Risk of Reinfection After Seroconversion to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Population-based Propensity-score Matched Cohort Study

  1. Antonio Leidi
  2. Flora Koegler
  3. Roxane Dumont
  4. Richard Dubos
  5. María-Eugenia Zaballa
  6. Giovanni Piumatti
  7. Matteo Coen
  8. Amandine Berner
  9. Pauline Darbellay Farhoumand
  10. Pauline Vetter
  11. Nicolas Vuilleumier
  12. Laurent Kaiser
  13. Delphine Courvoisier
  14. Andrew S Azman
  15. Idris Guessous
  16. Silvia Stringhini
  17. SEROCoV-POP study group
  18. Sabine Yerly Ferrillo
  19. Manuel Schibler
  20. Aglaé Tardin
  21. Camille Genecand
  22. Silvia Stringhini
  23. Idris Guessous
  24. Andrew S Azman
  25. Hélène Baysson
  26. Prune Collombet
  27. David De Ridder
  28. Paola d’Ippolito
  29. Matilde D’asaro-Aglieri Rinella
  30. Yaron Dibner
  31. Nacira El Merjani
  32. Natalie Francioli
  33. Marion Frangville
  34. Kailing Marcus
  35. Chantal Martinez
  36. Natacha Noel
  37. Francesco Pennacchio
  38. Javier Perez-Saez
  39. Dusan Petrovic
  40. Attilio Picazio
  41. Alborz Pishkenari
  42. Giovanni Piumatti
  43. Jane Portier
  44. Caroline Pugin
  45. Barinjaka Rakotomiaramanana
  46. Aude Richard
  47. Lilas Salzmann-Bellard
  48. Stephanie Schrempft
  49. Maria-Eugenia Zaballa
  50. Zoé Waldmann
  51. Ania Wisniak
  52. Alioucha Davidovic
  53. Joséphine Duc
  54. Julie Guérin
  55. Fanny Lombard
  56. Manon Will
  57. Antoine Flahault
  58. Isabelle Arm Vernez
  59. Olivia Keiser
  60. Loan Mattera
  61. Magdalena Schellongova
  62. Laurent Kaiser
  63. Isabella Eckerle
  64. Pierre Lescuyer
  65. Benjamin Meyer
  66. Géraldine Poulain
  67. Nicolas Vuilleumier
  68. Sabine Yerly
  69. François Chappuis
  70. Sylvie Welker
  71. Delphine Courvoisier
  72. Laurent Gétaz
  73. Mayssam Nehme
  74. Febronio Pardo
  75. Guillemette Violot
  76. Samia Hurst
  77. Philippe Matute
  78. Jean-Michel Maugey
  79. Didier Pittet
  80. Arnaud G L’Huillier
  81. Klara M Posfay-Barbe
  82. Jean-François Pradeau
  83. Michel Tacchino
  84. Didier Trono

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Abstract

Background

Serological assays detecting anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies are being widely deployed in studies and clinical practice. However, the duration and effectiveness of the protection conferred by the immune response remains to be assessed in population-based samples. To estimate the incidence of newly acquired SARS-CoV-2 infections in seropositive individuals as compared to seronegative controls, we conducted a retrospective longitudinal matched study.

Methods

A seroprevalence survey including a representative sample of the population was conducted in Geneva, Switzerland, between April and June 2020, immediately after the first pandemic wave. Seropositive participants were matched one-to-two to seronegative controls, using a propensity-score including age, gender, immunodeficiency, body mass index (BMI), smoking status, and education level. Each individual was linked to a state-registry of SARS-CoV-2 infections. Our primary outcome was confirmed infections occurring from serological status assessment to the end of the second pandemic wave (January 2021).

Results

Among 8344 serosurvey participants, 498 seropositive individuals were selected and matched with 996 seronegative controls. After a mean follow-up of 35.6 (standard deviation [SD] 3.2) weeks, 7 out of 498 (1.4%) seropositive subjects had a positive SARS-CoV-2 test, of whom 5 (1.0%) were classified as reinfections. In contrast, the infection rate was higher in seronegative individuals (15.5%, 154/996) during a similar follow-up period (mean 34.7 [SD 3.2] weeks), corresponding to a 94% (95% confidence interval [CI]: 86%– 98%, P < .001) reduction in the hazard of having a positive SARS-CoV-2 test for seropositives.

Conclusions

Seroconversion after SARS-CoV-2 infection confers protection against reinfection lasting at least 8 months. These findings could help global health authorities establishing priority for vaccine allocation.

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  1. Version published to 10.1093/cid/ciab495
  2. ScreenIT

    SciScore for 10.1101/2021.03.19.21253889: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Laboratory analysis: Seropositivity was defined in our primary analysis by the detection of anti-S1 domain of spike protein IgG antibodies using a two-step sequential strategy.
    anti-S1 domain of spike protein IgG
    suggested: None
    Software and Algorithms
    SentencesResources
    Two tests were available: Panbio Covid-19 Ag Rapid Test device (Abbott Diagnostics, Jena, Germany) and Standard Q (SD Biosensor/Roche, Switzerland).
    Abbott
    suggested: (Abbott, RRID:SCR_010477)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The same limitations characterized a subsequent analysis of seroconverted individuals within the Qatar population (only available in preprint form)16 limiting generalisation of conclusion to the general population. As the risk of infection is closely tied to intensity of exposure, our study allows to overcome these limitations by sampling a representative sample of the population with a follow-up covering into a high incidence phase having occurred several months after serological assessment. In a retrospective analysis of a de-identified data from commercial laboratories including over 3 million US individuals, seropositive individuals were less likely of being tested positive to SARS-CoV-2, starting from 30 days after serological testing17, although follow-up was limited (median of <2 months) and results were unadjusted for confounders. Promising preliminary results have been reported for vaccines using lipid nanoparticle-mRNA technology with protection rate above 90% after two injections after a median follow-up of 2 months30,31. In the present study, at least a similar rate of protection was conferred by seroconversion and lasted for a mean period of over 8 months. This study has some limitations. First, not all individuals included in SEROCoV-POP were randomly selected from the community, because original participants were invited to come with their household members. However, characteristics of participants were previously compared with participants of community-surveys...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.19.21253889 on medRxiv