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AuthorChemaitelly, Hiam
AuthorAyoub, Houssein H.
AuthorTang, Patrick
AuthorYassine, Hadi M.
AuthorAl Thani, Asmaa A.
AuthorHasan, Mohammad R.
AuthorCoyle, Peter
AuthorAl-Kanaani, Zaina
AuthorAl-Kuwari, Einas
AuthorJeremijenko, Andrew
AuthorKaleeckal, Anvar Hassan
AuthorLatif, Ali Nizar
AuthorShaik, Riyazuddin Mohammad
AuthorAbdul-Rahim, Hanan F.
AuthorNasrallah, Gheyath K.
AuthorAl-Kuwari, Mohamed Ghaith
AuthorButt, Adeel A.
AuthorAl-Romaihi, Hamad Eid
AuthorAl-Thani, Mohamed H.
AuthorAl-Khal, Abdullatif
AuthorBertollini, Roberto
AuthorAbu-Raddad, Laith J.
Available date2024-05-23T07:08:52Z
Publication Date2024-01-01
Publication NameFrontiers in Medicine
Identifierhttp://dx.doi.org/10.3389/fmed.2024.1363045
CitationChemaitelly H, Ayoub HH, Tang P, Yassine HM, Al Thani AA, Hasan MR, Coyle P, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R and Abu-Raddad LJ (2024) Addressing bias in the definition of SARS-CoV-2 reinfection: implications for underestimation. Front. Med. 11:1363045. doi: 10.3389/fmed.2024.1363045
URIhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85188427528&origin=inward
URIhttp://hdl.handle.net/10576/55334
AbstractIntroduction: Reinfections are increasingly becoming a feature in the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, accurately defining reinfection poses methodological challenges. Conventionally, reinfection is defined as a positive test occurring at least 90 days after a previous infection diagnosis. Yet, this extended time window may lead to an underestimation of reinfection occurrences. This study investigated the prospect of adopting an alternative, shorter time window for defining reinfection. Methods: A longitudinal study was conducted to assess the incidence of reinfections in the total population of Qatar, from February 28, 2020 to November 20, 2023. The assessment considered a range of time windows for defining reinfection, spanning from 1 day to 180 days. Subgroup analyses comparing first versus repeat reinfections and a sensitivity analysis, focusing exclusively on individuals who underwent frequent testing, were performed. Results: The relationship between the number of reinfections in the population and the duration of the time window used to define reinfection revealed two distinct dynamical domains. Within the initial 15 days post-infection diagnosis, almost all positive tests for SARS-CoV-2 were attributed to the original infection. However, surpassing the 30-day post-infection threshold, nearly all positive tests were attributed to reinfections. A 40-day time window emerged as a sufficiently conservative definition for reinfection. By setting the time window at 40 days, the estimated number of reinfections in the population increased from 84,565 to 88,384, compared to the 90-day time window. The maximum observed reinfections were 6 and 4 for the 40-day and 90-day time windows, respectively. The 40-day time window was appropriate for defining reinfection, irrespective of whether it was the first, second, third, or fourth occurrence. The sensitivity analysis, confined to high testers exclusively, replicated similar patterns and results. Discussion: A 40-day time window is optimal for defining reinfection, providing an informed alternative to the conventional 90-day time window. Reinfections are prevalent, with some individuals experiencing multiple instances since the onset of the pandemic.
SponsorThe author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The authors are grateful for institutional salary support from the Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, as well as for institutional salary support provided by the Ministry of Public Health, Hamad Medical Corporation, and Sidra Medicine. The authors are also grateful for the Qatar Genome Programme and Qatar University Biomedical Research Center for institutional support for the reagents needed for the viral genome sequencing. HA acknowledges the support of Qatar University Internal Grant ID QUCG-CAS-23/24–114. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the article. Statements made herein are solely the responsibility of the authors. AAB has received institutional grant funding from Gilead Sciences unrelated to the work presented in this paper.
Languageen
PublisherFrontiers Media
Subjectbias
COVID-19
epidemiology
immunity
reinfection
time window
TitleAddressing bias in the definition of SARS-CoV-2 reinfection: implications for underestimation
TypeArticle
Volume Number11
ESSN2296-858X
dc.accessType Open Access


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