Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom.
Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia.
J Glob Health. 2023 Nov 24;13:06051. doi: 10.7189/jogh.13.06051.
With the emergence of new variants and sub-lineages of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), reinfections can significantly impact herd immunity, vaccination policies, and decisions on other public health measures. We conducted a systematic review and meta-analysis to synthesise the global evidence on SARS-CoV-2 reinfections in the pre-Omicron era.
We searched five global databases (MEDLINE, Embase, CINAHL Plus, Global Health, WHO COVID-19) on 12 May 2022 and 28 July 2023 and three Chinese databases (CNKI, Wanfang, CQvip) on 16 October 2022 for articles reporting incidence and outcomes of SARS-CoV-2 reinfection before the period of Omicron (B.1.1.529) predominance. We assessed risk of bias using Joanna Briggs Institute critical appraisal tools and conducted meta-analyses with random effects models to estimate the proportion of SARS-CoV-2 reinfection among initially infected cases and hospitalisation and mortality proportions among reinfected ones.
We identified 7593 studies and extracted data from 64 included ones representing 21 countries. The proportion of SARS-CoV-2 reinfection was 1.16% (95% confidence interval (CI) = 1.01-1.33) based on 11 639 247 initially infected cases, with ≥45 days between the two infections. Healthcare providers (2.28%; 95% CI = 1.37-3.40) had a significantly higher risk of reinfection than the general population (1.00%; 95% CI = 0.81-1.20), while young adults aged 18 to 35 years (1.01%; 95% CI = 0.8-1.25) had a higher reinfection burden than other age groups (children <18 years old: 0.57%; 95% CI = 0.39-0.79, older adults aged 36-65 years old: 0.53%; 95% CI = 0.41-0.65, elderly >65 years old: 0.37%; 95% CI = 0.15-0.66). Among the reinfected cases, 8.12% (95% CI = 5.30-11.39) were hospitalised, 1.31% (95% CI = 0.29-2.83) were admitted to the intensive care unit, and 0.71% (95% CI = 0.02-2.01) died.
Our data suggest a relatively low risk of SARS-CoV-2 reinfection in the pre-Omicron era, but the risk of hospitalisation was relatively high among the reinfected cases. Considering the possibility of underdiagnosis, the reinfection burden may be underestimated.
PROSPERO: CRD42023449712.
随着严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的新变体和亚谱系的出现，再次感染会显著影响群体免疫、疫苗接种政策以及其他公共卫生措施的决策。我们进行了一项系统评价和荟萃分析，以综合 SARS-CoV-2 在奥密克戎时代之前的全球再感染证据。
我们于 2022 年 5 月 12 日和 2023 年 7 月 28 日在五个全球数据库（MEDLINE、Embase、CINAHL Plus、全球卫生、世界卫生组织 COVID-19）和 2022 年 10 月 16 日在中国的三个数据库（CNKI、万方、CQvip）中检索了在奥密克戎（B.1.1.529）流行之前报告 SARS-CoV-2 再感染发生率和结局的文章。我们使用乔安娜布里格斯研究所的批判性评估工具评估偏倚风险，并使用随机效应模型进行荟萃分析，以估计最初感染病例中 SARS-CoV-2 再感染的比例以及再感染病例中的住院和死亡率比例。
我们确定了 7593 项研究，并从代表 21 个国家的 64 项研究中提取了数据。根据 11639247 例首次感染病例，再感染的比例为 1.16%（95%置信区间[CI] = 1.01-1.33），两次感染之间至少间隔 45 天。与一般人群（1.00%；95%CI=0.81-1.20）相比，医疗保健提供者（2.28%；95%CI=1.37-3.40）再次感染的风险显著更高，而 18 至 35 岁的年轻成年人（1.01%；95%CI=0.8-1.25）比其他年龄组再次感染的负担更高（儿童<18 岁：0.57%；95%CI=0.39-0.79，36-65 岁成年人：0.53%；95%CI=0.41-0.65，65 岁以上老年人：0.37%；95%CI=0.15-0.66）。在再次感染的病例中，8.12%（95%CI=5.30-11.39）住院，1.31%（95%CI=0.29-2.83）住进重症监护病房，0.71%（95%CI=0.02-2.01）死亡。
我们的数据表明，在奥密克戎时代之前，SARS-CoV-2 再次感染的风险相对较低，但再次感染病例的住院风险相对较高。考虑到可能存在漏诊，再感染负担可能被低估。
PROSPERO：CRD42023449712。
