Evolution of COVID-19 Reinfection and Immunity

In the early stages of the COVID-19 pandemic, reactivation and reinfection were considered rare. However, as the pandemic progressed, records for the length of infection and number of reinfections began to break. By October 2020, there were five cases of reinfection with more severe second cases. By the end of 2021, prolonged positive tests were observed, such as a man in Bristol who remained SARS-CoV-2 positive for 290 days. A case report published in May 2023 (aren't academic reports obsolete by the time they are finally published?) asked "Is it possible to get Covid infection 3 times?" in the title. Now this question is rhetorical. In a recent Malawi study, the risk of reinfection was highest in the immediate 3 to 6 months following the initial infection and declined substantially after that, and age demonstrated a significant association with reinfection. In Southern Brazil, comparative genomic and phylogenetic analysis confirmed that the fourth reinfection was caused by a virus of the same lineage. Claims of sixth and seventh reinfections emerged on social media by mid-2022 and spring of 2023, respectively. On the other hand, some individuals gained T-cell immunity against SARS-CoV-2 without a detectable infection. 

An analysis from the National COVID Cohort Collaborative (N3C) revealed a mild protective effect of prior infection during the early and mid-stages of the pandemic, but this protection waned with the rise of the Omicron variant when prior infection was associated with a significant slightly elevated risk of severe disease. The post-COVID-19 population exhibited a high prevalence of cross-reactive antibodies to spikes from all Orthocoronavirinae genera. Infection and vaccination against SARS-CoV-2 have induced broadly cross-reactive binding antibodies, profoundly changing the coronavirus spike antibody landscape. 

In a highly vaccinated population (94% with >=3 vaccine doses), almost 20% of persons infected with the Omicron variant reported Long COVID symptoms 90 days post-diagnosis. Research on Long-Covid patients has revealed expanded antibody responses to other common Coronaviruses, suggesting an 'original antigenic sin' where pre-existing immune responses shape the response to current infection. NeuroPASC individuals, in particular, showed significantly expanded antibody responses to other common coronaviruses, , including 229E, HKU1, NL63 and OC43, marking a key prognostic indicator of long COVID. 


Here are a few recently publioshed case reports:


Nephrology

A 63-year-old male patient developed hematuria after the SARS-CoV-2 vaccination, leading to rapidly progressive glomerulonephritis and a diagnosis of IgA nephropathy. Treatment with pulse steroid therapy and mizoribine improved his renal function. SARS-CoV-2 mRNA vaccines activate T cells, which are involved in the pathophysiology of IgA nephropathy. Therefore, this case suggests that the exacerbation of IgA nephropathy by the vaccine favors the vasculitis aspect of the disease.


Ophthalmology

A 55-year-old woman experienced progressive vision loss and other symptoms 10 days after receiving the Pfizer–BioNTech COVID-19 vaccination. Treatment led to recovery, and this is the first reported case of this condition occurring as a potential side effect of the vaccine.


Rheumatology

A 52-year-old woman developed Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) syndrome after receiving the second dose of mRNA COVID-19 vaccination. She presented with hand edema, arthralgia, and morning stiffness. Treatment with prednisolone led to complete disappearance of symptoms. 



REFERENCES

Chaves EB, Dantas Filho FF, Fernandes FS, Fighera TM, Callegaro FP. Is it possible to get Covid infection 3 times? Case report: Covid-19 reinfection. Clinical and Biomedical Research. 2023 May 29;43(1).

Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nature medicine. 2022 Nov;28(11):2398-405.

Jacquet B, Curiale V, Mangeard H, Ferrer É, Chaillou S. Reactive systemic vasculitis in the course of a coronavirus OC43 infection: a case report. Geriatric Care. 2023 May 8;9(1).

Nathaniel Hendrix, Hythem Sidky, David K. Sahner, The N3C Consortium. Influence of Prior SARS-CoV-2 Infection on COVID-19 Severity: Evidence from the National COVID Cohort Collaborative medRxiv 2023.08.03.23293612; doi: https://doi.org/10.1101/2023.08.03.23293612

Marianna Spatola and others, Neurologic sequelae of COVID-19 are determined by immunologic imprinting from previous coronaviruses, Brain, 2023;, awad155, https://doi.org/10.1093/brain/awad155. Previously posted as: Spatola M, Nziza N, Deng Y, Jung W, Yuan D, Dinoto A, Bozzetti S, Chiodega V, Ferrari S, Lauffenburger DA, Mariotto S. Neurologic sequalae of COVID-19 are determined by immunologic imprinting from previous Coronaviruses. medRxiv. 2022:2022-11.

Fukuda, M., Kaneko, T., Kawai, T. et al. Secondary immunoglobulin A nephropathy with gross hematuria leading to rapidly progressive glomerulonephritis following severe acute respiratory syndrome coronavirus 2 vaccination: a case report. BMC Nephrol 24, 232 (2023). https://doi.org/10.1186/s12882-023-03287-y

Dutt DDCS, Lam J, Richards J. Bilateral Relentless Placoid Chorioretinitis Following Pfizer-BioNTech COVID-19 Vaccination: Specific Antigenic Trigger or Nonspecific Immune Activation? Ocul Immunol Inflamm. 2023 Aug 8:1-6. doi: 10.1080/09273948.2023.2239338. Epub ahead of print. PMID: 37552853.

Mulu Woldegiorgis, Gemma Cadby, Sera Ngeh, Rosemary Korda, Paul Armstrong, Jelena Maticevic, Paul Knight, Andrew Jardine, Lauren Bloomfield, Paul Effler. Long COVID in a highly vaccinated population infected during a SARS-CoV-2 Omicron wave – Australia, 2022 medRxiv 2023.08.06.23293706; doi: https://doi.org/10.1101/2023.08.06.23293706

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis ...
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an incr...
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high ...
Read more