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Meta-Analysis
. 2023 Apr 14;15(4):967.
doi: 10.3390/v15040967.

SARS-CoV-2 Reinfection and Severity of the Disease: A Systematic Review and Meta-Analysis

Nhu Ngoc Nguyen  1   2 , Y Ngoc Nguyen  3 , Van Thuan Hoang  4 , Matthieu Million  2   5 , Philippe Gautret  1   2
Affiliations
Meta-Analysis

SARS-CoV-2 Reinfection and Severity of the Disease: A Systematic Review and Meta-Analysis

Nhu Ngoc Nguyen et al. Viruses. .

Abstract

Since the discovery of SARS-CoV-2, changes in genotype and reinfection with different variants have been observed in COVID-19-recovered patients, raising questions around the clinical pattern and severity of primary infection and reinfection. In this systematic review, we summarize the results of 23 studies addressing SARS-CoV-2 reinfections. A total of 23,231 reinfected patients were included, with pooled estimated reinfection rates ranging from 0.1 to 6.8%. Reinfections were more prevalent during the Omicron variant period. The mean age of reinfected patients was 38.0 ± 6. years and females were predominant among reinfected patients (M/F = 0.8). The most common symptoms during the first and second infection were fever (41.1%), cough (35.7% and 44.6%), myalgia (34.5% and 33.3%), fatigue (23.8% and 25.6%), and headaches (24.4% and 21.4%). No significant differences of clinical pattern were observed between primary infection and reinfection. No significant differences in the severity of infection were observed between primary infection and reinfection. Being female, being a patient with comorbidities, lacking anti-nucleocapsid IgG after the first infection, being infected during the Delta and Omicron wave, and being unvaccinated were associated with a higher risk of reinfection. Conflicting age-related findings were found in two studies. Reinfection with SARS-CoV-2 suggests that natural immunity is not long-lasting in COVID-19 patients.

Keywords: COVID-19; SARS-CoV-2; coronavirus; reinfection; second infection; variant.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of selected studies.
Figure 2
Figure 2
Percentage of patients with clinical symptoms at first and second infection.
Figure 3
Figure 3
Forest plot of hospitalisations during the first and second infection.
Figure 4
Figure 4
Forest plot of critical/severe disease during the first and second infection.
See this image and copyright information in PMC

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Supplementary concepts