Negative Polymerase Chain Reaction Research Articles

The Correlation of Rapid Antibody Results with SARS-CoV-2 PCR in COVID-19 Patients in Ulin General Hospital Banjarmasin

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of clinical disease, better known as COVID-19. The most common method to detect COVID-19 is serological testing of IgM and IgG in response to viral infections using rapid diagnostic test (RDT). Several other guidelines consider polymerase chain reaction (PCR) as the gold standard for diagnosis becausePCR has high sensitivity and specificity values in detecting SARS-CoV-2.Methods: This was a descriptive analytical study. The samples were taken from medical records of COVID-19 patients in Ulin General Hospital Banjarmasin from March to October 2020. Statistical Package for the Social Sciences (SPSS) 16.0 software and Chi-Square test were used for data analysis.Results: From 751 COVID-19 patients, 408 patients (54.32%) had rapid antibody with positive PCR, 132 patients (17.57%) had reactive rapid antibody with negative PCR, 152 patients (20.23%) had non-reactive rapid antibody with positive PCR, and 59 patients (7.85%) had non-reactive rapid antibody with negative PCR. The rapid antibody had sensitivity of 72.85% and specificity of 30.89%. From Chi-Square test, reactive rapid antibody was not correlated with PCR positive results; values of p = 0.320, odds ratio (OR) 1.20.Conclusion: The rapid test antibody could not be recommended as a diagnostic tool. In this study, it was also found that there was no relationship between reactive rapid test results and positive SARS-CoV PCR.

Pharmacist‐driven methicillin‐resistantStaphylococcus aureus screening protocol and the impact on vancomycin exposure in hospitalized patients with pneumonia

AbstractIntroductionAlthough methicillin‐resistant Staphylococcus aureus (MRSA) is a rarely identified pathogen of pneumonia, providers are often compelled to use anti‐MRSA antibiotics empirically. As a result, patients may be exposed to unnecessary anti‐MRSA antibiotic therapy. Polymerase chain reaction (PCR) nares screening for MRSA colonization has repeatedly shown a negative predictive value of >95% for MRSA pneumonia. Therefore, nares screenings have the potential to serve as a valuable tool to de‐escalate anti‐MRSA antibiotics for patients with pneumonia. Our institution implemented a protocol whereby pharmacists order a MRSA PCR screen for patients with suspected MRSA pneumonia at the time of vancomycin initiation. For negative MRSA PCR results, pharmacists contact the provider and recommend discontinuation of vancomycin.ObjectivesThe primary objective of this study was to evaluate the impact of pharmacist‐driven MRSA PCR nares screening on duration of vancomycin therapy for patients with pneumonia.MethodsThis study was a retrospective cohort study of patients with suspected MRSA pneumonia pre‐ and post‐protocol implementation. The study was conducted at a community teaching hospital September 1, 2017 through November 30, 2017 (control) and September 1, 2018 through November 30, 2018 (intervention). Patients were excluded for the following: concomitant non‐pulmonary MRSA infection, septic shock requiring vasopressors, confirmed MRSA infection within the last 30 days, cystic fibrosis, or bronchiectasis. The primary endpoint was duration of vancomycin therapy.ResultsOur institutional review board‐approved study included 196 patients (n = 81 pre‐protocol, n = 115 post‐protocol). Post implementation of the MRSA nares screen protocol, patients received a significant reduction in median hours of vancomycin (38 vs 23.5 hours, P = .002). Reduction in vancomycin exposure was not found to adversely affect clinical outcomes such as length of stay or readmission at 30 days.ConclusionsImplementation of a pharmacist‐driven MRSA nares screen significantly and safely reduces unnecessary vancomycin exposure in patients with suspected pneumonia.

High attack rate of COVID-19 in an organized tour group of vaccinated travellers to Iceland.

In a COVID-19 outbreak in a group of 25 twice-vaccinated Israeli travelers, the attack rate was 84%, despite negative pre-flight PCR tests. This extremely high breakthrough infection rate is attributed mainly to close and prolonged exposures during long bus-drives. Masking, distancing, and personal responsibility are required to avoid such outbreaks.

Nosocomial COVID-19 infection in women undergoing elective cesarean delivery: a prospective cohort study

BACKGROUNDThe COVID-19 pandemic placed obstetricians in a difficult position of continuing to perform elective cesarean delivery without the knowledge of the risk of the spread of nosocomial infection of the COVID-19 virus.OBJECTIVEThis study aimed to determine the nosocomial infection rate in women undergoing elective cesarean delivery at 2 academic institutions.STUDY DESIGNThis nonrandomized prospective cohort trial evaluated patients undergoing elective cesarean delivery during the reopening phase of the COVID-19 pandemic in the state of New York at 2 large volume labor and delivery units. Eligible patients with a negative preoperative reverse transcriptase-polymerase chain reaction test and immunoglobulin G antibody test for COVID-19 were retested 6 to 9 days after discharge. The primary objective was the COVID-19 test conversion rate defined as a positive polymerase chain reaction test for SARS-CoV-2 after discharge with a negative preoperative test. This was used as a proxy for the nosocomial infection rate.RESULTSA total of 136 patients were screened for participation. Of these patients, 2 tested positive for COVID-19 on preoperative testing, and 25 declined to participate. Overall, 111 patients consented to participate, and 96 patients underwent both preoperative and postoperative testing. No patient with a negative polymerase chain reaction test preoperatively, had a positive polymerase chain reaction test for the COVID-19 virus postoperatively.CONCLUSIONWith strict and methodical perioperative and postpartum protocols, we can limit nosocomial COVID-19 infection in women undergoing elective cesarean delivery.

Evaluation of the ESGE recommendations for COVID-19 pre-endoscopy risk-stratification in a high-volume center in Germany.

Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) has defined COVID-19 infection prevention and control strategies within the endoscopy unit. These include pre-endoscopic questionnaire-based risk-stratification as well as pre-procedure viral testing. Real-life data on the effectiveness of these measures are presented here. Patients and methods Data from the outpatient endoscopic unit of the University Hospital Augsburg between July 1, 2020 and December 31, 2020 including the second pandemic wave were reviewed retrospectively. All patients were assessed with a pre-endoscopic risk-stratification questionnaire as well as viral testing using an antigen point-of-care test (Ag-POCT) in conjunction with a standard polymerase chain reaction (PCR) test. Highly elective procedures were postponed. The theoretically expected number of SARS-CoV-2-positive patients was simulated and compared with the actual number. In addition, endoscopy staff was evaluated with a rapid antibody test to determine the number of infections among the personnel. Results In total, 1029 procedures, 591 questionnaires, 591 Ag-POCTs, and 529 standard PCR tests were performed in 591 patients. 247 procedures in 142 patients were postponed. One Ag-POCT was positive but with a negative PCR test, while one PCR test was positive but with a negative Ag-POCT. This was lower than the theoretically expected number of COVID-19-positive patients (n = 15). One of 43 employees (2.3 %) in the outpatient endoscopy unit was seropositive. Conclusions Pre-endoscopic risk management including questionnaire-based risk stratification and viral testing seems to be an effective tool in combination with personal protective equipment for SARS-CoV-2 infection prevention and control within the endoscopy unit even in a high-prevalence setting.

Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study

BackgroundRobust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential.MethodsA lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group).ResultsIn total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067–0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128–8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021–1.202; P = 0.014).ConclusionsEarly, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.

Long-term clinical and biochemical residue after COVID-19 recovery

BackgroundThe long-term health consequences of coronavirus disease 2019 (COVID-19) are still unclear. The majority of previous trials addressed the post-COVID-19 symptoms through comprehensive medical questionnaires for relatively short periods after recovery. We tried to detect the potential pathological clinical signs and biochemical residue which persist for more than 3 months after the negative real-time polymerase chain reaction (RT-PCR) test of SARS-CoV-2.ResultsAmong 120 COVID-19 survivors of mean age 38.29 and 55.6% male proportion, systolic blood pressure was significantly elevated (P=0.001). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer showed higher values in COVID-19 survivors (P< 0.001). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl trans-peptidase (GGT), and alkaline phosphatase (ALP) were significantly elevated in contrast to serum albumin that was reduced in COVID-19 survivors (P ≤0.001). Serum lipase, amylase and albuminuria were higher in COVID-19 survivors (P ≤0.001). Regression analysis (AOR, 95% CI) showed that ESR (P = 0.014), haemoglobin concentration (P = 0.039), serum lipase (P= 0.018), blood urea nitrogen (P= 0.003), albuminuria (P= 0.046), 25(OH) vitamin D (P= 0.002), and serum uric acid (P= 0.005) were the significant predictors of COVID-19 survivors (94.8% an overall prediction).ConclusionCOVID-19 survivors experienced residual significant clinical and biochemical alterations that necessitate comprehensive medical care and close follow-up for longer periods.

Effects of adding L-arginine orally to standard therapy in patients with COVID-19: A randomized, double-blind, placebo-controlled, parallel-group trial. Results of the first interim analysis.

BackgroundWe and others have previously demonstrated that the endothelium is a primary target of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and L-arginine has been shown to improve endothelial dysfunction. However, the effects of L-arginine have never been evaluated in coronavirus disease 2019 (COVID-19).MethodsThis is a parallel-group, double-blind, randomized, placebo-controlled trial conducted on patients hospitalized for severe COVID-19. Patients received 1.66 g L-arginine twice a day or placebo, administered orally. The primary efficacy endpoint was a reduction in respiratory support assessed 10 and 20 days after randomization. Secondary outcomes were the length of in-hospital stay, the time to normalization of lymphocyte number, and the time to obtain a negative real-time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 on nasopharyngeal swab. This clinical trial had been registered at ClinicalTrials.gov, identifier: NCT04637906.FindingsWe present here the results of the initial interim analysis on the first 101 patients. No treatment-emergent serious adverse events were attributable to L-arginine. At 10-day evaluation, 71.1% of patients in the L-arginine arm and 44.4% in the placebo arm (p < 0.01) had the respiratory support reduced; however, a significant difference was not detected 20 days after randomization. Strikingly, patients treated with L-arginine exhibited a significantly reduced in-hospital stay vs placebo, with a median (interquartile range 25th,75th percentile) of 46 days (45,46) in the placebo group vs 25 days (21,26) in the L-arginine group (p < 0.0001); these findings were also confirmed after adjusting for potential confounders including age, duration of symptoms, comorbidities, D-dimer, as well as antiviral and anticoagulant treatments. The other secondary outcomes were not significantly different between groups.InterpretationIn this interim analysis, adding oral L-arginine to standard therapy in patients with severe COVID-19 significantly decreases the length of hospitalization and reduces the respiratory support at 10 but not at 20 days after starting the treatment.FundingBoth placebo and L-arginine were kindly provided by Farmaceutici Damor S.p.A., Naples

A descriptive study on Bulgarian preclinical dental students' knowledge and attitude towards coronavirus disease 2019 precautions and cross-infection control practices

BACKGROUND AND AIM: One year after the novel coronavirus pandemic, there is a sustained risk of further global spread and most countries continue to impose preventive measures to mitigate the spread of coronavirus disease 2019 (COVID-19). The current situation outlined a specific reformulation of dental education in Medical University of Sofia, Sofia, Bulgaria - initial transition of face-to-face classes towards electronic learning (e-learning) processes, and subsequently, a transition from online teaching toward hybrid education. Therefore, the aim of the present study was to investigate preclinical dental students' knowledge and attitude towards COVID-19 precautions as well as crossinfection control strategies. METHODS: This descriptive cross-sectional study was conducted online on 258 out of 516 preclinical dental students at the School of Dental Medicine, Sofia, using a self-administered questionnaire. Survey items were grouped in 3 general sections: educational experiences, students' knowledge and perceptions of COVID-19 precautions and sources of relevant information as well as students' personal experiences during the current pandemic. RESULTS: A total of 169 students participated in the study (response rate: 65.5%). Of them, 98 (57.9%) were secondyear students, 42.6% were men, and their mean age was 21 +/- 1 years. Almost one-third of the participants indicated violation of disinfection and sterilization protocols (28.9%) and the presence of aerosol-generating procedures (27.2%) as the most important COVID-19 predisposing factors in dental practice. Vaccination was suggested as the most effective way of prevention against the COVID-19. Proposed infection control practices included strict cleaning, disinfection, and sterilization (87.6%), personal protective equipment (PPE) (85.8%), frequent ventilation (53.3%), and treatment after a negative polymerase chain reaction (PCR) (or other) test (46.2%). Social media was considered as the main source for pandemic-related information (68.0%). CONCLUSION: In the light of COVID-19, dental students demonstrated a satisfactory level of knowledge regarding standard precautions in dental practice;however, more attention should be paid to additional transmission-based precautions to ensure the safety of educational and working environment.

Newborn with Failure to Thrive and Diarrhea.

Newborn with Failure to Thrive and Diarrhea.

Abnormal Lower Extremity Movements in a Term Infant.

Abnormal Lower Extremity Movements in a Term Infant.

Wolbachia spp. and Spiroplasma spp. in Musca spp.: Detection Using Molecular Approaches

This study aimed to detect the presence of Wolbachia and Spiroplasma endosymbionts in Musca flies through molecular approaches. In total, 40 Musca spp. (20 female and 20 male) were used. Before DNA extraction, the flies were dissected and their heads, wings and legs were detached from their bodies under a stereomicroscope. Genomic DNA was analysed by standard polymerase chain reaction (PCR) using primers against Musca beta-tubulin. Afterward, the samples were examined for the presence of Wolbachia spp. using primers against Wolbachia wsp and GroEL. Furthermore, the DNA samples were analysed by PCR to detect the presence of Spiroplasma using primers against the 16S rRNA. No Wolbachia positivity was detected in Musca flies, as shown by the negative PCR results for wsp and GroEL. Spiroplasma positivity was detected in 5% (1/20) of the female Musca flies but not in the male flies (0/20). Wolbachia spp. were not detected in Musca flies. Of the total Musca flies, only one was positive for Spiroplasma spp. To our knowledge, this is the first study to detect the presence of Spiroplasma in Musca flies.

A Statistical Model to Assess Risk for Supporting COVID-19 Quarantine Decisions

In Germany, local health departments are responsible for surveillance of the current pandemic situation. One of their major tasks is to monitor infected persons. For instance, the direct contacts of infectious persons at group meetings have to be traced and potentially quarantined. Such quarantine requirements may be revoked, when all contact persons obtain a negative polymerase chain reaction (PCR) test result. However, contact tracing and testing is time-consuming, costly and not always feasible. In this work, we present a statistical model for the probability that no transmission of COVID-19 occurred given an arbitrary number of negative test results among contact persons. Hereby, the time-dependent sensitivity and specificity of the PCR test are taken into account. We employ a parametric Bayesian model which combines an adaptable Beta-Binomial prior and two likelihood components in a novel fashion. This is illustrated for group events in German school classes. The first evaluation on a real-world dataset showed that our approach can support important quarantine decisions with the goal to achieve a better balance between necessary containment of the pandemic and preservation of social and economic life. Future work will focus on further refinement and evaluation of quarantine decisions based on our statistical model.

SARS-CoV-2 Shedding in Dialysis Patients With COVID-19

SARS-CoV-2 Shedding in Dialysis Patients With COVID-19

Diagnosis of Clostridioides difficile infection by analysis of volatile organic compounds in breath, plasma, and stool: A cross-sectional proof-of-concept study.

Clostridioides difficile infection (CDI) is an important infectious cause of antibiotic-associated diarrhea, with significant morbidity and mortality. Current diagnostic algorithms are based on identifying toxin by enzyme immunoassay (EIA) and toxin gene by real-time polymerase chain reaction (PCR) in patients with diarrhea. EIA's sensitivity is poor, and PCR, although highly sensitive and specific, cannot differentiate infection from colonization. An ideal test that incorporates microbial factors, host factors, and host-microbe interaction might characterize true infection, and assess prognosis and recurrence. The study of volatile organic compounds (VOCs) has the potential to be an ideal diagnostic test. The presence of VOCs accounts for the characteristic odor of stool in CDI but their presence in breath and plasma has not been studied yet. A cross-sectional proof-of-concept study analyzing VOCs using selected ion flow tube mass spectrometry (SIFT-MS) was done on breath, stool, and plasma of patients with clinical features and positive PCR for CDI (cases) and compared with patients with clinical features but a negative PCR (control). Our results showed that VOC patterns in breath, stool, and plasma, had good accuracy [area under the receiver operating characteristic curve (ROC) 93%, 86%, and 91%, respectively] for identifying patients with CDI.

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

AKI In Suspected Meningitis/Encephalitis May Be "Avoidable Kidney Injury".

Gastrointestinal manifestations with COVID-19 virus infection: A Moroccan prospective study

Background and study aimsGastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. They can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. The current study reports major gastrointestinal manifestations as initial symptoms of COVID-19. Patients and methodsThis prospective, descriptive, cross-sectional, and single-center study of 713 cases was conducted in a field hospital in Morocco over a 5-week period from June 21 to July 25, 2020. ResultsThe average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases.Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases.In multivariate analysis, following adjustment of the studied parameters, only the presence of gastrointestinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286–1.698; p < 0.001) and treatment side effects (OR = 1.069, CI: 1.020–1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. ConclusionGastrointestinal manifestations are common during COVID-19 and seem to be linked to a longer duration of disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal–oral transmission. Therefore, hygiene is extremely important, especially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.

Ultrasound and Influenza: The Spectrum of Lung and Cardiac Ultrasound Findings in Patients with Suspected Influenza A and B

In patients with influenza, cardiac and lung ultrasound may help determine the severity of illness and predict clinical outcomes. To determine the ultrasound characteristics of influenza and define the spectrum of lung and cardiac findings in patients with suspected influenza A or B, we conducted a prospective observational study in patients presenting to the emergency department at a tertiary care academic institution. An ultrasound protocol consisting of cardiac, lung and inferior vena cava scans was performed within 6 h of admission. We compared the ultrasound findings in cases with positive and negative influenza polymerase chain reaction, while controlling for comorbidities. We enrolled 117 patients, 41.9% of whom (49/117) tested positive for influenza. In those with influenza, ultrasound confirmed preserved left ventricular and right ventricular (RV) function in 81.3% of patients. The most common cardiac pathology was RV dilation (10.4%), followed by left ventricular systolic dysfunction (8.3%). Patients with negative influenza polymerase chain reaction with RV dysfunction demonstrated higher hospital admission than those those with normal RV function (45.1%, 23/51, vs. 17.9%, 5/28; p = 0.016). B-lines were prevalent in both influenza and non-influenza groups (40.8% and 69.1%, respectively; p = 0.013). Lung consolidation was identified in only 8.25% of patients with influenza. In conclusion, in patients with influenza we were unable to define distinct ultrasound features specific to influenza A or B, suggesting that ultrasound may not be beneficial in diagnosing influenza nor in evaluating its severity.

Coronavirus Disease-19 Pneumonia or Pneumocystis carinii Pneumonia in a Patient with Diabetes: A Diagnostic Dilemma

Coronavirus disease 2019 (COVID‐19) and pneumocystis pneumonia share many overlapping features and may be clinically indistinguishable on initial presentation in people living with human immunodeficiency virus severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) belongs to the subfamily of beta-coronavirus, which are responsible for respiratory, enteric, hepatic, and neurologic diseases, due to their broad tissue tropism. In the present patient, the course was acute with dyspnea being one of the major symptoms and lung involvement was seen to be peripheral. The two negative reverse transcription polymerase chain reaction (RT-PCR) reports for SARS-CoV-2 along with the differences in the interpretation of the computed tomography scans led to the diagnosis difficulty in the present case. COVID-19 pneumonia may have similar presentation like that of Pneumocystis carinii pneumonia. The low sensitivity of RT-PCR which is considered the gold standard of diagnosis of SARS-CoV-2 and the similarities in presentation between the two types of pneumonia, along with increased prevalence of both the types of pneumonia amongst diabetics, may give rise to diagnostic difficulties.

Severe acute respiratory syndrome coronavirus 2 reinfection in a coronavirus disease 2019 recovered young adult: a case report

BackgroundCoronavirus disease 2019 has been a public health threat and a worldwide emergency for more than a year. Unfortunately, many questions concerning the pathophysiology, management, and long-term side effects remain unanswered, and novel aspects of the disease keep on emerging. Of concern to healthcare providers are the recent reported cases of reinfection. Serum coronavirus disease 2019 antibodies have been detected within a few days after onset of the disease. However, it remains unclear whether this immune response is universal, or whether it can lead to latent immunity.Case presentationA previously healthy 27-year-old white man presented with fever, chills, back pain, and other constitutional symptoms, 2 days after being exposed to coronavirus disease 2019 positive patients. His severe acute respiratory syndrome coronavirus 2 polymerase chain reaction was positive, and his symptoms resolved over the next 2 weeks. One month after a confirmatory negative severe acute respiratory syndrome coronavirus 2 polymerase chain reaction, he was found to be ineligible for plasma donation as his anti-severe acute respiratory syndrome coronavirus 2 serology was negative. The patient redeveloped symptoms similar to his first infection 3 weeks after the negative serology test. He and his wife both tested positive via polymerase chain reaction. Their symptoms resolved over the next few days, and they had a negative polymerase chain reaction test 10 days after the positive polymerase chain reaction.ConclusionWhile studies showed that anti-severe acute respiratory syndrome coronavirus 2 immunoglobulins start to develop early after infection, our healthy young patient’s immune system failed to mount latent immunity against the virus. This left him, especially amid widespread social and medical misconceptions, vulnerable to reinfection by severe acute respiratory syndrome coronavirus 2. Our case disputes the timelines for immune response that were set and supported by research studies. Our case also raises questions regarding prioritizing vaccinating other individuals over those with prior infection.