Shastri Jayanthi, Parikh Swapneil, Aggarwal Veena, Agrawal Sachee, Chatterjee Nirjhar, Shah Rajit, Devi Priti, Mehta Priyanka, Pandey Rajesh
Kasturba Hospital for Infectious Disease, Mumbai, India.
IJCP Group & Heart Care Foundation of India, New Delhi, India.
Front Med (Lausanne). 2021 Aug 20;8:737007. doi: 10.3389/fmed.2021.737007. eCollection 2021.
Post infection immunity and post vaccination immunity both confer protection against COVID-19. However, there have been many whole genome sequencing proven reinfections and breakthrough infections. Both are most often mild and caused by Variants of Concern (VOC). The patient in our study underwent serial COVID-19 RT-PCR, blood tests for serology, acute phase reactants, and chest imaging as part of clinical care. We interviewed the patient for clinical history and retrieved reports and case papers. We retrieved stored RT-PCR positive samples for whole genome sequencing (WGS) of SARS-CoV-2 from the patient's breakthrough infections and the presumed index case. The patient had three RT-PCR confirmed SARS-CoV-2 infections. Two breakthrough infections occurred in quick succession with the first over 3 weeks after complete vaccination with COVISHIELD and despite post-vaccination seroconversion. The first breakthrough infection was due to the Alpha variant and the second due to the Delta variant. The Delta variant infection resulted in hypoxia, hospitalization, and illness lasting seven weeks. Serial serology, acute phase reactants, and chest imaging supported WGS in establishing distinct episodes of infection. WGS established a fully vaccinated family member as the index case. The patient had an Alpha variant breakthrough infection despite past infection, complete vaccination, and seroconversion. Despite boosting after this infection, the patient subsequently had a severe Delta variant breakthrough infection. This was also a WGS proven reinfection and, therefore, a case of breakthrough reinfection. The patient acquired the infection from a fully vaccinated family member.
感染后免疫和疫苗接种后免疫均可提供针对新冠病毒的保护。然而，已有许多经全基因组测序证实的再次感染和突破性感染病例。这两种情况大多症状较轻，由变异株（VOC）引起。作为临床护理的一部分，我们研究中的患者接受了一系列新冠病毒逆转录聚合酶链反应（RT-PCR）检测、血清学血液检测、急性期反应物检测以及胸部成像检查。我们询问了患者的临床病史，并查阅了报告和病例文件。我们从患者的突破性感染病例和推测的索引病例中获取了储存的RT-PCR阳性样本，用于新冠病毒的全基因组测序（WGS）。该患者有三次经RT-PCR确认的新冠病毒感染。两次突破性感染相继迅速发生，第一次发生在接种COVISHIELD疫苗完全接种超过3周后，尽管接种疫苗后发生了血清转化。第一次突破性感染是由阿尔法变异株引起的，第二次是由德尔塔变异株引起的。德尔塔变异株感染导致缺氧、住院，病程持续了七周。系列血清学、急性期反应物检测和胸部成像检查为全基因组测序确定不同的感染发作提供了支持。全基因组测序确定一名完全接种疫苗的家庭成员为索引病例。尽管该患者既往有感染史、已完全接种疫苗且发生了血清转化，但仍出现了阿尔法变异株突破性感染。在这次感染后进行加强免疫后，该患者随后又出现了严重的德尔塔变异株突破性感染。这也是一例经全基因组测序证实的再次感染，因此是一例突破性再感染病例。该患者是从一名完全接种疫苗的家庭成员那里感染的。
