Hümeyra ASLANER, Hacı Ahmet ASLANER, Yasemin SAVRANLAR, Ali Ramazan BENLİ

COVID-19 Nüks, Reenfeksiyon Sıklığı ve Vakaların Klinik Özellikleri

Amaç: SARS-CoV-2 ile enfekte kişilerin virüse karşı bağışıklık yanıtının nasıl geliştiği ve ne kadar süreyle etkili olduğu pandemi döneminde en önemli sorulardan biridir. Bu çalışmada nüks ve yeniden enfeksiyon sıklığını, etkileyen faktörleri, vakaların klinik durumlarını ve semptomlarını değerlendirmeyi ve sonraki enfeksiyon şiddetini incelemeyi amaçladık.Araçlar ve Yöntem: TC Sağlık Bakanlığı Halk Sağlığı Yönetim Sistemi (PHMS) kayıtlarının kullanıldığı tanımlayıcı ve kesitsel tipte bir çalışmadır. Klinik düzelme ile birlikte RT-PCR test sonuçları negatif çıkan ve ilk enfeksiyondan en az 45 gün sonra tekrar RT-PCR test sonucu pozitifleşen vakalar bu çalışmaya dahil edildi. CDC tarafından önerilen şekilde vakalar iki gruba ayrıldı: İlk enfeksiyondan 45-89 gün sonra pozitif olanlar nüks grubu ve 90 gün sonra pozitif olanlar yeniden enfeksiyon grubu olarak belirlendi. Demografik özellikler, sağlık çalışanı olup olmama, eşlik eden kronik hastalık ve tekrar pozitiflik dönemleri değerlendirildi.Bulgular: Toplam vaka sayısı 103.096 idi. 45 gün sonra tekrar pozitifliği saptanan vaka sayısı 78 oldu. Çalışmada nüks grubundaki (45-89 gün) vaka sayısı 49, reenfeksiyon grubundaki (90 gün üzeri) vaka sayısı 29 ise olarak belirlendi.Sonuç: İkinci enfeksiyonda çok düşük reenfeksiyon oranı ve daha hafif semptomlar aşı çalışmaları için umut vericidir. COVID-19'un yeniden bulaşmasını anlamak, önümüzdeki aylarda hükümet ve halk sağlığı kararlarına rehberlik etmenin anahtarı olabilir.

Anahtar Kelimeler:

epidemiyoloji, SARS-CoV-2, pandemi

COVID-19 Relapse and Reinfection Frequency, Clinical Features of Cases

Purpose: How the immune response of people infected with SARS-CoV-2 develops against the virus and how long its effectiveness is one of the most important questions during the pandemic period. We aimed to examine the frequency of relapse and re-infection, examine the influencing factors, evaluate the cases' clinical conditions and symptoms, and examine the severity of subsequent infection.Materials and Methods: This is a descriptive and cross-sectional type study using the Public Health Management System (PHMS) records of the Turkish Ministry of Health. Clinical improvement and negative RT-PCR test results, and positive RT-PCR test results at least 45 days after the first infection were included in this study. The cases were divided into two groups: the relapse group, those positive for 45-89 days after the first infection, and the reinfection group after 90 days recommended by the CDC. Demographic characteristics, whether or not to be a health worker, accompanying chronic illness, and re-positivity periods were evaluated.Results: The total number of cases was 103.096. The number of cases with repeat positivity detected after 45 days was 78. In the study, the number of cases in the relapse group (45-89 days) was 49, while the number of cases in the reinfection group (over 90 days) was 29.Conclusions: The very low rate of reinfection and milder symptoms in the second infection are promising for vaccination studies. Understanding the COVID-19 reinfection could be the key to guiding government and public health decisions in the coming months.

Keywords:

epidemiology, pandemic, SARS-CoV-2,

PDF

___

1. Siracusano G, Pastori C, Lopalco L. Humoral Immune Responses in COVID-19 Patients: A Window on the State of the Art. Front Immunol. 2020;11:1049.
2. García LF. Immune Response, Inflammation, and the Clinical Spectrum of COVID-19. Front Immunol. 2020;11:1441.
3. Li G, Fan Y, Lai Y, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-432.
4. Mo H, Zeng G, Ren X, et al. Longitudinal profile of antibodies against SARS-coronavirus in SARS patients and their clinical significance. Respirology. 2006;11(1):49-53.
5. Payne DC, Iblan I, Rha B, et al. Persistence of antibodies against middle east respiratory syndrome coronavirus. Emerg Infect Dis. 2016;22(10):1824-1826.
6. Gousseff M, Penot P, Gallay L, et al. Clinical recurrences of COVID-19 symptoms after recovery: Viral relapse, reinfection or inflammatory rebound? J Infect. 2020;81(5):816-846.
7. Investigative criteria for suspected cases of SARS‐CoV‐2 reinfection (ICR).2020. https://www.cdc.gov/ coronavirus/2019-ncov/php/invest-criteria.html Access date April 15, 2021.
8. Jones NK, Rivett L, Sparkes D, Forrest S, et. al. Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19. eLife. 2020;9:e59391.
9. Tillett RL, Sevinsky JR, Hartley PD, et al. Genomic evidence for reinfection with SARS-CoV-2: a case study. Lancet Infect Dis. 2021;21(1):52-58.
10. Garcia-Beltran WF, Lam EC, Astudillo MG, et al. COVID-19-neutralizing antibodies predict disease severity and survival. Cell. 2021;184(2):476-488.
11. Bentivegna E, Sentimentale A, Luciani M, Speranza ML, Guerritore L, Martelletti P. New IgM seroconversion and positive RT-PCR test after exposure to the virus in recovered COVID-19 patient. J Med Virol. 2021;93(1):97-98.
12. Sheehan MM, Reddy AJ, Rothberg MB. Reinfection Rates among Patients who Previously Tested Positive for COVID-19: a Retrospective Cohort Study. Clin. Infect. Dis. 2021;73(10):1882-1886.
13. Pilz S, Chakeri A, Ioannidis JPA, et al. SARS-CoV-2 re-infection risk in Austria. Eur J Clin Invest. 2021;51(4):1-7.
14. Salehi M, SeyedAlinaghi S, Alavi Darazam I, et al. COVID-19 Reinfection or Relapse? A Retrospective Multicenter Cohort Study from Iran. Arch Clin Infect Dis. 2021;16(5):e116381.
15. Ye G, Pan Z, Pan Y, et al. Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation. J Infect. 2020;80(5):14-17.
16. Liu H, Chen S, Liu M, Nie H, Lu H. Comorbid chronic diseases are strongly correlated with disease severity among COVID-19 patients: A systematic review and meta-analysis. Aging Dis. 2020;11(3):668-678.
17. Adrielle dos Santos L, Filho PG de G, Silva AMF, et al. Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers. J Infect. 2021;82(3):399-406.
18. Alkundi A, Mahmoud I, Musa A, Naveed S, Alshawwaf M. Clinical characteristics and outcomes of COVID-19 hospitalized patients with diabetes in the United Kingdom: A retrospective single centre study. Diabetes Res Clin Pract. 2020;165:108263.
19. Bruni M, Cecatiello V, Diaz-Basabe A, et al. Persistence of anti-SARS-CoV-2 antibodies in nonhospitalized COVID-19 convalescent health care workers. J. Clin. Med. 2020;9(10):3188.
20. Lumley SF, O’Donnell D, Stoesser NE, et al. Antibody Status and Incidence of SARS-CoV-2 Infection in Health Care Workers. N Engl J Med. 2021;384(6): 533-540.
21. Lechien JR, Chiesa-Estomba CM, Radulesco T, et al. Clinical features of patients who had two COVID-19 episodes: a European multicentre case series. J Intern Med. 2021;290(2):421-429.
22. Dan JM, Mateus J, Kato Y, et al. Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science. 2021;371(6529):4063.
23. UK Biobank. UK Biobank SARS-CoV-2 serology study.https://www.ukbiobank.ac.uk/media/x0nd5sul/ukb_serologystudy_report_revised_6months_jan21.pdf. Access date April 23, 2021.
24. Udwadia ZF, Singh P, Barkate H, et al. Efficacy and safety of favipiravir, an oral RNA-dependent RNA polymerase inhibitor, in mild-to-moderate COVID-19: A randomized, comparative, open-label, multicenter, phase 3 clinical trial. Int J Infect Dis. 2021;103:62-71.
25. Ip A, Ahn J, Zhou Y, et al. Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: A multi-center observational study. medRxiv. BMC Infect. Dis. 2021;21(1):1-12.