key: cord-0951797-wt9a6ia1
authors: Natori, Yoichiro; Andrews, David; Guerra, Giselle
title: Rapid reinfection of severe acute respiratory syndrome coronavirus 2 confirmed with sequencing in a solid organ transplant recipient
date: 2022-05-06
journal: Transpl Infect Dis
DOI: 10.1111/tid.13840
sha: 9d60ae837f9f567e5ff0e25135d712f90e0ab9f3
doc_id: 951797
cord_uid: wt9a6ia1

nan

Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has afflicted millions throughout the world. Until now, we have experienced several surges from different variants of concern including delta and omicron 1 ; however, the impact of these variants on different susceptible groups remains unclear, especially with the latest variant, Omicron. The immune suppression that solid organ transplant (SOT) recipients receive places them at greater risk for morbidity and mortality in addition to limiting their ability to mount protection after being vaccinated. 2, 3 Although reports exist that SOT recipients can still develop higher T-cell mediated immunity after natural infection compared to vaccination, 4 this may not be enough to prevent re-infection. While re-infection has been reported in the general population, 5 we still have very limited data on re-infection in the immunocompromised population. 6 The Centers for Disease Control and prevention (CDC) defined re-infection as infections requiring 90 days duration between the first and second infections and ideally divergence in whole-genome sequencing (WGS) data. 7 In a clinical setting where WGS is not always feasible, it may be difficult to differentiate between re-infection and prolonged shedding as SOT recipients are known to have polymerase chain reaction or even culture positivity longer than the immunocompetent host. SOT recipients who at higher risk for progression should benefit from early initiation of treatment Genome sequencing did not take place with the first infection, thus not allowing us to define with certainty the COVID-19 variant. However, the first identified Omicron case in our region took place several weeks after the patient's first infection.

In conclusion, we report SARS-CoV-2 re-infection due to the Omicron variant 43 days post initial breakthrough infection after three doses of the BNT162b2 vaccine and treatment with a monoclonal antibody in a kidney transplant recipient. Casirivimab/imdevimab may not be able to prevent infection from the omicron variant. We should be aware of this phenomenon in order to initiate and optimize the management of our immunocompromised patients during a pandemic with numerous circulating variants.

Omicron variant: what you need to know

COVID-19 in solid organ transplant recipients: a systematic review and meta-analysis of current literature

Antibody response to 2-Dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients

Severe acute respiratory syndrome coronavirus 2 infection induces greater T-Cell responses compared to vaccination in solid organ transplant recipients

Risk for reinfection after SARS-CoV-2: a living, rapid review for American College of Physicians practice points on the role of the antibody response in conferring immunity following SARS-CoV-2 infection

SARS-CoV-2 reinfection in a liver transplant recipient

Coronavirus disease 2019 (COVID-19) 2021 case definition

Early remdesivir to prevent progression to severe COVID-19 in outpatients

Monoclonal antibody therapy for COVID-19 in solid organ transplant recipients

Incidence of positive SARS-CoV-2 PCR after COVID-19 vaccination with up to eight months of followup: real life data from the Capital Region of Denmark

Rapid reinfection of severe acute respiratory syndrome coronavirus 2 confirmed with sequencing in a solid organ transplant recipient

The authors thank to Ms. Yamina Carattini for the analysis. We also appreciate the interpretation of the data by Drs. Shweta Anjan,Stephen Morris, Jacques Simkins, Christine A. Vu, Lumen Mendez Castaner, and Lilian M. Abbo.

None.

The authors declare no conflict of interest.

Yoichiro Natori https://orcid.org/0000-0002-4938-125X Giselle Guerra https://orcid.org/0000-0002-4098-4652