Estimating protection afforded by prior infection in preventing reinfection: Applying the test-negative study design.
Date
2023-12-07Author
Ayoub, Houssein HTomy, Milan
Chemaitelly, Hiam
Altarawneh, Heba N
Coyle, Peter
Tang, Patrick
Hasan, Mohammad R
Al Kanaani, Zaina
Al Kuwari, Einas
Butt, Adeel A
Jeremijenko, Andrew
Kaleeckal, Anvar Hassan
Latif, Ali Nizar
Shaik, Riyazuddin Mohammad
Nasrallah, Gheyath K
Benslimane, Fatiha M
Al Khatib, Hebah A
Yassine, Hadi M
Al Kuwari, Mohamed G
Al Romaihi, Hamad Eid
Abdul-Rahim, Hanan F
Al-Thani, Mohamed H
Al Khal, Abdullatif
Bertollini, Roberto
Abu-Raddad, Laith J
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The COVID-19 pandemic has highlighted the need to use infection testing databases to rapidly estimate effectiveness of prior infection in preventing reinfection ($P{E}_S$) by novel SARS-CoV-2 variants. Mathematical modeling was used to demonstrate a theoretical foundation for applicability of the test-negative, case-control study design to derive $P{E}_S$. Apart from the very early phase of an epidemic, the difference between the test-negative estimate for $P{E}_S$ and true value of $P{E}_S$ was minimal and became negligible as the epidemic progressed. The test-negative design provided robust estimation of $P{E}_S$ and its waning. Assuming that only 25% of prior infections are documented, misclassification of prior infection status underestimated $P{E}_S$, but the underestimate was considerable only when >50% of the population was ever infected. Misclassification of latent infection, misclassification of current active infection, and scale-up of vaccination all resulted in negligible bias in estimated $P{E}_S$. The test-negative design was applied to national-level testing data in Qatar to estimate $P{E}_S$ for SARS-CoV-2. $P{E}_S$ against SARS-CoV-2 Alpha and Beta variants was estimated at 97.0% (95% CI: 93.6-98.6) and 85.5% (95% CI: 82.4-88.1), respectively. These estimates were validated using a cohort study design. The test-negative design offers a feasible, robust method to estimate protection from prior infection in preventing reinfection.
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