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Review
. 2020 Dec 1;16(12):3061-3073.
doi: 10.1080/21645515.2020.1830683.

SARS-CoV-2 reinfection and implications for vaccine development

Firzan Nainu  1 , Rufika Shari Abidin  2 , Muh Akbar Bahar  1 , Andri Frediansyah  3   4 , Talha Bin Emran  5 , Ali A Rabaan  6 , Kuldeep Dhama  7 , Harapan Harapan  8   9   10
Affiliations
Review

SARS-CoV-2 reinfection and implications for vaccine development

Firzan Nainu et al. Hum Vaccin Immunother. .

Abstract

Coronavirus disease 2019 (COVID-19) pandemic continues to constitute a public health emergency of international concern. Multiple vaccine candidates for COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have entered clinical trials. However, some evidence suggests that patients who have recovered from COVID-19 can be reinfected. For example, in China, two discharged COVID-19 patients who had recovered and fulfilled the discharge criteria for COVID-19 were retested positive to a reverse transcription polymerase chain reaction (RT-PCR) assay for the virus. This finding is critical and could hamper COVID-19 vaccine development. This review offers literature-based evidence of reinfection with SARS-CoV-2, provides explanation for the possibility of SARS-CoV-2 reinfection both from the agent and host points of view, and discusses its implication for COVID-19 vaccine development.

Keywords: SARS-CoV-2; covid-19; reactivation; reinfection; vaccine.

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Figures

Figure 1.
Figure 1.
Potential causes of lymphopenia in COVID-19 patients. (A) Lymphopenia is possible to occur as a result of T cell depletion due to either SARS-CoV-2-mediated or IL-6-mediated pyroptotic cell death. (B) Alternatively, lymphocyte count in circulation may be reduced due to massive infiltration of lymphocytes into infected tissues (e.g. alveolus) (created with BioRender)
Figure 2.
Figure 2.
Possible cause(s) of re-positivity of COVID-19 patients. Status of SARS-CoV-2 negative patients are decided based on at least two consecutive negative results on SARS-CoV-2 presence in patients’ samples using reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR). Plausible assumptions of patients who turned positive RT-qPCR after discharged from hospital are based on the status of patients’ adaptive immunity (exhaustive memory cells and/or depleted memory cells) and the origin of SARS-CoV-2 present in the patients’ samples (either already present in a low copy number or obtained by reexposure). The scarce evidence is unbale to conclude either this as reinfection or relapse cases (created with BioRender)
See this image and copyright information in PMC

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