The Importance and Challenges of Identifying SARS-CoV-2 Reinfections.
The Importance and Challenges of Identifying SARS-CoV-2 Reinfections.
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DOI：
10.1128/jcm.02769-20
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发表时间：
2021-03-19
影响因子：
9.4
通讯作者：
Piantadosi A
中科院分区：
文献类型：
--
作者：
Babiker A;Marvil CE;Waggoner JJ;Collins MH;Piantadosi A
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）再感染的报告提出了关于对原发感染的免疫反应的强度和持久性的重要问题，这是预测大流行过程的关键因素。识别再感染需要在两个不同的时间点检测病毒，并使用病毒基因组数据来区分再感染和持续的病毒携带。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）再感染的报告提出了关于对原发感染的免疫反应的强度和持久性的重要问题，这是预测大流行过程的关键因素。识别再感染需要在两个不同的时间点检测病毒，并使用病毒基因组数据来区分再感染和持续的病毒携带。这一进程受到后勤和能力挑战的阻碍，例如储存初次感染的样本和进行病毒基因组测序。这些挑战可能有助于解释为什么迄今为止描述的病例很少。此外，再感染可能是一种罕见的现象，但需要详细的前瞻性研究来严格评估其频率。为了给未来SARS-CoV-2再感染的研究提供背景，我们回顾了迄今为止已发表或可在预印本中获得的16例病例。再感染发生在人口统计学谱和初始感染为无症状/轻度和中度/重度的患者中。对于严重程度可以在发作之间进行比较的病例，一半的再感染不太严重，这增加了部分免疫保护的可能性。虽然许多患者在再感染时总免疫球蛋白或IgG结果呈阳性，但很少对其免疫反应进行检查。需要进一步的工作来阐明SARS-CoV-2再感染的频率、决定因素和后果。建立必要的监测和调查框架将在很大程度上依赖于临床实验室和临床研究人员，我们提出了几个考虑因素，以指导医学界识别和表征SARS-CoV-2再感染。
Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection have raised important questions about the strength and durability of the immune response to primary infection, which are key factors in predicting the course of the pandemic. Identifying reinfection requires detecting the virus at two different time points and using viral genomic data to distinguish reinfection from persistent viral carriage. Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection have raised important questions about the strength and durability of the immune response to primary infection, which are key factors in predicting the course of the pandemic. Identifying reinfection requires detecting the virus at two different time points and using viral genomic data to distinguish reinfection from persistent viral carriage. This process is hindered by challenges of logistics and capacity, such as banking samples from primary infection and performing viral genome sequencing. These challenges may help to explain why very few cases have been described to date. In addition, reinfection may be a rare phenomenon, but detailed prospective studies are needed to rigorously assess its frequency. To provide context for future investigations of SARS-CoV-2 reinfection, we review 16 cases that have been published to date or are available in preprint. Reinfection occurred across demographic spectra and in patients whose initial infections were both asymptomatic/mild and moderate/severe. For cases in which severity could be compared between episodes, half of reinfections were less severe, raising the possibility of partial immune protection. Although many patients had a positive total immunoglobulin or IgG result at the time of reinfection, very little examination of their immune response was performed. Further work is needed to elucidate the frequency, determinants, and consequences of SARS-CoV-2 reinfection. Establishing the necessary frameworks for surveillance and investigation will rely heavily on clinical laboratories and clinical investigators, and we propose several considerations to guide the medical community in identifying and characterizing SARS-CoV-2 reinfections.