Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers.
Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers.
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DOI：
10.1016/j.jinf.2021.01.020
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
de Almeida RP
中科院分区：
文献类型：
--
作者：
Adrielle Dos Santos L;Filho PGG;Silva AMF;Santos JVG;Santos DS;Aquino MM;de Jesus RM;Almeida MLD;da Silva JS;Altmann DM;Boyton RJ;Alves Dos Santos C;Santos CNO;Alves JC;Santos IL;Magalhães LS;Belitardo EMMA;Rocha DJPG;Almeida JPP;Pacheco LGC;Aguiar ERGR;Campos GS;Sardi SI;Carvalho RH;de Jesus AR;Rezende KF;de Almeida RP
人们越来越关注报告的重复COVID-19疾病发作的个人，这些病例在少数情况下被描述为具有不同序列的新发感染，表明即使在短期内也没有足够的保护性免疫力。观察性病例系列和病例对照研究报告了33例复发性、症状性、qRT-PCR阳性COVID-19病例。复发性疾病定义为无症状临床恢复后的症状性复发，从症状开始后>14天解除隔离，通过qRT-PCR证实。病例对照研究设计比较了这组患者与从同一COVID-19数据库中随机选择的62名患者的对照组。在33名复发的COVID-19患者中，26名为女性，30名为HCW。平均复发时间为50.5天，与HCW（OR 36.4（p <0.0001））和A型血（OR 4.8（p = 0.002））相关。SARS-CoV-2抗体在初次COVID-19后复发患者（2.4 ± 0.610; p<0.0001）和复发后（6.4 ± 11.34; p = 0.007）中显著较低。病毒基因组测序确定了1名患者的不同分离株的再感染。这是第一个详细的病例系列显示COVID-19复发与qRT-PCR阳性。对于一个个体，在第一和第二次发作中检测到遗传学上不同的基因组序列证实了真正的再感染，但在大多数情况下，数据并没有正式区分再感染和慢性感染储库的重新出现。这些事件与初始疾病期间抗体应答降低显著相关，并认为需要持续警惕，而无需假设首次事件后的保护。
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.
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