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      SARS-CoV-2 Reinfection Rate and Outcomes in Saudi Arabia: A National Retrospective Study

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          Abstract

          Background

          The characterization of reinfection with SARS-CoV-2 has been a subject of concern and controversy, especially with the surge of infections with highly transmissible variants worldwide.

          Methods

          This retrospective national study used comorbidities, vaccination status, SARS-CoV-2 variants of concern, and demographics data to profile participants who were reinfected with SARS-CoV-2, defined as having two reverse transcriptase-polymerase chain reaction-positive SARS-CoV-2 tests within at least 90 days apart. A multivariate logistic regression model assessed the risk factors associated with reinfection . Two control groups were selected: nonreinfected participants reporting a positive test (control group one) and those reporting a negative test (control group two).

          Results

          Between March 2020 and December 2021, 4454 reinfected participants were identified in Saudi Arabia (0.8%, 95% confidence interval [CI] 0.7-0.8). The majority (67.3%) were unvaccinated (95% CI 65.9-68.7) and 0.8% (95% CI 0.6-1.1) had severe or fatal SARS-CoV-2 disease. COVID-19 vaccines were 100% effective against mortality in reinfected individuals who received at least one dose, whereas it conferred 61% (odds ratio [OR] 0.4, 95% CI 0.1-1.0) additional protection against severe disease after the first dose and 100% after the second dose. In the risk factor analysis, reinfection was highly associated with comorbidities, such as HIV (OR 2.5, 95% CI 1.3-5.2; P = 0.009), obesity (OR 2.3, 95% CI 1.3-3.9; P = 0.003), pregnancy (OR 3.2, 95% CI 1.4-7.4; P = 0.005), and working in health care facilities (OR 6.1, 95% CI 3.1-12.9; P <0.0001). The delta variant (B.1.617.2) was the most frequent variant of concern among the reinfected cohort.

          Conclusion

          This in-depth study of the reinfection profile identified risk factors and highlighted the associated SARS-CoV-2 variants. Results showed that naturally acquired immunity to SARS-CoV-2 through multiple reinfections together with vaccine-induced immunity provided substantial protection against severe SARS-CoV-2 disease and mortality.

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          Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

          Jamie Lopez Bernal, Nick Andrews, Charlotte Gower … (2021)
          Background The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. Methods We used a test-negative case–control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike ( S ) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients’ vaccination status. Results Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. Conclusions Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)
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            Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization

            Delphine Planas, David Veyer, Artem Baidaliuk … (2021)
            The SARS-CoV-2 B.1.617 lineage was identified in October 2020 in India1-5. Since then, it has become dominant in some regions of India and in the UK, and has spread to many other countries6. The lineage includes three main subtypes (B1.617.1, B.1.617.2 and B.1.617.3), which contain diverse mutations in the N-terminal domain (NTD) and the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein that may increase the immune evasion potential of these variants. B.1.617.2-also termed the Delta variant-is believed to spread faster than other variants. Here we isolated an infectious strain of the Delta variant from an individual with COVID-19 who had returned to France from India. We examined the sensitivity of this strain to monoclonal antibodies and to antibodies present in sera from individuals who had recovered from COVID-19 (hereafter referred to as convalescent individuals) or who had received a COVID-19 vaccine, and then compared this strain with other strains of SARS-CoV-2. The Delta variant was resistant to neutralization by some anti-NTD and anti-RBD monoclonal antibodies, including bamlanivimab, and these antibodies showed impaired binding to the spike protein. Sera collected from convalescent individuals up to 12 months after the onset of symptoms were fourfold less potent against the Delta variant relative to the Alpha variant (B.1.1.7). Sera from individuals who had received one dose of the Pfizer or the AstraZeneca vaccine had a barely discernible inhibitory effect on the Delta variant. Administration of two doses of the vaccine generated a neutralizing response in 95% of individuals, with titres three- to fivefold lower against the Delta variant than against the Alpha variant. Thus, the spread of the Delta variant is associated with an escape from antibodies that target non-RBD and RBD epitopes of the spike protein.
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              Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic

              Salim S Abdool Karim, Quarraisha Karim (2021)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Infect Dis
                Journal ID (iso-abbrev): Int J Infect Dis
                Title: International Journal of Infectious Diseases
                Publisher: The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
                ISSN (Print): 1201-9712
                ISSN (Electronic): 1878-3511
                Publication date PMC-release: 14 July 2022
                Publication date (Print): September 2022
                Publication date (Electronic): 14 July 2022
                Volume: 122
                Pages: 758-766
                Affiliations
                [1 ]The Saudi Ministry of Health, Riyadh, Saudi Arabia
                [2 ]Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [3 ]Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                [4 ]Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
                [5 ]Saudi Center for Disease Control and Prevention, Riyadh, Saudi Arabia
                [6 ]Immunocompromised Host Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
                Author notes
                [* ]Corresponding Author: Maram Al-Otaiby, President of Health Support Services, The Saudi Ministry of Health, Riyadh, Saudi Arabia. Associate Professor of Medicine, Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
                Article
                Publisher Item ID: S1201-9712(22)00420-9
                DOI: 10.1016/j.ijid.2022.07.025
                PMC ID: 9364818
                PubMed ID: 35840098
                SO-VID: 57954c31-019c-4372-8d1f-04cc115014da
                Copyright © © 2022 The Authors
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 30 March 2022
                Date revision received : 11 June 2022
                Date accepted : 7 July 2022
                Categories
                Subject: Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: sars-cov-2 reinfection,vaccination,protective immunity,variant of concern,risk factor,saudi arabia
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: sars-cov-2 reinfection, vaccination, protective immunity, variant of concern, risk factor, saudi arabia

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