Fantini...; João Victor Gomes...; Douglas Siqueira ...; Marília Marques A...; Rafaela Mota de J...; Maria Luiza Dória...; João Santana da S...; Daniel M. Altmann; Rosemary J. Boyton; Cliomar Alves dos...; Camilla Natália O...; Juliana Cardoso A...; Ianaline Lima Santos; Lucas Sousa Magal...; Emilia M.M.A. Bel...; Danilo J.P.G. Rocha; João P.P. Almeida; Luis G.C. Pacheco; Eric R.G.R. Aguiar; Gubio Soares Campos; Silvia Inês Sardi; Rejane Hughes Car...; Amélia Ribeiro de...; Karla Freire Rezende; Roque Pacheco de ...
• Keywords: Microbiology (medical); 0301 basic medicine; SARS-CoV-2; Health Personnel; 610; COVID-19; 1103 Clinical Sciences; Microbiology; Severity of Illness Index; Antibodies; Article; 3. Good health; 03 medical and health sciences; Infectious Diseases; Recurrence; Case-Control Studies; Reinfection; Humans; Female; Brazil

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.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.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.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.