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

•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.•Rec...

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Published in:	The Journal of infection Vol. 82; no. 3; pp. 399 - 406
Main Authors:	Adrielle dos Santos, Letícia, Filho, Pedro Germano de Góis, Silva, Ana Maria Fantini, Santos, João Victor Gomes, Santos, Douglas Siqueira, Aquino, Marília Marques, de Jesus, Rafaela Mota, Almeida, Maria Luiza Dória, da Silva, João Santana, Altmann, Daniel M., Boyton, Rosemary J., Alves dos Santos, Cliomar, Santos, Camilla Natália Oliveira, Alves, Juliana Cardoso, Santos, Ianaline Lima, Magalhães, Lucas Sousa, Belitardo, Emilia M.M.A., Rocha, Danilo J.P.G., Almeida, João P.P., Pacheco, Luis G.C., Aguiar, Eric R.G.R., Campos, Gubio Soares, Sardi, Silvia Inês, Carvalho, Rejane Hughes, de Jesus, Amélia Ribeiro, Rezende, Karla Freire, de Almeida, Roque Pacheco
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-03-2021 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association
Subjects:	Antibodies Brazil - epidemiology Case-Control Studies COVID-19 Female Health Personnel Humans Recurrence Reinfection SARS-CoV-2 Severity of Illness Index Brazil COVID-19 Antibodies Recurrence SARS-CoV-2 Reinfection
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Summary:	•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. 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. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 These authors are senior investigators and contributed equally to this manuscript. These authors contributed equally to this manuscript.
ISSN:	0163-4453 1532-2742
DOI:	10.1016/j.jinf.2021.01.020