Assessment of the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reinfection in an Intense Reexposure Setting

Abu-Raddad, Laith J; Chemaitelly, Hiam; Malek, Joel A.; Ahmed, Ayeda A.; Mohamoud, Yasmin Ali; Younuskunju, Shameem; Ayoub, Houssein H.; Kanaani, Zaina Al; Khal, Abdullatif Al; Kuwari, Einas Al; Butt, Adeel A.; Coyle, Peter; Jeremijenko, Andrew; Kaleeckal, Anvar Hassan; Latif, Ali Nizar; Shaik, Riyazuddin Mohammad; Rahim, Hanan F. Abdul; Yassine, Hadi M.; Al‐Kuwari, Mohamed Ghaith; Romaihi, Hamad Eid Al; Al-Thani, Mohamed H.; Bertollini, Roberto

doi:10.1093/cid/ciaa1846

Cited by 152 publications

(169 citation statements)

References 21 publications

Supporting

Mentioning

153

Contrasting

Order By: Relevance

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused extensive disease and death, with heavy social and economic losses [1-4]. In addition to the risk of first infection, reinfection during this prolonged pandemic has raised additional public health concerns [5-9].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 reinfection in a cohort of 43,000 antibody-positive individuals followed for up to 35 weeks

Abu‐Raddad

Chemaitelly

Coyle

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Reinfection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been documented, raising public health concerns. Risk and incidence rate of SARS-CoV-2 reinfection were assessed in a large cohort of antibody-positive persons in Qatar. Methods: All SARS-CoV-2 antibody-positive persons with a PCR-positive swab ≥14 days after the first-positive antibody test were individually investigated for evidence of reinfection. Viral genome sequencing was conducted for paired viral specimens to confirm reinfection. Incidence of reinfection was compared to incidence of infection in the complement cohort of those antibody-negative. Results: Among 43,044 anti-SARS-CoV-2 positive persons who were followed for a median of 16.3 weeks (range: 0-34.6), 314 individuals (0.7%) had at least one PCR positive swab ≥14 days after the first-positive antibody test. Of these individuals, 129 (41.1%) had supporting epidemiological evidence for reinfection. Reinfection was next investigated using viral genome sequencing. Applying the viral-genome-sequencing confirmation rate, the risk of reinfection was estimated at 0.10% (95% CI: 0.08-0.11%). The incidence rate of reinfection was estimated at 0.66 per 10,000 person-weeks (95% CI: 0.56-0.78). Incidence rate of reinfection versus month of follow-up did not show any evidence of waning of immunity for over seven months of follow-up. Meanwhile, in the complement cohort of 149,923 antibody-negative persons followed for a median of 17.0 weeks (range: 0-45.6), risk of infection was estimated at 2.15% (95% CI: 2.08-2.22%) and incidence rate of infection was estimated at 13.69 per 10,000 person-weeks (95% CI: 13.22-14.14). Efficacy of natural infection against reinfection was estimated at 95.2% (95% CI: 94.1-96.0%). Reinfections were less severe than primary infections. Only one reinfection was severe, two were moderate, and none were critical or fatal. Most reinfections (66.7%) were diagnosed incidentally through random or routine testing, or through contact tracing. Conclusions: Reinfection is rare. Natural infection appears to elicit strong protection against reinfection with an efficacy ~95% for at least seven months.

show abstract

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 reinfection in a cohort of 43,000 antibody-positive individuals followed for up to 35 weeks

Abu‐Raddad

Chemaitelly

Coyle

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…A key assumption is that those infected acquire protective immunity against reinfection that lasts for at least a year. While this assumption is supported by current evidence [8][9][10], studies with longer-term follow-up are still needed to assess the duration of natural immunity. Vaccine-induced immunity is assumed to last for one year, but the duration of this immunity is also unknown.…”

Section: Discussionmentioning

confidence: 98%

“…Prioritizing vaccination for specific subpopulations that will benefit most from it is one potential approach to optimize vaccine impact while vaccine supply is being expanded. Evidence suggests that reinfection with SARS-CoV-2 is a rare phenomenon and that most infected persons develop protective immunity against reinfection that lasts for at least a few months post-primary infection [8][9][10]. Therefore, vaccination is conceivably more beneficial for those who are antibodynegative than those whose immune systems have already confronted this infection and cleared it.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological impact of prioritizing SARS-CoV-2 vaccination by antibody status: Mathematical modeling analyses

Ayoub

Chemaitelly

Makhoul

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundVaccines against SARS-CoV-2 have been developed, but their availability falls far short of global needs. This study aimed to investigate the impact of prioritizing available doses on the basis of recipient antibody status, that is by exposure status, using Qatar as an example.MethodsVaccination impact was assessed under different scale-up scenarios using a deterministic meta-population mathematical model describing SARS-CoV-2 transmission and disease progression in the presence of vaccination.ResultsFor a vaccine that protects against infection with an efficacy of 95%, half as many vaccinations were needed to avert one infection, disease outcome, or death by prioritizing antibody-negative individuals for vaccination. Prioritization by antibody status reduced incidence at a faster rate and led to faster elimination of infection and return to normalcy. Further prioritization by age group amplified the gains of prioritization by antibody status. Gains from prioritization by antibody status were largest in settings where the proportion of the population already infected at the commencement of vaccination was 30-60%, which is perhaps where most countries will be by the time vaccination programs are up and running. For a vaccine that only protects against disease and not infection, vaccine impact was reduced by half, whether this impact was measured in terms of averted infections or disease outcomes, but the relative gains from using antibody status to prioritize vaccination recipients were similar.ConclusionsMajor health, societal, and economic gains can be achieved more quickly by prioritizing those who are antibody-negative while doses of the vaccine remain in short supply.

show abstract

“…Since the evidence suggests that reinfection with this virus is a rare event [10][11][12][13][14][15], those recovered from infection were assumed protected against reinfection, but only for one year, based on the behavior of other "common cold" coronaviruses [16]. For the same purpose, it was assumed that vaccine-induced immunity will also last for only one year, a conservative assumption given that studies have been increasingly suggesting that immunity may be more durable and long-lasting [10,15,[17][18][19]. The waning of both natural and vaccine immunity was assumed to follow a gamma distribution of order n = 15.…”

Section: Mathematical Model and Parameterizationmentioning

confidence: 99%

“…Since the US has experienced a large epidemic, it was assumed that 20% of the US population has already been infected by 1 January 2021 [33], with those already infected (if subsequently vaccinated) assumed to have natural immunity against reinfection as supported by reinfection studies [10,15,19]. Moreover, the basic reproduction number at time of onset of vaccination was assumed at R 0 = 1.2, reflecting the current phase of an expanding epidemic.…”

Section: Characteristics Of the Vaccine And Scale-up Scenariosmentioning

confidence: 99%

Epidemiological Differences in the Impact of COVID-19 Vaccination in the United States and China

et al. 2021

Self Cite

View full text Add to dashboard Cite

This study forecasts Coronavirus Disease 2019 (COVID-19) vaccination impact in two countries at different epidemic phases, the United States (US) and China. We assessed the impact of both a vaccine that prevents infection (VES of 95%) and a vaccine that prevents only disease (VEP of 95%) through mathematical modeling. For VES of 95% and gradual easing of restrictions, vaccination in the US reduced the peak incidence of infection, disease, and death by >55% and cumulative incidence by >32% and in China by >77% and >65%, respectively. Nearly three vaccinations were needed to avert one infection in the US, but only one was needed in China. For VEP of 95%, vaccination benefits were half those for VES of 95%. In both countries, impact of vaccination was substantially enhanced with rapid scale-up, vaccine coverage >50%, and slower or no easing of restrictions, particularly in the US. COVID-19 vaccination can flatten, delay, and/or prevent future epidemic waves. However, vaccine impact is destined to be heterogeneous across countries because of an underlying “epidemiologic inequity” that reduces benefits for countries already at high incidence, such as the US. Despite 95% efficacy, actual vaccine impact could be meager in such countries if vaccine scale-up is slow, acceptance is poor, or restrictions are eased prematurely.

show abstract

Assessment of the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reinfection in an Intense Reexposure Setting

Cited by 152 publications

References 21 publications

SARS-CoV-2 reinfection in a cohort of 43,000 antibody-positive individuals followed for up to 35 weeks

SARS-CoV-2 reinfection in a cohort of 43,000 antibody-positive individuals followed for up to 35 weeks

Epidemiological impact of prioritizing SARS-CoV-2 vaccination by antibody status: Mathematical modeling analyses

Epidemiological Differences in the Impact of COVID-19 Vaccination in the United States and China

Contact Info

Product

Resources

About