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. 2022 Apr:117:146-154.
doi: 10.1016/j.ijid.2022.01.006. Epub 2022 Jan 10.

Evidence of SARS-CoV-2 symptomatic reinfection in four healthcare professionals from the same hospital despite the presence of antibodies

Saba Gargouri  1 , Amal Souissi  2 , Nabil Abid  3 , Amel Chtourou  1 , Lamia Feki-Berrajah  1 , Rim Karray  4 , Hana Kossentini  4 , Ikhlass Ben Ayed  2 , Fatma Abdelmoula  2 , Olfa Chakroun  4 , Abdennour Nasri  4 , Adnène Hammami  1 , Noureddine Rekik  4 , Saber Masmoudi  2 , Hela Karray-Hakim  1 , Ahmed Rebai  5
Affiliations

Evidence of SARS-CoV-2 symptomatic reinfection in four healthcare professionals from the same hospital despite the presence of antibodies

Saba Gargouri et al. Int J Infect Dis. 2022 Apr.

Abstract

Objectives: Since the onset of the COVID-19 pandemic, cases of reinfection with SARS-CoV-2 have been reported, raising additional public health concerns. SARS-CoV-2 reinfection was assessed in healthcare workers (HCWs) in Tunisia because they are at the greatest exposure to infection by different variants.

Methods: We conducted whole-genome sequencing of the viral RNA from clinical specimens collected during the initial infection and the suspected reinfection from 4 HCWs, who were working at the Habib Bourguiba University Hospital (Sfax, Tunisia) and retested positive for SARS-CoV-2 through reverse transcriptase-polymerase chain reaction (RT-PCR) after recovery from a first infection. A total of 8 viral RNAs from the patients' respiratory specimens were obtained, which allowed us to characterize the differences between viral genomes from initial infection and positive retest. The serology status for total Ig, IgG, and IgM against SARS-CoV-2 was also determined and followed after the first infection.

Results: We confirmed through whole-genome sequencing of the viral samples that all 4 cases experienced a reinfection event. The interval between the 2 infection events ranged between 45 and 141 days, and symptoms were milder in the second infection for 2 patients and more severe for the remaining 2 patients. Reinfection occurred in all 4 patients despite the presence of antibodies in 3 of them.

Conclusion: This study adds to the rapidly growing evidence of COVID-19 reinfection, where viral sequences were used to confirm infection by distinct isolates of SARS-CoV-2 in HCWs. These findings suggest that individuals who are exposed to different SARS-CoV-2 variants might not acquire sufficiently protective immunity through natural infection and emphasize the necessity of their vaccination and the regular follow-up of their immune status both in quantitative and qualitative terms.

Keywords: Coronavirus disease 2019; Healthcare professional; Reinfection; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest All authors declare no competing interest.

Figures

Figure 1
Figure 1
Timeline of symptom onset and molecular diagnosis of specimens.
Figure 2
Figure 2
Nextclade analysis of the 8 SARS-CoV-2 isolates from the 4 reinfection cases. Other genomes were retrieved from GISAID (https://www.gisaid.org, accessed on March 21, 2021). Clade information using the GISAID and Nextstrain nomenclatures is shown. The strains of the first infection and reinfection episode are shown in red and yellow circles, respectively. The S477N mutation in the S glycoprotein is indicated.
Figure 3
Figure 3
Clade distribution in the World. (A) Geographic distribution of SARS-CoV-2 clades (Nextclade, accessed on March 21, 2021); (B) Time evolution of clades; (C) Time evolution of S477 frequency.
Figure 4
Figure 4
Phylogenetic analysis of the 4 SARS-CoV-2 isolates from the reinfection episodes. Other 836 sequences undergoing the S477N mutation were retrieved from GISAID (https://www.gisaid.org, accessed on March 21, 2021). The strains of the reinfection are highlighted in red color.
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