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Mokhayeri Y, Taherpour N, Shahbazi F, Ghorbani SS, Fallah S, Etemad K, Izadi N, Mehri A, Farhadi-Babadi K, Rahimi E, Feyzi R, Seifi A, Hashemi Nazari SS. Estimation of outpatient SARS-CoV-2 reinfection and recurrence rates and associated factors among COVID-19 hospitalized patients over one-year old: a multicenter retrospective cohort study. BMC Infect Dis 2024; 24:999. [PMID: 39294562 PMCID: PMC11411993 DOI: 10.1186/s12879-024-09872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024] Open
Abstract
INTRODUCTION Reinfection with SARS-Cov-2 after recovery can occur that most of them don't require hospitalization. The aim of this study is estimation of out-patient COVID-19 reinfection and recurrence rates and its associated factors among Iranian patients with history of confirmed SARS-Cov-2 infection and hospitalization. METHODS This study is a retrospective cohort conducted from May 2021 to May 2022 in Iran. The national Medical Care Monitoring Center (MCMC) database, obtained from the Ministry of Health and Medical Education, includes all information about confirmed COVID-19 patients who are hospitalized and diagnosed during the pandemic. Using probability proportional to size sampling from 31 provinces, 1,532 patients over one years of age with a history of hospitalization in the MCMC data are randomly selected. After that, interviews by phone are performed with all of the selected patients using a researcher-made questionnaire about the occurrence of overall reinfection without considering the time of infection occurrence, reinfection occurring at least 90 days after the discharge and recurrence (occurring within 90 days after discharge). Univariate and multivariable Cox regression analyses are performed to assess the factors associated with each index. All of the analyses are performed using Stata software version 16. RESULTS In general, 1,532 phone calls are made, out of which 1,095 individuals are willing to participate in the study (response rate ≃ 71%). After assessing the 1,095 patients with a positive history of COVID-19, the rates of non-hospitalized overall SARS-Cov-2 reinfection, reinfection and recurrence are 122.64, 114.09, and 8.55 per 1,000 person-years, respectively. The age range of 19-64 years (aHR:3.93, 95%CI : 1.24-12.41) and COVID-19-related healthcare worker (aHR: 3.67, 95%CI: 1.77-7.61) are identified as risk factors for reinfection, while having comorbidity, being fully vaccinated, and having a partial pressure of oxygen (PaO2) ≥ 93 mmHg during the initial infection are identified as factors that reduce the risk of non-hospitalized reinfection. CONCLUSION Reinfection due to COVID-19 is possible because of the weakened immune system for various reasons and the mutation of the virus. Vaccination, timely boosters, and adherence to preventive measures can help mitigate this risk.
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Affiliation(s)
- Yaser Mokhayeri
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences Hamadan, Hamadan, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Fallah
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Izadi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Farhadi-Babadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Rahimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Feyzi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin Ave, Tehran, 198353-5511, Iran.
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Holubovska O, Babich P, Mironenko A, Milde J, Lebed Y, Stammer H, Mueller L, te Velthuis AJW, Margitich V, Goy A. RNA Polymerase Inhibitor Enisamium for Treatment of Moderate COVID-19 Patients: A Randomized, Placebo-Controlled, Multicenter, Double-Blind Phase 3 Clinical Trial. Adv Respir Med 2024; 92:202-217. [PMID: 38804439 PMCID: PMC11130936 DOI: 10.3390/arm92030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
Enisamium is an orally available therapeutic that inhibits influenza A virus and SARS-CoV-2 replication. We evaluated the clinical efficacy of enisamium treatment combined with standard care in adult, hospitalized patients with moderate COVID-19 requiring external oxygen. Hospitalized patients with laboratory-confirmed SARS-CoV-2 infection were randomly assigned to receive either enisamium (500 mg per dose, four times a day) or a placebo. The primary outcome was an improvement of at least two points on an eight-point severity rating (SR) scale within 29 days of randomization. We initially set out to study the effect of enisamium on patients with a baseline SR of 4 or 5. However, because the study was started early in the COVID-19 pandemic, and COVID-19 had been insufficiently studied at the start of our study, an interim analysis was performed alongside a conditional power analysis in order to ensure patient safety and assess whether the treatment was likely to be beneficial for one or both groups. Following this analysis, a beneficial effect was observed for patients with an SR of 4 only, i.e., patients with moderate COVID-19 requiring supplementary oxygen. The study was continued for these COVID-19 patients. Overall, a total of 592 patients were enrolled and randomized between May 2020 and March 2021. Patients with a baseline SR of 4 were divided into two groups: 142 (49.8%) were assigned to the enisamium group and 143 (50.2%) to the placebo group. An analysis of the population showed that if patients were treated within 4 days of the onset of COVID-19 symptoms (n = 33), the median time to improvement was 8 days for the enisamium group and 13 days for the placebo group (p = 0.005). For patients treated within 10 days of the onset of COVID-19 symptoms (n = 154), the median time to improvement was 10 days for the enisamium group and 12 days for the placebo group (p = 0.002). Our findings suggest that enisamium is safe to use with COVID-19 patients, and that the observed clinical benefit of enisamium is worth reporting and studying in detail.
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Affiliation(s)
- Olga Holubovska
- Department of Infectious Diseases, O.O. Bogomolets National Medical University, T. Shevchenko Blvd. 13, 01601 Kyiv, Ukraine;
| | - Pavlo Babich
- State Expert Center, Smolenska Str. 10, 03057 Kyiv, Ukraine;
| | - Alla Mironenko
- Department of Respiratory and Other Viral Infections, L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the NAMS of Ukraine, Amosova Str. 5a, 03083 Kyiv, Ukraine;
| | - Jens Milde
- Pharmalog Institut für Klinische Forschung GmbH, Oskar-Messter-Str. 29, 85737 Ismaning, Germany; (J.M.); (H.S.)
| | - Yuriy Lebed
- Pharmaxi LLC, Filatova Str. 10A, 01042 Kyiv, Ukraine;
| | - Holger Stammer
- Pharmalog Institut für Klinische Forschung GmbH, Oskar-Messter-Str. 29, 85737 Ismaning, Germany; (J.M.); (H.S.)
| | - Lutz Mueller
- Regenold GmbH, Zöllinplatz 4, 79410 Badenweiler, Germany;
| | - Aartjan J. W. te Velthuis
- Department of Molecular Biology, Princeton University, Princeton, NJ 08544, USA
- Division of Virology, Department of Pathology, University of Cambridge Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK
| | - Victor Margitich
- Farmak Joint Stock Company, Kyrylivska Str., 04080 Kyiv, Ukraine
| | - Andrew Goy
- Farmak Joint Stock Company, Kyrylivska Str., 04080 Kyiv, Ukraine
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Cao X, Xie Y, Zhou C, Mu H. Clinical characteristics associated with recurrent viral RNA positivity in patients within two weeks after recovering from the first SARS-CoV-2 infection. BIOMOLECULES & BIOMEDICINE 2024; 24:196-204. [PMID: 37702601 PMCID: PMC10787619 DOI: 10.17305/bb.2023.9661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023]
Abstract
Many studies have shown that recovered coronavirus disease 2019 (COVID-19) patients frequently exhibit recurrent viral RNA positivity (RP) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our study aimed to summarize the clinical characteristics of these patients and explore potential reasons for RP occurrence. We divided 439 participants into four groups based on the severity of illness prior to the COVID-19 recovery and age: mild-child group, moderate-child group, mild-adult group, and moderate-adult group. Laboratory data were collected and statistical analyzed using the SPSS software, version 24.0. Significant differences were observed in age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), interleukin 6 (IL-6), and neutrophil to lymphocyte ratio (NLR) levels between the mild-adult group and the moderate-adult group (P < 0.05). Additionally, AST levels differed significantly between the mild-child group and the moderate-child group (P < 0.05). The proportion of RP patients within the four groups varied from 7.95% to 26.13% within a 2-week period. Logistic regression analysis revealed that younger age and moderate symptoms were risk factors for RP in children, while the presence of comorbidities (such as chronic heart, lung, liver, and kidney diseases), elevated IL-6 levels, and NLR were risk factors for RP in adults. We constructed two predictive models containing these relevant parameters, and the results of the receiver operating characteristic (ROC) curves indicated strong predictive utility. Our findings suggest that younger children with more severe symptoms, as well as adult patients with elevated levels of IL-6 and NLR and underlying diseases, are at higher risk of RP occurrence.
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Affiliation(s)
- Xi Cao
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Yongli Xie
- Department of Clinical Laboratory, Tianjin Stomatological Hospital, Tianjin, China
- Department of Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin Stomatological Hospital, Tianjin, China
| | - Chunlei Zhou
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
| | - Hong Mu
- Department of Clinical Laboratory, Tianjin First Central Hospital, Tianjin, China
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Santos CNO, Caldas GC, de Oliveira FA, da Silva AM, da Silva JS, da Silva RLL, de Jesus AR, Magalhães LS, de Almeida RP. COVID-19 recurrence is related to disease-early profile T cells while detection of anti-S1 IgG is related to multifunctional T cells. Med Microbiol Immunol 2023; 212:339-347. [PMID: 37488347 DOI: 10.1007/s00430-023-00776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
COVID-19 is caused by SARS-CoV-2 infection and leads from asymptomatic to severe outcomes. The recurrence of the COVID-19 has been described, however, mechanisms involved remains unclear. Thus, the work aimed to investigate the role of multifunctional T cells in patients with recurrent COVID-19. We evaluated clinical characteristics, presence of anti-S1 and anti-Nucleocapsid IgG in patients' sera, and multifunctional T cells (for IFN-γ, IL-2, and TNF-α) in patients with multiple episodes of COVID-19 and controls. Data demonstrate that patients with recurrent COVID-19 have a T cell pattern predominantly related to IFN-γ production. Also, patients with COVID-19 history and absence of anti-S1 IgG had lower levels of CD4+ IFN + IL-2 + TNF + T cells independently of number of disease episodes. Complementary, vaccination changed the patterns of T cells phenotypes and induced IgG seroconversion, despite not induce higher levels of multifunctional T cells in all patients. In conclusion, the data suggest that recurrent disease is related to early-disease T cell profile and absence of anti-S1 IgG is related to lower multifunctional CD4 T cell response, what suggests possibility of new episodes of COVID-19 in these patients.
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Affiliation(s)
- Camilla Natália O Santos
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brazil
| | - Gustavo C Caldas
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
| | - Fabricia A de Oliveira
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
| | - Angela Maria da Silva
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brazil
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
| | - João S da Silva
- Plataforma de Medicina Translacional da Fundação Oswaldo Cruz e Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, Brazil
| | - Ricardo Luís L da Silva
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Departamento de Educação em Saúde, Universidade Federal de Sergipe, Lagarto, Brazil
| | - Amélia R de Jesus
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brazil
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
- Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciência e Tecnologia, São Paulo, Brazil
| | - Lucas S Magalhães
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil.
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brazil.
- Setor de Parasitologia e Patologia, Instituto de Ciência Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, Brazil.
| | - Roque P de Almeida
- Laboratório de Imunologia e Biologia Molecular, Universidade Federal de Sergipe, Aracaju, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brazil
- Departamento de Medicina, Hospital Universitário, Universidade Federal de Sergipe, Aracaju, Brazil
- Instituto de Investigação em Imunologia (iii), Instituto Nacional de Ciência e Tecnologia, São Paulo, Brazil
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La Torre G, Paglione G, Barone LC, Cammalleri V, Faticoni A, Marte M, Pocino RN, Previte CM, Bongiovanni A, Colaprico C, Ricci E, Imeshtari V, Manai MV, Shaholli D, Barletta VI, Carluccio G, Moretti L, Vezza F, Volpicelli L, Massetti AP, Cinti L, Roberto P, Napoli A, Antonelli G, Mastroianni CM, Sernia S. Evaluation of the Factors Associated with Reinfections towards SARS-CoV-2 Using a Case Control Design. J Clin Med 2023; 12:jcm12113861. [PMID: 37298055 DOI: 10.3390/jcm12113861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. METHODS A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. RESULTS 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38-4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19-1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41-8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21-2.25). CONCLUSION From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants.
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Affiliation(s)
- Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Gianluca Paglione
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Lavinia Camilla Barone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Augusto Faticoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Mattia Marte
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberta Noemi Pocino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Carlo Maria Previte
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Bongiovanni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Corrado Colaprico
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Eleonora Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Valentin Imeshtari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Vittoria Manai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - David Shaholli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Vanessa India Barletta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanna Carluccio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Luca Moretti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesca Vezza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Paola Massetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Lilia Cinti
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Piergiorgio Roberto
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Napoli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Sabina Sernia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
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Peng M, Hu M, Peng X, Gong Y, Qian K, Li J, Zhao J, Li X, Huang J, Zhang M, Chai L, Chen L, Zhang D, Peng L. What contributes to the re-positive nucleic acid test results for the omicron variant of SARS-CoV-2 in the shelter cabin hospital in Shanghai, China? Heliyon 2023; 9:e15679. [PMID: 37124338 PMCID: PMC10123020 DOI: 10.1016/j.heliyon.2023.e15679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
Background Despite the increasing reports of re-positive SARS-CoV-2 cases after recovery and discharge from hospitals, our knowledge remains very limited regarding the contributing factors of re-positivity and its roles in the transmission and epidemiology of the Omicron variant. Methods In this retrospective study, re-positivity is defined as the positive nucleic acid result (Ct < 35) following two consecutive negative results during hospitalization. A total of 751 patients from Shanghai Shelter Cabin Hospital were enrolled and divided with a ratio of about 1:2 into the re-positivity group and the non-re-positivity group. Patients required three consecutive negative results daily as the de-isolation criterion. The follow-up time of discharged patients lasted five weeks. Univariate regression analysis was used to compare variables between the re-positivity and non-re-positivity groups, and the single re-positivity and multiple re-positivity groups, with P < 0.05 defined as the statistical significance of differences. Subsequently, variables with P < 0.2 were subjected to multivariate logistic regression analysis to investigate the odds ratio (OR) of re-positivity and the influencing factors of re-positivity of the Omicron variant. Results The re-positivity group had a higher proportion of males (68.1% vs 58.1%, p = 0.000), a higher education level (31.9% vs 12.7%, p = 0.007), a longer hospitalization duration (13 days vs 8 days, p = 0.000), and a higher Convidecia vaccination rate (6.0% vs 2.4%, p = 0.011). Further multivariable analysis showed male (OR = 2.168, p = 0.000), Convidecia vaccination (OR = 2.634, p = 0.014), hospitalization duration (OR = 2.146, p = 0.000) and education level (OR = 1.595, p = 0.007) were associated with re-positivity. The average rate of re-positivity was 25% during hospitalization and decreased to 0.4% among discharged patients. Re-positivity was more common in the period with a larger number of hospitalized patients and in larger wards with a larger number of patients. Conclusion A large number of hospitalized patients, large-sized wards, and gender are significant contributing factors to re-positivity. Division of the shelter cabin hospital into small independent wards and requirement of three consecutive results daily as the de-isolation criterion might be more beneficial to the control and prevention of the spread of the Omicron variant.
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Affiliation(s)
- Mei Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Maozi Hu
- Gastroenterology Department, Jiulongpo District Hospital of Chongqing, Chongqing, China
| | - Xiaolu Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Gong
- Critical Care Medicine Department, Jiulongpo District Hospital of Chongqing, Chongqing, China
| | - Keli Qian
- Department of Nosocomial Infection Control, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junnan Li
- Department of Obstetrics and Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinqiu Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Huang
- Department of Respiratory Medicine, Chongqing General Hospital, Chongqing, China
| | - Meng Zhang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Lili Chai
- Infectious Department, The Fifth Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Li Chen
- Medical Service Division, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tavakoli A, Lotfi F, Lotfi M, Bayati M, Seif M, Salesi M, Emadi M, Keshavarz K, Delavari S. COVID-19 Reinfection Rate and Related Risk Factors in Fars Province, Iran: A Retrospective Cohort Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:302-312. [PMID: 37791328 PMCID: PMC10542930 DOI: 10.30476/ijms.2022.94615.2598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 10/05/2023]
Abstract
Background Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021. Methods The patients' data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection. Results A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055; P<0.001), men (OR=1.283; P<0.001), urban population (OR=1.313; P<0.001), and healthcare providers (OR=4.453; P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection. Conclusion The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases.
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Affiliation(s)
- Ali Tavakoli
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Ccenter, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Emadi
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Ukwishaka J, Ndayishimiye Y, Destine E, Danwang C, Kirakoya-Samadoulougou F. Global prevalence of coronavirus disease 2019 reinfection: a systematic review and meta-analysis. BMC Public Health 2023; 23:778. [PMID: 37118717 PMCID: PMC10140730 DOI: 10.1186/s12889-023-15626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/07/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged with a high transmissibility rate and resulted in numerous negative impacts on global life. Preventive measures such as face masks, social distancing, and vaccination helped control the pandemic. Nonetheless, the emergence of SARS-CoV-2 variants, such as Omega and Delta, as well as coronavirus disease 2019 (COVID-19) reinfection, raise additional concerns. Therefore, this study aimed to determine the overall prevalence of reinfection on global and regional scales. METHODS A systematic search was conducted across three databases, PubMed, Scopus, and ProQuest Central, including all articles pertaining to COVID-19 reinfection without language restriction. After critical appraisal and qualitative synthesis of the identified relevant articles, a meta-analysis considering random effects was used to pool the studies. RESULTS We included 52 studies conducted between 2019 and 2022, with a total sample size of 3,623,655 patients. The overall prevalence of COVID-19 reinfection was 4.2% (95% confidence interval [CI]: 3.7-4.8%; n = 52), with high heterogeneity between studies. Africa had the highest prevalence of 4.7% (95% CI: 1.9-7.5%; n = 3), whereas Oceania and America had lower estimates of 0.3% (95% CI: 0.2-0.4%; n = 1) and 1% (95% CI: 0.8-1.3%; n = 7), respectively. The prevalence of reinfection in Europe and Asia was 1.2% (95% CI: 0.8-1.5%; n = 8) and 3.8% (95% CI: 3.4-4.3%; n = 43), respectively. Studies that used a combined type of specimen had the highest prevalence of 7.6% (95% CI: 5.8-9.5%; n = 15) compared with those that used oropharyngeal or nasopharyngeal swabs only that had lower estimates of 6.7% (95% CI: 4.8-8.5%; n = 8), and 3.4% (95% CI: 2.8-4.0%; n = 12) respectively. CONCLUSION COVID-19 reinfection occurs with varying prevalence worldwide, with the highest occurring in Africa. Therefore, preventive measures, including vaccination, should be emphasized to ensure control of the pandemic.
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Affiliation(s)
- Joyeuse Ukwishaka
- Maternal Child and Community Health Division, Rwanda Bio-Medical Center, Kigali, Rwanda.
- IntraHealth International, Kigali, Rwanda.
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
| | - Yves Ndayishimiye
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Esmeralda Destine
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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9
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Xu X, Wu H, Jin G, Huang J, Li J, Zhou J, Cao M, Sun D, Zhang W, Peng W, Pu Y, Chen C, Sun Y, Yang H, Zhou S, Fang B. Efficacy of Lianhua Qingwen for children with SARS-CoV-2 Omicron infection: A propensity score-matched retrospective cohort study. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 111:154665. [PMID: 36641977 PMCID: PMC9831666 DOI: 10.1016/j.phymed.2023.154665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Lianhua Qingwen Granules or Capsules (LHQW) has accumulated much research evidence in the fight against the coronavirus disease 2019 (COVID-19) epidemic. However, there are still few data on its efficacy and safety in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PURPOSE To evaluate the efficacy and safety of LHQW in children with SARS-CoV-2 Omicron infection. METHODS We conducted a single-center, propensity-score matched retrospective cohort study of children with SARS-CoV-2 Omicron infection in Shanghai New International Expo Center mobile cabin hospital between April 1st and June 1st, 2022. Eligible patients received either LHQW granules/capsules plus supportive care (LHQW group) or supportive care alone (control group). The primary outcome was the negative conversion time of nucleic acid. Secondary outcomes included the negative conversion rate of nucleic acid, the length of hospital stay, clinical disease progression, and cycle threshold [Ct] values for SARS-CoV-2 open reading frame [ORF1ab] or nucleocapsid [N] genes. RESULTS Overall, 2808 patients were enrolled, and 346 patients in each group were included in the analysis. Among the propensity-score matched groups, LHQW treatment was associated with an accelerated negative conversion time of nucleic acid (median: 5 d vs. 6 d, Hazard ratio: 1.25, 95% CI: 1.08 - 1.46, Log-rank p < 0.001), a higher negative conversion rate of nucleic acid (Day 2 - 6: 2.9% vs. 0.6%, p = 0.036; 29.8% vs. 5.5%, p < 0.001; 42.5% vs. 24.3%, p < 0.001; 51.4% vs. 31.5%, p < 0.001; 63.3% vs. 55.2%, p = 0.030), shorter hospital stay (median: 10 d vs. 11 d, Hazard ratio: 1.50, 95% CI: 1.29 - 1.74, Log-rank p < 0.001), and lower rates of asymptomatic infection progressing to mild (37.9% vs. 46.5%, p = 0.021). CONCLUSION Our study suggested that LHQW treatment was associated with faster clinical recovery in children with SARS-CoV-2 Omicron infection.
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Affiliation(s)
- Xiangru Xu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongze Wu
- Jiangxi Provincial Traditional Chinese Medicine Nephropathy Clinical Research Center, Jiujiang Hospital of Traditional Chinese Medicine, Jiujiang, Jiangxi, China
| | - Guoqiang Jin
- Department of Health Management, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jihan Huang
- Center for Drug Clinical Research, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinhua Li
- Jiangxi Provincial Traditional Chinese Medicine Nephropathy Clinical Research Center, Jiujiang Hospital of Traditional Chinese Medicine, Jiujiang, Jiangxi, China
| | - Jing Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Min Cao
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ding Sun
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Zhang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Peng
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuting Pu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Caiyu Chen
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuting Sun
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongqiang Yang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuang Zhou
- Acupuncture and Massage College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Bangjiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Institute of Critical Care, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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10
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Xu Z, Wei D, Zhang H, Demongeot J. A Novel Mathematical Model That Predicts the Protection Time of SARS-CoV-2 Antibodies. Viruses 2023; 15:v15020586. [PMID: 36851801 PMCID: PMC9962246 DOI: 10.3390/v15020586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Infectious diseases such as SARS-CoV-2 pose a considerable threat to public health. Constructing a reliable mathematical model helps us quantitatively explain the kinetic characteristics of antibody-virus interactions. A novel and robust model is developed to integrate antibody dynamics with virus dynamics based on a comprehensive understanding of immunology principles. This model explicitly formulizes the pernicious effect of the antibody, together with a positive feedback stimulation of the virus-antibody complex on the antibody regeneration. Besides providing quantitative insights into antibody and virus dynamics, it demonstrates good adaptivity in recapturing the virus-antibody interaction. It is proposed that the environmental antigenic substances help maintain the memory cell level and the corresponding neutralizing antibodies secreted by those memory cells. A broader application is also visualized in predicting the antibody protection time caused by a natural infection. Suitable binding antibodies and the presence of massive environmental antigenic substances would prolong the protection time against breakthrough infection. The model also displays excellent fitness and provides good explanations for antibody selection, antibody interference, and self-reinfection. It helps elucidate how our immune system efficiently develops neutralizing antibodies with good binding kinetics. It provides a reasonable explanation for the lower SARS-CoV-2 mortality in the population that was vaccinated with other vaccines. It is inferred that the best strategy for prolonging the vaccine protection time is not repeated inoculation but a directed induction of fast-binding antibodies. Eventually, this model will inform the future construction of an optimal mathematical model and help us fight against those infectious diseases.
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Affiliation(s)
- Zhaobin Xu
- Department of Life Science, Dezhou University, Dezhou 253023, China
- Correspondence: (Z.X.); (J.D.)
| | - Dongqing Wei
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Hongmei Zhang
- Department of Life Science, Dezhou University, Dezhou 253023, China
| | - Jacques Demongeot
- Laboratory AGEIS EA 7407, Team Tools for e-Gnosis Medical, Faculty of Medicine, University Grenoble Alpes (UGA), 38700 La Tronche, France
- Correspondence: (Z.X.); (J.D.)
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11
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Song QX, Jin Z, Fang W, Zhang C, Peng C, Chen M, Zhuang X, Zhai W, Wang J, Cao M, Wei S, Cai X, Pan L, Xu Q, Zheng J. The machine learning model based on trajectory analysis of ribonucleic acid test results predicts the necessity of quarantine in recurrently positive patients with SARS-CoV-2 infection. Front Public Health 2022; 10:1011277. [PMID: 36466454 PMCID: PMC9714505 DOI: 10.3389/fpubh.2022.1011277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background SARS-CoV-2 patients re-experiencing positive nucleic acid test results after recovery is a concerning phenomenon. Current pandemic prevention strategy demands the quarantine of all recurrently positive patients. This study provided evidence on whether quarantine is required in those patients, and predictive algorithms to detect subjects with infectious possibility. Methods This observational study recruited recurrently positive patients who were admitted to our shelter hospital between May 12 and June 10, 2022. The demographic and epidemiologic data was collected, and nucleic acid tests were performed daily. virus isolation was done in randomly selected cases. The group-based trajectory model was developed based on the cycle threshold (Ct) value variations. Machine learning models were validated for prediction accuracy. Results Among the 494 subjects, 72.04% were asymptomatic, and 23.08% had a Ct value under 30 at recurrence. Two trajectories were identified with either rapid (92.24%) or delayed (7.76%) recovery of Ct values. The latter had significantly higher incidence of comorbidities; lower Ct value at recurrence; more persistent cough; and more frequently reported close contacts infection compared with those recovered rapidly. However, negative virus isolation was reported in all selected samples. Our predictive model can efficiently discriminate those with delayed Ct value recovery and infectious potentials. Conclusion Quarantine seems to be unnecessary for the majority of re-positive patients who may have low transmission risks. Our predictive algorithm can screen out the suspiciously infectious individuals for quarantine. These findings may assist the enaction of SARS-CoV-2 pandemic prevention strategies regarding recurrently positive patients in the future.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Weilin Fang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenxu Zhang
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Chi Peng
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Min Chen
- Department of Nursing, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu Zhuang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhai
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Department of Interventional Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Cao
- Department of Emergency, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shun Wei
- Department of Information Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Cai
- BSL-3 Laboratory of Fudan University, Shanghai, China
| | - Lei Pan
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingrong Xu
- Department of Orthopedics, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junhua Zheng
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Junhua Zheng
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12
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A retrospective cross-sectional observational study of SARS-CoV-2 reinfection in La Ribera Health Department, Valencia, Spain. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. The possibility of reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a widely proven fact and may have clinical implications.
Hypothesis /Gap Statement. It is not known whether there have been cases of reinfection by SARS-CoV-2 in La Ribera Health Department.
Aim. To determine whether there have been cases of reinfection by SARS-CoV-2 in La Ribera Health Department and to identify their characteristics.
Methodology. Retrospective cross-sectional observational study of cases of reinfection by SARS-CoV-2 in the population of La Ribera Department between March 2020 and February 2021. The positive baseline cohort includes all cases positive by RT-PCR for SARS-CoV-2, with reinfection cases being those that, after resolution of the first episode according to the World Health Organization (WHO) criteria, presented a new positive RT-PCR result.
Results. Out of a total of 15 687 cases with positive RT-PCR, 40 were considered to be reinfections, which meant a cumulative incidence of 0.255 % and an incidence density of 5.05 cases per 100 000 person-days. Most of the cases occurred during the highest incidence peaks of the pandemic in the department. Seventy-five per cent of the patients in these cases were older than 40 years, 42.5 % were healthcare professionals or nursing home residents and 12.5 % had an immunosuppressive comorbidity. There were no severe, critical or death cases. In the reinfection episodes, with respect to the first episode, there was a tendency to be milder, they required fewer days of hospitalization, their RT-PCR became negative earlier, they developed a greater humoral response and the sick leave period was shorter. The median period between the RT-PCR in the first episode and the RT-PCR in the second episode was 127.5 days (range: 48–301; IQR: 89.5–256.25)
Conclusions. SARS-CoV-2 reinfection cases are rare, tend to be mild and can occur within a median period of 127.5 days.
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Brynjolfsson SF, Sigurgrimsdottir H, Gudlaugsson O, Kristjansson M, Kristinsson KG, Ludviksson BR. Determining SARS-CoV-2 non-infectivity state-A brief overview. Front Public Health 2022; 10:934242. [PMID: 36033758 PMCID: PMC9412020 DOI: 10.3389/fpubh.2022.934242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
From the beginning of the COVID-19 pandemic, it has claimed over 6 million lives, and globally the pandemic rages with detrimental consequences, with the emergence of new more infectious and possibly virulent variants. A clinical obstacle in this battle has been to determine when an infected individual has reached a non-infectious state. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can be transmitted under diverse circumstances, and various rules and regulations, along with different testing methods, have been applied in an attempt to confine the transmission. However, that has proven to be a difficult task. In this review, we take together recently published data on infectivity and transmission of SARS-CoV-2 and have combined it with the clinical experience that physicians in Iceland have accumulated from the pandemic. In addition, we suggest guidelines for determining when patients with COVID-19 reach a non-infectious state based on a combination of clinical experience, scientific data, and proficient use of available tests. This review has addressed some of the questions regarding contagiousness and immunity against SARS-CoV-2.
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Affiliation(s)
- Siggeir F. Brynjolfsson
- Department of Immunology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland,Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,*Correspondence: Siggeir F. Brynjolfsson
| | - Hildur Sigurgrimsdottir
- Department of Immunology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland,Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Olafur Gudlaugsson
- Department of Infectious Diseases, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Mar Kristjansson
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Infectious Diseases, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Karl G. Kristinsson
- Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Clinical Microbiology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bjorn R. Ludviksson
- Department of Immunology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland,Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Bjorn R. Ludviksson
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14
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Huang XY, Yang LJ, Hu X, Zhang XX, Gu X, Du LJ, He ZY, Gu XJ. Elevated levels of fructosamine are independently associated with SARS-CoV-2 reinfection: A 12-mo follow-up study. World J Diabetes 2022; 13:543-552. [PMID: 36051424 PMCID: PMC9329841 DOI: 10.4239/wjd.v13.i7.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/29/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The association between blood levels of fructosamine (FMN) and recurrent coronavirus disease 2019 (COVID-19) is currently unclear.
AIM To investigate a prospective relationship between blood levels of FMN and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection.
METHODS A total of 146 Chinese hospitalized patients infected with SARS-CoV-2 were consecutively collectively recruited and followed from January 2020 to May 2021. Diagnosis of COVID-19 and SARS-CoV-2 reinfection was based on the diagnostic criteria and treatment protocol in China. The levels of FMN were determined in blood and divided into tertiles based on their distribution in the cohort of COVID-19 patients. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for SARS-CoV-2 reinfection across the tertiles of FMN levels. A Cox regression model was used to generate the HR for SARS-CoV-2 reinfection in the participants in the top tertile of FMN levels compared with those at the bottom. Disease-free survival was used as the time variable, and relapse was used as the state variable, adjusted for age, gender, influencing factors such as diabetes mellitus, hypertension, and corticosteroid therapy, and clinical indexes such as acute liver failure, acute kidney failure, white blood cell (WBC) count, C-reactive protein, prognostic nutritional index (PNI), and blood lipids. Kaplan-Meier analysis with log-rank tests was used to compare the survival rate between patients with elevated FMN levels (FMN > 1.93 mmol/L, the top tertile) and those with nonelevated levels.
RESULTS Clinical data for the 146 patients with confirmed COVID-19 [age 49 (39-55) years; 49% males] were analyzed. Eleven patients had SARS-CoV-2 reinfection. The SARS-CoV-2 reinfection rate in patients with elevated FMN levels was significantly higher than that in patients with nonelevated FMN (17% vs 3%; P = 0.008) at the end of the 12-mo follow-up. After adjustments for gender, age, diabetes mellitus, hypertension, corticosteroid therapy, WBC count, PNI, indexes of liver and renal function, and blood lipids, patients with nonelevated FMN levels had a lower risk of SARS-CoV-2 reinfection than those with elevated FMN levels (HR = 6.249, 95%CI: 1.377-28.351; P = 0.018). Kaplan-Meier analysis showed that the cumulative survival rate of patients infected with SARS-CoV-2 was higher in patients with nonelevated FMN levels than in those with elevated FMN levels (97% vs 83%; log rank P = 0.002).
CONCLUSION Elevated levels of FMN are independently associated with SARS-CoV-2 reinfection, which highlights that patients with elevated FMN should be cautiously monitored after hospital discharge.
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Affiliation(s)
- Xiao-Yan Huang
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
- Department of Endocrine and Metabolic Disease, Yueqing People’s Hospital, Affiliated Hospital of Wenzhou Medical University, Wenzhou 325600, Zhejiang Province, China
| | - Li-Juan Yang
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiang Hu
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xing-Xing Zhang
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiao Gu
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Lin-Jia Du
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Zhi-Ying He
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xue-Jiang Gu
- Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
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Comba IY, Riestra Guiance I, Corsini Campioli C, Challener D, Sampathkumar P, Orenstein R, Gordon J, Bosch W, O'Horo JC. Clinical Characteristics and Outcomes of Patients with SARS-CoV-2 Reinfection. Mayo Clin Proc Innov Qual Outcomes 2022; 6:361-372. [PMID: 35665315 PMCID: PMC9149045 DOI: 10.1016/j.mayocpiqo.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To examine the clinical characteristics, risk of hospitalization and mortality of patients diagnosed with SARS-CoV-2 reinfection. Patients and Methods We retrospectively reviewed all patients with SARS-CoV-2 reinfection all Mayo Clinic sites between May 23, 2020, and June 30, 2021 (the period before emergence of delta variant in United States). The reinfection was defined as positive SARS-CoV-2 test ≥ 90 days after initial infection or 45-89 days after with symptomatic second episode. Vaccination status was classified as fully vaccinated, first dose and unvaccinated. Comparative analysis of baseline characteristics and comorbidities was performed by hospitalization and vaccination status. The survival analysis of hospitalized patients was performed using cox-proportional hazard regression. Results Among 554 reinfected patients, 59 (10.6%) were pediatric, and 495 (89.4%) were adults. The median age was 13.9 years (interquartile range [IQR], 8.5-16.5) for pediatric and 50.2 years (IQR, 28.4-65.6) for adult population. Among adult patients, majority were unvaccinated (83.4%, n=413) and duration to reinfection from initial infection was longest in fully vaccinated group (p < .001). 42 (75%) out of 56 patients were seropositive within seven days of reinfection. In hospitalized adult patients, Charlson Comorbidity Index (CCI) was an independent risk factor for mortality (adjusted hazard ratio [aHR], 0.35; 95% CI, 0.19 to 0.51). Conclusion In this study, majority of adult patients with SARS-CoV-2 reinfection were unvaccinated. Furthermore, the duration to reinfection was longest in fully vaccinated individuals. Seropositivity was common among adult patients.
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Affiliation(s)
| | | | | | | | | | - Robert Orenstein
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Joel Gordon
- Department of Family Medicine CMIO, Mayo Clinic Community Practices MCHS-SWMN, Mankato, MN, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - John C O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
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Kurra NC, Sriram K, Gandrakota N, Nagarajan JS, Khasnavis S, Ramakrishnan M, Dalal S, Irfan SA, Khan S, JK H, Patel D, Samudrala G. Frontliners on the Move: A Quantitative Analysis of the Prevalence of COVID-19 Reinfection Among Healthcare Workers. Cureus 2022; 14:e24652. [PMID: 35663721 PMCID: PMC9155986 DOI: 10.7759/cureus.24652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/01/2022] [Indexed: 11/05/2022] Open
Abstract
This study was conducted to review relevant articles and demonstrate the prevalence of coronavirus disease 2019 (COVID-19) reinfection among healthcare workers (HCWs). A systemic search was conducted on PubMed and Medline from their inception to July 17, 2021. All statistical analyses were conducted using ReviewManager 5.4.1. Studies meeting the following inclusion criteria were selected: (a) articles having HCWs with COVID-19; (b) studies describing reinfection of COVID-19; and (c) articles having a defined number of patients and controls. Three studies were selected for meta-analysis. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the cohort studies. NOS scores of 1-5 were considered high risk for bias, scores of 6-7 were deemed moderate, and scores >7 were considered low risk for bias. A random-effect model was used when heterogeneity was seen to pool the studies, and the results were reported in inverse variance (IV) and corresponding 95% confidence interval (CI). Pooled prevalence of reinfection of COVID-19 in HCWs was 3% (OR: 0.03 [-0.04, 0.01]; p=0.44; I2=4%). A non-significant prevalence was found among the healthcare professionals in terms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection in Europe. The preformed antibodies were protective against reinfection. However, the waning of antibodies with respect to time was evident, varying differently in different individuals, thereby resulting in reinfection.
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17
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Mao Y, Wang W, Ma J, Wu S, Sun F. Reinfection rates among patients previously infected by SARS-CoV-2: systematic review and meta-analysis. Chin Med J (Engl) 2022; 135:145-152. [PMID: 34908003 PMCID: PMC8769121 DOI: 10.1097/cm9.0000000000001892] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Asymptomatic or symptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be followed by reinfection. The protection conferred by prior infection among coronavirus disease 2019 (COVID-19) patients is unclear. We assessed the incidence of SARS-CoV-2 reinfection and the protection effect of previous infection against reinfection. METHODS We searched PubMed, EMBASE, Cochrane, Scopus, Web of Science, and ClinicalTrials.gov for publications up until the end date of May 1, 2021. The reinfection rate of recovered patients and the protection against reinfection were analyzed using meta-analysis. RESULTS Overall, 19 studies of 1096 reinfection patients were included. The pooled reinfection rate was 0.65% (95% confidence interval [CI] 0.39-0.98%). The symptomatic reinfection rate was a bit lower (0.37% [95% CI 0.11-0.78%], I2 = 99%). The reinfection rate was much higher in high-risk populations (1.59% [95% CI 0.30-3.88%], I2 = 90%). The protection against reinfection and symptomatic reinfection was similar (87.02% [95% CI 83.22-89.96%] and 87.17% [95% CI 83.09-90.26%], respectively). CONCLUSIONS The rate of reinfection with SARS-CoV-2 is relatively low. The protection against SARS-CoV-2 after natural infection is comparable to that estimated for vaccine efficacy. These data may help guide public health measures and vaccination strategies in response to the COVID-19 pandemic. High-quality clinical studies are needed to establish the relevant risk factors in recovered patients.
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Affiliation(s)
- Yinjun Mao
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China
| | - Weiwei Wang
- National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Jun Ma
- Institute of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shanshan Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, 100050, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing 100191, China
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18
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Sotoodeh Ghorbani S, Taherpour N, Bayat S, Ghajari H, Mohseni P, Hashemi Nazari SS. Epidemiologic characteristics of cases with reinfection, recurrence, and hospital readmission due to COVID-19: A systematic review and meta-analysis. J Med Virol 2022; 94:44-53. [PMID: 34411311 PMCID: PMC8427032 DOI: 10.1002/jmv.27281] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023]
Abstract
Recent studies reported that some recovered COVID-19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID-19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long-term immunity after SARS-Cov-2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID-19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled.
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Affiliation(s)
- Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Sahar Bayat
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Hadis Ghajari
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Parisa Mohseni
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Saeed Hashemi Nazari
- Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
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19
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Abrokwa SK, Müller SA, Méndez-Brito A, Hanefeld J, El Bcheraoui C. Recurrent SARS-CoV-2 infections and their potential risk to public health - a systematic review. PLoS One 2021; 16:e0261221. [PMID: 34882750 PMCID: PMC8659325 DOI: 10.1371/journal.pone.0261221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To inform quarantine and contact-tracing policies concerning re-positive cases-cases testing positive among those recovered. MATERIALS AND METHODS We systematically reviewed and appraised relevant literature from PubMed and Embase for the extent of re-positive cases and their epidemiological characteristics. RESULTS In 90 case reports/series, a total of 276 re-positive cases were found. Among confirmed reinfections, 50% occurred within 90 days from recovery. Four reports related onward transmission. In thirty-five observational studies, rate of re-positives ranged from zero to 50% with no onward transmissions reported. In eight reviews, pooled recurrence rate ranged from 12% to 17.7%. Probability of re-positive increased with several factors. CONCLUSION Recurrence of a positive SARS-CoV-2 test is commonly reported within the first weeks following recovery from a first infection.
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Affiliation(s)
- Seth Kofi Abrokwa
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Alba Méndez-Brito
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence- based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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20
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Dhillon RA, Qamar MA, Gilani JA, Irfan O, Waqar U, Sajid MI, Mahmood SF. The mystery of COVID-19 reinfections: A global systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 72:103130. [PMID: 34900250 PMCID: PMC8642249 DOI: 10.1016/j.amsu.2021.103130] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection. MATERIALS AND METHODS A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval (CI). RESULTS Eighty-one studies reporting 577 cases were included from 22 countries. The mean age of patients was 46.2 ± 18.9 years and 179 (31.0%) cases of comorbidities were reported. The average time duration between first infection and reinfection was 63.6 ± 48.9 days. During first infection and reinfection, fever was the most common symptom (41.4% and 36.4%, respectively) whilst anti-viral therapy was the most common treatment regimen administered (44.5% and 43.0%, respectively). Comparable odds of symptomatic presentation and management were reported for the two infections. However, a higher Intensive Care Unit (ICU) admission rate was observed in reinfection compared to first infection (10 vs 3). Ten deaths were reported with respiratory failure being the most common cause of death (7/10 deaths). CONCLUSION Our findings support immunization practices given increased ICU admissions and mortality in reinfections. Our cohort serves as a guide for clinicians and authorities in devising an optimal strategy for controlling the pandemic. (249 words).
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Affiliation(s)
| | | | | | - Omar Irfan
- Amaris Consulting, Toronto, Ontario, Canada
| | - Usama Waqar
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Syed Faisal Mahmood
- Section of Infectious Diseases, Aga Khan University, Karachi, Sindh, Pakistan
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21
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Liu K, Yang X, Feng C, Chen M, Zhang C, Wang Y. Clinical features and independent predictors for recurrence of positive SARS-CoV-2 RNA: A propensity score-matched analysis. J Med Virol 2021; 94:1402-1411. [PMID: 34766661 PMCID: PMC8662258 DOI: 10.1002/jmv.27450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022]
Abstract
Patients with COVID‐19 may be recurrence positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA after being cured and discharged from the hospital. The aim of this study was to explore independent influencing factors as markers for predicting positive SARS‐CoV‐2 RNA recurrence. The study included 601 COVID‐19 patients who were cured and discharged from the Public and Health Clinic Centre of Chengdu from January 2020 to March 2021, and the recurrence positive of patients within 6 weeks after SARS‐CoV‐2 RNA turned negative was followed up. We used propensity score matching to eliminate the influence of confounding factors, and multivariate Logistic regression analysis was used to determine the independent influencing factors for positive SARS‐CoV‐2 RNA recurrence. Multivariate Logistic regression showed that the elevated serum potassium (odds ratio [OR] = 6.537, 95% confidence interval [CI]: 1.864–22.931, p = 0.003), elevated blood chlorine (OR = 1.169, 95% CI: 1.032–1.324, p = 0.014) and elevated CD3+CD4+ count (OR = 1.003, 95% CI: 1.001–1.004, p < 0.001) were identified as independent risk factors for positive SARS‐CoV‐2 RNA recurrence (p < 0.05). The difference in virus shedding duration (OR = 1.049, 95% CI: 1.000–1.100, p = 0.05) was borderline statistically significant. For sensitivity analysis, we included virus shedding duration as a categorical variable in the model again and found that the OR value related to recurrence positively increased with delayed virus shedding duration, and the trend test showed a statistical difference (P trend = 0.03). Meanwhile, shortening of activated partial prothrombinase time (OR = 0.908, 95% CI: 0.824–1.000, p = 0.049) was identified as an independent protection factor for SARS‐CoV‐2 RNA recurrence positive. We have identified independent factors that affect the recurrence of SARS‐CoV‐2 RNA positive. It is recommended that doctors pay attention to these indicators when first admitted to the hospital.
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Affiliation(s)
- Ke Liu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiuli Yang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen Feng
- Ministry of Law, The Public and Health Clinic Centre of Chengdu, Chengdu, Sichuan, China
| | - Mei Chen
- Department of Respiratory Medicine, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Chuantao Zhang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuelian Wang
- National Key Laboratory of Traditional Chinese Medicine for the Prevention and Treatment of Infectious Diseases, The Public and Health Clinic Centre of Chengdu, Chengdu, Sichuan, China
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22
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Xiao CH, Chen LF, Li Y. Recurrent SARS-CoV-2 RNA positivity and prolonged viral shedding in a patient with COVID-19: a case report. BMC Infect Dis 2021; 21:1076. [PMID: 34663257 PMCID: PMC8523010 DOI: 10.1186/s12879-021-06776-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
Background The ongoing coronavirus disease 2019 (COVID-19) global pandemic caused by the SARS-CoV-2 virus remains a major threat to public health. At present, it is recommended that patients with known or suspected COVID-19 undergo quarantine or medical observation for 14 days. However, recurrent SARS-CoV-2 RNA positivity and prolonged viral shedding have been documented in convalescent COVID-19 patients, complicating efforts to control viral spread and ensure patient recovery. Case presentation We report the case of a patient who experienced two recurrent episodes of SARS-CoV-2 RNA and IgM positivity and viral shedding over 60 days during hospitalization. Conclusions This case report demonstrates that relapses of SARS-CoV-2 RNA and IgM positivity may occur even after COVID-19 symptoms have resolved, possibly as a consequence of prolonged viral shedding rather than re-infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06776-3.
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Affiliation(s)
- Chun-Hua Xiao
- Department of Infectious Diseases, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516000, China
| | - Lin-Fa Chen
- Department of Infectious Diseases, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516000, China.,Department of Neurology, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, 516000, China
| | - You Li
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China.
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23
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Correia AM, Borges V, Isidro J, Lima AR, Fernandes A, Godinho ML, Duarte S, Ferrão J, Vieira L, Gomes JP. Potential recurrence of COVID-19 in a healthcare professional: SARS-CoV-2 genome sequencing confirms contagiousness after re-positivity. Int J Infect Dis 2021; 112:318-320. [PMID: 34547489 PMCID: PMC8450161 DOI: 10.1016/j.ijid.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 11/15/2022] Open
Abstract
Re-positivity of SARS-CoV-2 tests is widely reported, raising discussion about guidance for patient discharge and ending isolation. The unsuccessful recovery of replication-competent virus and/or absence of secondary cases has suggested that re-positive patients are not contagious. This study reports SARS-CoV-2 re-positivity in a healthcare professional 16 days after three negative tests, with viral genome sequencing supporting contagiousness leading to secondary cases.
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Affiliation(s)
- Ana M Correia
- Northern Regional Health Administration, Cávado I - Braga Primary Healthcare Centres Group, Public Health Unit, Braga, Portugal.
| | - Vítor Borges
- Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Joana Isidro
- Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Ana R Lima
- Northern Regional Health Administration, Cávado I - Braga Primary Healthcare Centres Group, Public Health Unit, Braga, Portugal
| | - Alberto Fernandes
- Northern Regional Health Administration, Cávado I - Braga Primary Healthcare Centres Group, Public Health Unit, Braga, Portugal
| | - Maria Leonor Godinho
- Northern Regional Health Administration, Cávado I - Braga Primary Healthcare Centres Group, Public Health Unit, Braga, Portugal
| | - Sílvia Duarte
- Innovation and Technology Unit, Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - José Ferrão
- Innovation and Technology Unit, Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Luís Vieira
- Innovation and Technology Unit, Department of Human Genetics, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - João P Gomes
- Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
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24
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Zaffina S, Lanteri P, Gilardi F, Garbarino S, Santoro A, Vinci MR, Carsetti R, Scorpecci A, Raponi M, Magnavita N, Camisa V. Recurrence, Reactivation, or Inflammatory Rebound of SARS-CoV-2 Infection With Acute Vestibular Symptoms: A Case Report and Revision of Literature. Front Hum Neurosci 2021; 15:666468. [PMID: 34456694 PMCID: PMC8385757 DOI: 10.3389/fnhum.2021.666468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/15/2021] [Indexed: 01/08/2023] Open
Abstract
A case of recurrent coronavirus disease 2019 (COVID-19) with neurovestibular symptoms was reported. In March 2020, a physician working in an Italian pediatric hospital had flu-like symptoms with anosmia and dysgeusia, and following a reverse transcription PCR (RT/PCR) test with a nasopharyngeal swab tested positive for SARS-CoV-2. After home quarantine, 21 days from the beginning of the symptoms, the patient tested negative in two subsequent swabs and was declared healed and readmitted to work. Serological testing showed a low level of immunoglobulin G (IgG) antibody title and absence of immunoglobulin M (IgM). However, 2 weeks later, before resuming work, the patient complained of acute vestibular syndrome, and the RT/PCR test with mucosal swab turned positive. On the basis of the literature examined and reviewed for recurrence cases and vestibular symptoms during COVID-19, to our knowledge this case is the first case of recurrence with vestibular impairment as a neurological symptom, and we defined it as probably a viral reactivation. The PCR retest positivity cannot differentiate re-infectivity, relapse, and dead-viral RNA detection. Serological antibody testing and viral genome sequencing could be always performed in recurrence cases.
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Affiliation(s)
- Salvatore Zaffina
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Lanteri
- Department of Diagnostics and Applied Technology, Neurophysiopathology Centre, Fondazione IRCCS, Istituto Neurologico “Carlo Besta”, Milan, Italy
| | | | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences, University of Genoa, Genoa, Italy
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Carsetti
- Department of Laboratories, Unit of Diagnostic Immunology and Immunology Research Area, Unit of B-Cell Pathophysiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Scorpecci
- Audiology and Otosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Nicola Magnavita
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Post-graduate School of Occupational Health, Section of Occupational Medicine and Labor Law, Università Cattolica del Sacro Cuore, Rome, Italy
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25
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Santiago-Espinosa O, Prieto-Torres ME, Cabrera-Gaytán DA. Laboratory-confirmed SARS-CoV-2 reinfection in the population treated at social security. Respir Med Case Rep 2021; 34:101493. [PMID: 34395189 PMCID: PMC8351271 DOI: 10.1016/j.rmcr.2021.101493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022] Open
Abstract
The scientific community has questioned whether reinfection with SARS-CoV-2 is possible. Gradually, cases of reinfection have been documented. In Mexico, people with SARS-CoV-2 reinfection have not been officially identified. To allow a retrospective investigation of patients with PCR-confirmed SARS-CoV-2 and to identify how reinfected with this virus occurs in a population that requires medical attention. A retrospective search of the epidemiological surveillance system was performed to identify people who met the clinical criteria based on laboratory diagnosis of SARS-CoV-2 and temporality to identify cases of reinfection. Clinical information was collected from clinical records. Seven people with two separate COVID-19 events were identified in medical units in Quintana Roo, Mexico between April and December 2020. The overall median interval between the two events was 156 days (61-191 days). Six people were health workers, and one was a member of the general population. This is one of the first reports of reinfection in health personnel in Mexico, revealing that the frequency of reinfection is low among positive cases and that the interval between infection episodes was three months. There are several scenarios in the natural history of the disease that must be considered based on adequate anamnesis with a clinical-epidemiological approach to determine the correct diagnostic category.
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Affiliation(s)
- Oscar Santiago-Espinosa
- Instituto Mexicano del Seguro Social. Coordinación de Información y Análisis Estratégico. Av. Politécnico, entre Tepich y Knic SM 509, Manzana 1, Lote 1. CP. 077533. Cancún, Quintana Roo. México
| | - María Erandhi Prieto-Torres
- Instituto Mexicano del Seguro Social. Coordinación de Información y Análisis Estratégico. Av. Politécnico, entre Tepich y Knic SM 509, Manzana 1, Lote 1. CP. 077533. Cancún, Quintana Roo. México
| | - David Alejandro Cabrera-Gaytán
- Instituto Mexicano del Seguro Social. Coordinación de Investigación en Salud. Av. Cuauhtémoc # 330, Bloque “B” 4° piso, Anexo a la Unidad de Congresos del Centro Médico Nacional Siglo XXI, Col. Doctores, Alcaldía Cuauhtémoc, CP. 06720, Ciudad de México, México
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26
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Zhu L, Li Y, Tang Y, Shen L, Onar-Thomas A, Sun J. Sample size calculation for recurrent event data with additive rates models. Pharm Stat 2021; 21:89-102. [PMID: 34309179 DOI: 10.1002/pst.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/20/2021] [Accepted: 06/28/2021] [Indexed: 11/06/2022]
Abstract
This paper discusses the design of clinical trials where the primary endpoint is a recurrent event with the focus on the sample size calculation. For the problem, a few methods have been proposed but most of them assume a multiplicative treatment effect on the rate or mean number of recurrent events. In practice, sometimes the additive treatment effect may be preferred or more appealing because of its intuitive clinical meaning and straightforward interpretation compared to a multiplicative relationship. In this paper, new methods are presented and investigated for the sample size calculation based on the additive rates model for superiority, non-inferiority, and equivalence trials. They allow for flexible baseline rate function, staggered entry, random dropout, and overdispersion in event numbers, and simulation studies show that the proposed methods perform well in a variety of settings. We also illustrate how to use the proposed methods to design a clinical trial based on real data.
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Affiliation(s)
- Liang Zhu
- Neurology group, Eisai, Woodcliff Lake, New Jersey, USA
| | - Yimei Li
- Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Liji Shen
- Biostatistics and Research Decision Sciences, Merck Sharp & Dohme, North Wales, Pennsylvania, USA
| | - Arzu Onar-Thomas
- Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jianguo Sun
- Statistics, University of Missouri, Columbia, Missouri, USA
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27
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Alsalih NJ, Saeed ZF, Thwiny HT, Al-Yasari AMR, Alnassar AWD, Hobkirk JP, Alsaadawi MA. Case Report: Reinfection of COVID-19, with second infection less severe. F1000Res 2021. [DOI: 10.12688/f1000research.53652.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There is concern that an individual may contract COVID-19 twice, either as a result of being a viral carrier that was not entirely cleared from the body in the first instance or as a result of reinfection. The recurrent infection may be qRT-PCR positive, which must be distinguished from post-COVID-19 symptoms that are qRT-PCR negative. Although it is known that recovered patients of viral diseases can be immune for the next infection, recurrent infections of COVID-19 have been recorded in Brazilian healthcare workers. We report a case of recurrent COVID-19 infection in a 34-year-old man working in the Gynecology and Children Hospital in Al-Muthanna Province, south of Iraq. The patient suffered from a sharp and noticeable rise in the body temperature at 39 ºC and cough on the 16th of July 2020. Then, the patient was symptomized with another course of COVID-19 on the 27th of August 2020, which was contracted from the patient’s workmate. Nose swab PCR test and CT scan were performed to confirm the second infection. The clinical signs of repeated infection with coronavirus were obviously less than the first infection of the same patient. It is clear that the first infection symptoms of COVID-19 are more severe than the signs of recurrent disease.
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28
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Wang J, Kaperak C, Sato T, Sakuraba A. COVID-19 reinfection: a rapid systematic review of case reports and case series. J Investig Med 2021; 69:1253-1255. [PMID: 34006572 DOI: 10.1136/jim-2021-001853] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has infected millions of people worldwide and many countries have been suffering from a large number of deaths. Acknowledging the ability of SARS-CoV-2 to mutate into distinct strains as an RNA virus and investigating its potential to cause reinfection is important for future health policy guidelines. It was thought that individuals who recovered from COVID-19 generate a robust immune response and develop protective immunity; however, since the first case of documented reinfection of COVID-19 in August 2020, there have been a number of cases with reinfection. Many cases are lacking genomic data of the two infections, and it remains unclear whether they were caused by different strains. In the present study, we undertook a rapid systematic review to identify cases infected with different genetic strains of SARS-CoV-2 confirmed by PCR and viral genome sequencing. A total of 17 cases of genetically confirmed COVID-19 reinfection were found. One immunocompromised patient had mild symptoms with the first infection but developed severe symptoms resulting in death with the second infection. Overall, 68.8% (11/16) had similar severity; 18.8% (3/16) had worse symptoms; and 12.5% (2/16) had milder symptoms with the second episode. Our case series shows that reinfection with different strains is possible, and some cases may experience more severe infections with the second episode. The findings also suggest that COVID-19 may continue to circulate even after achieving herd immunity through natural infection or vaccination, suggesting the need for longer-term transmission mitigation efforts.
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Affiliation(s)
- Jingzhou Wang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Toshiro Sato
- Department of Organoid Medicine, Keio University School of Medicine, Tokyo, Japan.,Coronavirus Task Force, Keio Univeristy, Tokyo, Japan
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Jain VK, Iyengar K, Garg R, Vaishya R. Elucidating reasons of COVID-19 re-infection and its management strategies. Diabetes Metab Syndr 2021; 15:1001-1006. [PMID: 33989898 PMCID: PMC8102074 DOI: 10.1016/j.dsx.2021.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Reinfection is gradually being recognised after symptomatic or asymptomatic COVID-19 infection. We try to elucidate various explanations behind COVID-19 reinfection and suggest possible strategies to counteract this threat. METHODS We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Reinfection', 'Vaccines' and 'India' on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in March 2021 and first half of April 2021 during the current COVID-19 pandemic. Epidemiology, risk factors and trends of reinfection were assessed. RESULTS A multitude of factors have been associated with rising incidence of COVID-19 reinfection in India and across the world. Emergence of 'Variants of Concern (VOC)', pandemic fatigue and disregard of infection prevention strategies appear to be the most obvious reasons. CONCLUSIONS COVID-19 reinfection is an emerging concern amongst the worldwide population with newer mutant strains demonstrating increasing transmissibility and responsible for continuing waves of the pandemic. COVID Appropriate Behaviour (CAB), improvised vaccines and enhanced vaccination drives are necessary to mitigate global threat.
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Affiliation(s)
- Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | - KarthikeyanP Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK.
| | - Rakesh Garg
- Anaesthesiology, Critical Care and Pain, Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India.
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30
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Li ZY, Zhang Y, Peng LQ, Gao RR, Jing JR, Wang JL, Ren BZ, Xu JG, Wang T. Demand for longer quarantine period among common and uncommon COVID-19 infections: a scoping review. Infect Dis Poverty 2021; 10:56. [PMID: 33902695 PMCID: PMC8072089 DOI: 10.1186/s40249-021-00847-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND As one of the non-pharmacological interventions to control the transmission of COVID-19, determining the quarantine duration is mainly based on the accurate estimates of the incubation period. However, patients with coarse information of the exposure date, as well as infections other than the symptomatic, were not taken into account in previously published studies. Thus, by using the statistical method dealing with the interval-censored data, we assessed the quarantine duration for both common and uncommon infections. The latter type includes the presymptomatic, the asymptomatic and the recurrent test positive patients. METHODS As of 10 December 2020, information on cases have been collected from the English and Chinese databases, including Pubmed, Google scholar, CNKI (China National Knowledge Infrastructure) and Wanfang. Official websites and medias were also searched as data sources. All data were transformed into doubly interval-censored and the accelerated failure time model was applied. By estimating the incubation period and the time-to-event distribution of worldwide COVID-19 patients, we obtain the large percentiles for determining and suggesting the quarantine policies. For symptomatic and presymptomatic COVID-19 patients, the incubation time is the duration from exposure to symptom onset. For the asymptomatic, we substitute the date of first positive result of nucleic acid testing for that of symptom onset. Furthermore, the time from hospital discharge or getting negative test result to the positive recurrence has been calculated for recurrent positive patients. RESULTS A total of 1920 laboratory confirmed COVID-19 cases were included. Among all uncommon infections, 34.1% (n = 55) of them developed symptoms or were identified beyond fourteen days. Based on all collected cases, the 95th and 99th percentiles were estimated to be 16.2 days (95% CI 15.5-17.0) and 22.9 days (21.7‒24.3) respectively. Besides, we got similar estimates based on merely symptomatic and presymptomatic infections as 15.1 days (14.4‒15.7) and 21.1 days (20.0‒22.2). CONCLUSIONS There are a certain number of infected people who require longer quarantine duration. Our findings well support the current practice of the extended active monitoring. To further prevent possible transmissions induced and facilitated by such infectious outliers after the 14-days quarantine, properly prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources.
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Affiliation(s)
- Zhi-Yao Li
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Yu Zhang
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Liu-Qing Peng
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Rong-Rong Gao
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Jia-Rui Jing
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Jia-Le Wang
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China
| | - Bin-Zhi Ren
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, 030001, People's Republic of China
- Shanxi Provincial Key Laboratory of Major Infectious Disease Pandemic Response, Taiyuan, 030001, People's Republic of China
| | - Jian-Guo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
- Institute of Public Health, Nankai University, Tianjing, 300350, People's Republic of China
| | - Tong Wang
- Department of Health Statistics and Epidemiology, School of Public Health, Collaborative Innovation Center of Reverse Microbial Etiology, Shanxi Medical University, 56 Xinjiannanlu Street, Yingze District, Taiyuan, 030001, Shanxi, People's Republic of China.
- Shanxi Provincial Key Laboratory of Major Infectious Disease Pandemic Response, Taiyuan, 030001, People's Republic of China.
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31
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Zhao H, Zhang C, Chen XX, Zhu Q, Huang WX, Zeng YL, Liu YX, Li GJ, Du WJ, Yao J, Li JW, Peng P, Wang GQ. The relationship between SARS-COV-2 RNA positive duration and the risk of recurrent positive. Infect Dis Poverty 2021; 10:45. [PMID: 33789752 PMCID: PMC8010778 DOI: 10.1186/s40249-021-00831-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of discharge COVID-19 patients with recurrent positive SARS-CoV-2 RNA is challenging. However, there are fewer scientific dissertations about the risk of recurrent positive. The aim of this study was to explore the relationship between SARS-COV-2 RNA positive duration (SPD) and the risk of recurrent positive. METHODS This case-control multi-center study enrolled participants from 8 Chinese hospital including 411 participants (recurrent positive 241). Using unadjusted and multivariate-adjusted logistic regression analyses, generalized additive model with a smooth curve fitting, we evaluated the associations between SPD and risk of recurrent positive. Besides, subgroup analyses were performed to explore the potential interactions. RESULTS Among recurrent positive patients, there were 121 females (50.2%), median age was 50 years old [interquartile range (IQR): 38-63]. In non-adjusted model and adjusted model, SPD was associated with an increased risk of recurrent positive (fully-adjusted model: OR = 1.05, 95% CI: 1.02-1.08, P = 0.001); the curve fitting was not significant (P = 0.286). Comparing with SPD < 14 days, the risk of recurrent positive in SPD > 28 days was risen substantially (OR = 3.09, 95% CI: 1.44-6.63, P = 0.004). Interaction and stratified analyses showed greater effect estimates of SPD and risk of recurrent positive in the hypertension, low monocyte count and percentage patients (P for interaction = 0.008, 0.002, 0.036, respectively). CONCLUSION SPD was associated with a higher risk of recurrent positive and especially SPD > 28 day had a two-fold increase in the relative risk of re-positive as compared with SPD < 14 day. What's more, the risk may be higher among those with hypertension and lower monocyte count or percentage.
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Affiliation(s)
- Hong Zhao
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China.,Department of Infectious Disease, Peking University International Hospital, Beijing, China
| | - Chi Zhang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Xian-Xiang Chen
- Administrative Office, Wuhan Pulmonary Hospital, Wuhan, China
| | - Qi Zhu
- Department of Tuberculosis, Wuhan Pulmonary Hospital, Wuhan, China
| | - Wen-Xiang Huang
- Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Lan Zeng
- Administrative Office, Chengdu Public Health Clinical Center, Chengdu, China
| | - Ying-Xia Liu
- Administrative Office, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Guo-Jun Li
- Department of Hepatology III, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Wei-Jun Du
- Department of Internal Medicine, Fankou Branch of Ezhou Central Hospital, Ezhou, China
| | - Jing Yao
- Department of Obstetrics and Gynecology, Fankou Branch of Ezhou Central Hospital, Ezhou, China
| | - Jia-Wen Li
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China
| | - Peng Peng
- Administrative Office, Wuhan Pulmonary Hospital, Wuhan, China.
| | - Gui-Qiang Wang
- Department of Infectious Disease, Center for Liver Disease, Peking University First Hospital, Beijing, China. .,Department of Infectious Disease, Peking University International Hospital, Beijing, China.
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32
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Hong LX, Liu L, Lin A, Yan WH. Risk factors for SARS-CoV-2 re-positivity in COVID-19 patients after discharge. Int Immunopharmacol 2021; 95:107579. [PMID: 33756229 PMCID: PMC7953440 DOI: 10.1016/j.intimp.2021.107579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
Objective Re-positivity of SARS-CoV-2 in discharged COVID-19 patients have been reported; however, early risk factors for SARS-CoV-2 re-positivity evaluation are limited. Methods This is a prospective study, a total of 145 COVID-19 patients were treated and all discharged according to the guideline criteria by Mar 11th 2020. After discharge, clinical visits and viral RT-PCR tests by the second and fourth week follow-up were carried-out. Patient demographic and clinical characteristics and laboratory data on admission and discharge were retrieved, and predictive factors for SARS-CoV-2 re-positivity were analyzed. Results 13 out of 145 (9.0%) COVID-19 patients were confirmed re-positivity of SARS-CoV-2 by RT-PCR test. The median interval between disease onset to recurrence was 38 days. SARS-CoV-2 re-positive cases were of significantly longer virus shedding duration, notably higher body temperature, heart rate and lower TNF-α and IgG levels on admission. Covariate logistic regression analysis revealed virus shedding duration and IgG levels are independent risk factors for SARS-CoV-2 return positive after discharge. Conclusion Longer viral shedding duration and lower IgG levels are risk factors for re-positivity of SARS-CoV-2 for discharged COVID-19 patients.
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Affiliation(s)
- Lu-Xiao Hong
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Luqiao, Zhejiang 318050, China
| | - Lian Liu
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province, Luqiao, Zhejiang 318050, China
| | - Aifen Lin
- Biological Resource Center, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang 317000, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China
| | - Wei-Hua Yan
- Medical Research Center, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang 317000, China; Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province, Linhai, Zhejiang, China.
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33
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Adrielle Dos Santos L, Filho PGDG, 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. Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers. J Infect 2021; 82:399-406. [PMID: 33589297 PMCID: PMC7880834 DOI: 10.1016/j.jinf.2021.01.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Letícia Adrielle Dos Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Pedro Germano de Góis Filho
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Ana Maria Fantini Silva
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - João Victor Gomes Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Douglas Siqueira Santos
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Marília Marques Aquino
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Rafaela Mota de Jesus
- Division of Pulmonology, Institute of Health Promotion and Assistance for Employees of the State of Sergipe (IPESAÚDE), Sergipe, Brazil
| | - Maria Luiza Dória Almeida
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - João Santana da Silva
- Fiocruz - Bi-Institutional Translational Medicine Project, Ribeirao Preto Medical School, Department of Biochemistry and Immunology, 14049-900 Ribeirao Preto, SP, Brazil
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, W12 ONN, United Kingdom.
| | - Rosemary J Boyton
- Department of Immunology and Inflammation, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, W12 ONN, United Kingdom
| | - Cliomar Alves Dos Santos
- Health Foundation Parreiras Horta, Central Laboratory of Public Health (LACEN/SE), State Secretary for Health, Sergipe, Brazil
| | - Camilla Natália Oliveira Santos
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Juliana Cardoso Alves
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Ianaline Lima Santos
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Lucas Sousa Magalhães
- Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | | | - Danilo J P G Rocha
- Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - João P P Almeida
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte-MG, Brazil
| | - Luis G C Pacheco
- Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Eric R G R Aguiar
- Department of Biological Sciences, Center of Biotechnology and Genetics, State University of Santa Cruz (UESC), Ilhéus-BA, Brazil
| | - Gubio Soares Campos
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Silvia Inês Sardi
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Rejane Hughes Carvalho
- Virology Laboratory, Institute of Health Sciences, Federal University of Bahia, Salvador-BA, Brazil
| | - Amélia Ribeiro de Jesus
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil; Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil
| | - Karla Freire Rezende
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil
| | - Roque Pacheco de Almeida
- Department of Medicine, Federal University of Sergipe, Immunology Investigative Institute (III), INCT, CNPq, Aracaju, Sergipe 49060-100, Brazil; Division of Immunology and Molecular Biology Laboratory, University Hospital/EBSERH, Federal University of Sergipe, Sergipe CEP 49.060-025, Brazil.
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34
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Shoar S, Khavandi S, Tabibzadeh E, Khavandi S, Naderan M, Shoar N. Recurrent coronavirus diseases 19 (COVID-19): A different presentation from the first episode. Clin Case Rep 2021; 9:2149-2152. [PMID: 33821190 PMCID: PMC8013608 DOI: 10.1002/ccr3.3967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/30/2021] [Accepted: 02/08/2021] [Indexed: 01/25/2023] Open
Abstract
A 31-year-old Caucasian male developed reinfection with SARS-CoV-2, 2 ½ months after an initial episode of ICU admission for respiratory support due to COVID-19. The second episode was in the form of malaise, aphthous gingival ulcer, and desquamating palmar lesion.
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Affiliation(s)
- Saeed Shoar
- Department of Clinical Research Scientific Writing Corporation Houston TX USA
| | - Siamak Khavandi
- Department of Ophthalmology Tabriz University of Medical Sciences Tabriz Iran
| | - Elsa Tabibzadeh
- Department of Anaesthesiology and Critical Care Tabriz University of Medical Sciences Tabriz Iran
| | - Soheila Khavandi
- Department of Cardiology Tabriz University of Medical Sciences Tabriz Iran
| | - Mohammad Naderan
- Department of Medicine and Clinical Research Tehran University of Medical Sciences Tehran Iran
| | - Nasrin Shoar
- Department of Clinical Research Scientific Writing Corporation Houston TX USA.,Department of Medicine and Clinical Research Kashan University of Medical Sciences Kashan Iran
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35
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Huang K, Liu W, Zhou J, Wang Y, Zhang Y, Tang X, Liang J, Bi FF. Repositive RT-PCR test in discharged COVID-19 patients during medical isolation observation. Int J Med Sci 2021; 18:2545-2550. [PMID: 34104085 PMCID: PMC8176169 DOI: 10.7150/ijms.58766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/14/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives: The epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) have been researched. However, the prevalence of repositivity by real-time PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. Methods: A retrospective study was conducted involving 599 discharged patients with COVID-19 in a single medical centre. The clinical features of patients during their hospitalization and 14-day post-discharge quarantine were collected. Results: A total of 122 patients (20.4%) out of 599 patients retested positive after discharge. Specifically, 94 (15.7%) retested positive within 24 h of discharge, and another 28 patients (4.7%) were repositive on day 7 after discharge, although none showed any clinical symptomatic recurrence. Both repositives and non‑repositives have similar patterns of IgG and IgM. Notably, the length of hospitalization of non-repositive patients was longer than that of 24-h repositive patients and 7-day repositive patients. In addition, the length of hospitalization of 24-h repositive patients was shorter than that of 7-day repositive patients, indicating that the length of hospitalization was also a determinant of viral shedding. Conclusion: Our study provides further information for improving the management of recovered and discharged patients, and further studies should be performed to elucidate the infectiveness of individuals with prolonged or RNA repositivity.
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Affiliation(s)
- Kun Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Wen Liu
- Department of laboratory medicine, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jinxia Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
| | - Yao Wang
- Department of laboratory medicine, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yuxiang Zhang
- Department of laboratory medicine, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xinle Tang
- Department of laboratory medicine, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jing Liang
- Department of laboratory medicine, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
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