Systematic Genomic and Clinical Analysis of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfections and Recurrences Involving the Same Strain.

Cristina Rodríguez-Grande,Iñaki Comas,Fernando González-Candelas,Carmen Losada,Luis Alcalá,Carolina Martínez-Laperche,Darío García De Viedma,Carla Rico-Luna,Víctor Manuel De La Cueva,Javier Adán-Jiménez,Cristina Andrés-Zayas,Pilar Catalán,Patricia Muñoz,Agustín Estévez,Pedro J Sola-Campoy,Laura Pérez-Lago,Sergio Buenestado-Serrano,Roberto Alonso

doi:10.3201/eid2801.211952

Abstract

Estimates of the burden of severe acute respiratory syndrome coronavirus 2 reinfections are limited by the scarcity of population-level studies incorporating genomic support. We conducted a systematic study of reinfections in Madrid, Spain, supported by genomic viral analysis and host genetic analysis, to cleanse laboratory errors and to discriminate between reinfections and recurrences involving the same strain. Among the 41,195 cases diagnosed (March 2020–March 2021), 93 (0.23%) had 2 positive reverse transcription PCR tests (55–346 days apart). After eliminating cases with specimens not stored, of suboptimal sequence quality, or belonging to different persons, we obtained valid data from 22 cases. Of those, 4 (0.01%) cases were recurrences involving the same strain; case-patients were 39–93 years of age, and 3 were immunosuppressed. Eighteen (0.04%) cases were reinfections; patients were 19–84 years of age, and most had no relevant clinical history. The second episode was more severe in 8 cases.

Highlights

We conducted a systematic study of reinfections in Madrid, Spain, supported by genomic viral analysis and host genetic analysis, to cleanse laboratory errors and to discriminate between reinfections and recurrences involving the same strain
Our analysis was supported by genomic viral analysis, cleansing of laboratory errors by host genetic analysis, consideration of both reinfections and recurrences involving the same strain, and integrating clinical features of the cases
The cases selected for study were required to have 2 sequential positive reverse transcription PCR (RT-PCR) tests taken >45 days apart with >1 negative RT-PCR between positive tests

Summary

Introduction

Since the first description of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection on August 24, 2020, in a patient from Hong Kong [1] who acquired a second infection after having traveled to Europe, several reports have described other individual reinfection cases in different countries. These cases suggest the lack of a common reinfection pattern, with a variety of intervals between episodes, severity of episodes, clinical history, etc [2,3,4,5]. Our analysis was supported by genomic viral analysis, cleansing of laboratory errors by host genetic analysis, consideration of both reinfections and recurrences involving the same strain, and integrating clinical features of the cases

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Conclusion