Reduction of the overall burden of death and disease linked to SARS-CoV-2 infection will require strategies aimed at the prevention of reinfection, according to study findings published in the journal Nature Medicine.
Researchers sought to evaluate whether reinfection with COVID-19 adds to risks incurred following an initial SARS-CoV-2 infection. They used the national electronic health care database from the US Department of Veterans Affairs to:
- Characterize the risks and 6-month burdens of a range of prespecified outcomes among a cohort of individuals who had experienced a SARS-CoV-2 reinfection compared with those who had experienced no reinfection;
- Describe the risks of acute and post-acute outcomes among individuals who had experienced a reinfection; and
- Estimate the cumulative risks and 1-year burdens associated with 1, 2, 3 or more infections compared with a non-infected control group.
A total of 443,588 cohort participants reported no SARS-CoV-2 reinfection (ie, only a single SARS-CoV-2 infection), whereas 40,947 participants reported a SARS-CoV-2 reinfection (ie, 2 or more COVID-19 infections). The non-infected group included 5,334,729 individuals with no record of a positive SARS-CoV-2 infection.
Among individuals who had experienced a reinfection, 92.8% (37,997 of 40,947) of them had 2 infections, 6.3% (2572 of 40,947) of them had 3 infections, and 0.9% (378 40,947) of them had 4 or more infections. The median time between the first and second infections was 191 days (range, 127-228 days).
Compared with individuals with no reinfection, those who experienced a reinfection had an increased risk for all-cause mortality (hazard ratio [HR], 2.17; 95% CI, 1.93-2.45) and an excess burden of all-cause mortality estimated to be 19.33 (95% CI, 15.34-23.82) per 1000 persons at 6 months.
Individuals who experienced a reinfection also had an increased risk for hospitalization (HR, 3.32; 95% CI, 3.13-3.51; a burden of 100.19 [95% CI, 92.53-108.25]) and of having 1 or more sequela of a SARS-CoV-2 infection (HR, 2.10; 95% CI, 2.04-2.16; a burden of 235.91 [95% CI, 225.54-246.34]).
Additionally, compared with those who experienced no reinfection, those with a reinfection exhibited an increased risk for sequelae in the pulmonary system (HR, 3.54; 95% CI, 3.29-3.82; burden, 75.74 [95% CI, 68.47-83.50]) and several extrapulmonary organ systems, including:
- cardiovascular disorders,
- coagulation and hematologic disorders,
- gastrointestinal disorders,
- kidney disorders,
- mental health disorders,
- musculoskeletal disorders, and
- neurologic disorders.
Analyses of prespecified subgroups according to vaccination status prior to reinfection (ie, no vaccination, 1 vaccination, or 2 or more vaccinations) demonstrated that reinfection (compared with no reinfection) was associated with a higher risk for all-cause mortality, hospitalization, 1 or more sequela, and sequelae in different organ systems, regardless of vaccination status.
The study presented several limitations, such as the individuals in the cohorts evaluated were mostly White men. Further, the cohorts of individuals with 1, 2, 3 or more infections included those who had a positive test for SARS-CoV-2 infection and did not include those who may have had a COVID-19 infection but were not tested. This might have led to the misclassification of exposure, since these individuals would have been enrolled in the control groups.
The researchers concluded that “Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.”
Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.
This article originally appeared on Neurology Advisor
Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. Published online November 10, 2022. doi:10.1038/s41591-022-02051-3