TY - JOUR
T1 - Acute and postacute sequelae associated with SARS-CoV-2 reinfection
AU - Bowe, Benjamin
AU - Xie, Yan
AU - Al-Aly, Ziyad
N1 - Funding Information:
This study used data from the VA COVID-19 Shared Data Resource. This research was funded by the US Department of Veterans Affairs (Z.A.-A.) and two American Society of Nephrology and KidneyCure fellowship awards (B.B. and Y.X.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
Funding Information:
This study used data from the VA COVID-19 Shared Data Resource. This research was funded by the US Department of Veterans Affairs (Z.A.-A.) and two American Society of Nephrology and KidneyCure fellowship awards (B.B. and Y.X.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The contents do not represent the views of the US Department of Veterans Affairs or the US Government.
Publisher Copyright:
© 2022, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2022/11
Y1 - 2022/11
N2 - First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risk of acute and postacute death and sequelae in various organ systems. Whether reinfection adds to risks incurred after first infection is unclear. Here we used the US Department of Veterans Affairs’ national healthcare database to build a cohort of individuals with one SARS-CoV-2 infection (n = 443,588), reinfection (two or more infections, n = 40,947) and a noninfected control (n = 5,334,729). We used inverse probability-weighted survival models to estimate risks and 6-month burdens of death, hospitalization and incident sequelae. Compared to no reinfection, reinfection contributed additional risks of death (hazard ratio (HR) = 2.17, 95% confidence intervals (CI) 1.93–2.45), hospitalization (HR = 3.32, 95% CI 3.13–3.51) and sequelae including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders. The risks were evident regardless of vaccination status. The risks were most pronounced in the acute phase but persisted in the postacute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections. Limitations included a cohort of mostly white males. The evidence shows that reinfection further increases risks of death, hospitalization and sequelae in multiple organ systems in the acute and postacute phase. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
AB - First infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risk of acute and postacute death and sequelae in various organ systems. Whether reinfection adds to risks incurred after first infection is unclear. Here we used the US Department of Veterans Affairs’ national healthcare database to build a cohort of individuals with one SARS-CoV-2 infection (n = 443,588), reinfection (two or more infections, n = 40,947) and a noninfected control (n = 5,334,729). We used inverse probability-weighted survival models to estimate risks and 6-month burdens of death, hospitalization and incident sequelae. Compared to no reinfection, reinfection contributed additional risks of death (hazard ratio (HR) = 2.17, 95% confidence intervals (CI) 1.93–2.45), hospitalization (HR = 3.32, 95% CI 3.13–3.51) and sequelae including pulmonary, cardiovascular, hematological, diabetes, gastrointestinal, kidney, mental health, musculoskeletal and neurological disorders. The risks were evident regardless of vaccination status. The risks were most pronounced in the acute phase but persisted in the postacute phase at 6 months. Compared to noninfected controls, cumulative risks and burdens of repeat infection increased according to the number of infections. Limitations included a cohort of mostly white males. The evidence shows that reinfection further increases risks of death, hospitalization and sequelae in multiple organ systems in the acute and postacute phase. Reducing overall burden of death and disease due to SARS-CoV-2 will require strategies for reinfection prevention.
UR - http://www.scopus.com/inward/record.url?scp=85141735869&partnerID=8YFLogxK
U2 - 10.1038/s41591-022-02051-3
DO - 10.1038/s41591-022-02051-3
M3 - Article
C2 - 36357676
AN - SCOPUS:85141735869
SN - 1078-8956
VL - 28
SP - 2398
EP - 2405
JO - Nature Medicine
JF - Nature Medicine
IS - 11
ER -