key: cord-0955133-nb5tord9
authors: Sampson, Mindy M.; Reeves, Kimberly D.; Polk, Christopher M.; Hawkins, Gregory A.; Passaretti, Catherine L.
title: A case of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reinfection within ninety days of primary infection in a healthcare worker
date: 2022-02-22
journal: Infection control and hospital epidemiology
DOI: 10.1017/ice.2022.42
sha: fcc8343e64086c006352a8928642d245000d9fda
doc_id: 955133
cord_uid: nb5tord9

nan

To the Editor-Case definitions and prior literature typically describe reinfections with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in situations when someone becomes infected >90 days from their prior infection. 1 Healthcare workers (HCWs) may be particularly susceptible to reinfection. 2 With the emergence of the o (omicron) variant of SARS-CoV-2, an increased risk of reinfection has been described. 3 Here, we describe a case of reinfection that occurred only 2 weeks after the primary infection.

A 38-year-old female HCW developed a primary infection with SARS-CoV-2 in November 2021. She had no comorbidities or immunocompromising conditions. She was not vaccinated for SARS-CoV-2. Symptoms at that time consisted of fever, myalgias, headache, fatigue, congestion, and cough. A polymerase chain reaction (PCR) analysis of a nasopharyngeal (NP) swab sample collected 4 days after symptom presentation resulted in cycle threshold (Ct) values of 23.2 and 23.6, respectively, for the ORF1 and E genes on the Roche cobas platform (Roche Diagnostics, Basel, Switzerland). Subsequent analysis of the NP swab sample identified the δ (delta) variant (sublineage AY.3) as the causal pathogen.

The patient had complete resolution of symptoms. She received 1 dose of dexamethasone during her primary infection but otherwise received no treatment. Then, 7 weeks after her primary diagnosis, she developed fever, sore throat, fatigue, congestion, and cough. An NP swab sample was collected and tested 2 days after symptom onset, which was again positive for SARS-CoV This is a unique case demonstrating an early reinfection with SARS-CoV-2 occurring within 90 days of prior infection. Reinfection is likely to be more frequent with the o (omicron) lineage due to the escape of this variant from prior neutralizing SARS-CoV-2 antibodies. 4,5 Importantly, symptomatic individuals should be tested and evaluated for the possibility of reinfection, even within 90 days of their last infection. Understanding the dynamics of reinfections is particularly important as we update testing protocols and infection prevention policies during this surge of the omicron variant, and as we prepare for future emerging variants. This individual did have low Ct values, which would likely represent the presence of live virus; therefore, isolation would have been important to prevent continued spread. 6, 7 This finding also highlights the importance of vaccination in our healthcare workers, given we now know that individuals who have completed their vaccine series and have received a booster are less likely to become infected with the o (omicron) variant. 8 Cases like these also emphasize the importance of making genomic sequencing more widely available as we work to understand the virology and epidemiology of evolving variants.

COVID-19) 2021 case definition

Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers

Increased risk of SARS-CoV-2 reinfection associated with emergence of the omicron variant in South Africa

Considerable escape of SARS-CoV-2 omicron to antibody neutralization

Omicron escapes the majority of existing SARS-CoV-2 neutralizing antibodies

Predicting infectious SARS-CoV-2 from diagnostic samples

Correlation between 3790 qPCR positives samples and positive cell cultures including 1941 SARS-CoV-2 isolates

Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and delta variants

Acknowledgments. We thank the research teams at Atrium Health and Wake Forest who support our sequencing efforts. Conflicts of interest. All authors report no conflicts of interest relevant to this article.