Henry Ford Hospital, Division of Infectious Disease, 2799 West Grand BLVD, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E. Canfield Ave., Detroit, MI 48201, USA.
Henry Ford Hospital, Department of Internal Medicine, 2799 West Grand BLVD, Detroit, MI 48202, USA.
J Infect Public Health. 2023 Aug;16(8):1262-1268. doi: 10.1016/j.jiph.2023.06.003. Epub 2023 Jun 8.
Studies comparing SARS-CoV-2 reinfection outcomes among individuals with previous infection (natural immunity) and previous infection plus vaccination (hybrid immunity) are limited.
Retrospective cohort study comparing SARS-CoV-2 reinfection among patients with hybrid immunity (cases) and natural immunity (controls) from March 2020 to February 2022. Reinfection was defined as positive PCR> 90 days after initial laboratory-confirmed SARS-CoV-2 infection. Outcomes included time to reinfection, symptom severity, COVID-19-related hospitalization, critical COVID-19 illness (need for intensive care unit, invasive mechanical ventilation, or death), length of stay (LOS).
A total of 773 (42%) vaccinated and 1073 (58%) unvaccinated patients with reinfection were included. Most patients (62.7%) were asymptomatic. Median time to reinfection was longer with hybrid immunity (391 [311-440] vs 294 [229-406] days, p < 0.001). Cases were less likely to be symptomatic (34.1% vs 39.6%, p = 0.001) or develop critical COVID-19 (2.3% vs 4.3%, p = 0.023). However, there was no significant difference in rates of COVID-19-related hospitalization (2.6% vs 3.8%, p = 0.142) or LOS (5 [2-9] vs 5 [3-10] days, p = 0.446). Boosted patients had longer time to reinfection (439 [IQR 372-467] vs 324 [IQR 256-414] days, p < 0.001) and were less likely to be symptomatic (26.8% vs 38%, p = 0.002) compared to unboosted patients. Rates of hospitalization, progression to critical illness and LOS were not significantly different between the two groups.
Natural and hybrid immunity provided protection against SARS-CoV-2 reinfection and hospitalization. However, hybrid immunity conferred stronger protection against symptomatic disease and progression to critical illness and was associated with longer time to reinfection. The stronger protection conferred by hybrid immunity against severe outcomes due to COVID-19 should be emphasized with the public to further the vaccination effort, especially in high-risk individuals.
比较有既往感染（自然免疫）和既往感染加接种（混合免疫）的个体中 SARS-CoV-2 再感染结果的研究有限。
这是一项回顾性队列研究，比较了 2020 年 3 月至 2022 年 2 月期间具有混合免疫（病例）和自然免疫（对照）的 SARS-CoV-2 再感染患者。再感染定义为初次实验室确诊 SARS-CoV-2 感染后 90 天以上的阳性 PCR。结果包括再感染时间、症状严重程度、COVID-19 相关住院、重症 COVID-19 疾病（需要重症监护病房、有创机械通气或死亡）、住院时间（LOS）。
共纳入 773 例（42%）接种疫苗和 1073 例（58%）未接种疫苗的再感染患者。大多数患者（62.7%）无症状。混合免疫组的再感染中位时间更长（391 [311-440] 天 vs 294 [229-406] 天，p<0.001）。病例组症状出现的可能性较小（34.1% vs 39.6%，p=0.001）或发生重症 COVID-19 的可能性较小（2.3% vs 4.3%，p=0.023）。然而，COVID-19 相关住院率（2.6% vs 3.8%，p=0.142）或 LOS（5 [2-9] 天 vs 5 [3-10] 天，p=0.446）无显著差异。加强免疫组的再感染中位时间更长（439 [IQR 372-467] 天 vs 324 [IQR 256-414] 天，p<0.001），且症状出现的可能性更小（26.8% vs 38%，p=0.002）。与未加强免疫组相比，两组的住院、进展为重症和 LOS 率无显著差异。
自然免疫和混合免疫均可预防 SARS-CoV-2 再感染和住院。然而，混合免疫对有症状疾病和进展为重症的保护作用更强，并与再感染时间延长有关。混合免疫对 COVID-19 严重结局的保护作用更强，应向公众强调这一点，以进一步推动疫苗接种工作，尤其是在高危人群中。
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