Risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time from prior infection: a cohort study, Reggio Emilia province, Italy, February 2020 to February 2022

BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the...

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Published in:	Euro surveillance : bulletin européen sur les maladies transmissibles Vol. 28; no. 13
Main Authors:	Vicentini, Massimo, Venturelli, Francesco, Mancuso, Pamela, Bisaccia, Eufemia, Zerbini, Alessandro, Massari, Marco, Cossarizza, Andrea, De Biasi, Sara, Pezzotti, Patrizio, Bedeschi, Emanuela, Giorgi Rossi, Paolo
Format:	Journal Article
Language:	English
Published:	Sweden Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS) 30.03.2023 European Centre for Disease Prevention and Control (ECDC)
Subjects:	Antibodies Cohort analysis Cohort Studies COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 vaccines Humans Immunization Italy - epidemiology Reinfection - epidemiology Reinfection - prevention & control Risk factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Surveillance Vaccination Italy Reggio Emilia Italy Omicron Reinfection Epidemiology Immunity Sars-CoV-2
ISSN:	1560-7917, 1025-496X, 1560-7917
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Abstract	BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities.ResultsThe cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87-90), prior infection reduced risk by 90% (95% CI: 88-91), while two doses and infection reduced risk by 98% (95% CI: 96-99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52-55), 9% (95% CI: 4-14) and 76% (95% CI: 74-77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65-76) at 5 months to 21% (95% CI: 10-30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10-57) lower risk of severe disease than first infections.ConclusionsNatural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease.
AbstractList	Background Understanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period. Aim To evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection. Methods We conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities. Results The cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87–90), prior infection reduced risk by 90% (95% CI: 88–91), while two doses and infection reduced risk by 98% (95% CI: 96–99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52–55), 9% (95% CI: 4–14) and 76% (95% CI: 74–77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65–76) at 5 months to 21% (95% CI: 10–30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10–57) lower risk of severe disease than first infections. Conclusions Natural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease. BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities.ResultsThe cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87-90), prior infection reduced risk by 90% (95% CI: 88-91), while two doses and infection reduced risk by 98% (95% CI: 96-99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52-55), 9% (95% CI: 4-14) and 76% (95% CI: 74-77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65-76) at 5 months to 21% (95% CI: 10-30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10-57) lower risk of severe disease than first infections.ConclusionsNatural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease. BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities.ResultsThe cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87-90), prior infection reduced risk by 90% (95% CI: 88-91), while two doses and infection reduced risk by 98% (95% CI: 96-99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52-55), 9% (95% CI: 4-14) and 76% (95% CI: 74-77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65-76) at 5 months to 21% (95% CI: 10-30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10-57) lower risk of severe disease than first infections.ConclusionsNatural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease.BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time after first infection.MethodsWe conducted a cohort study including all residents in the Reggio Emilia province on 31 December 2019, followed up until 28 February 2022 for SARS-CoV-2 first infection and reinfection after 90 days. Cox models were used to compare risk of first infection vs reinfection, adjusting for age, sex, vaccine doses and comorbidities.ResultsThe cohort included 538,516 residents, 121,154 with first SARS-CoV-2 infections and 3,739 reinfections, most in the Omicron BA.1 period. In the pre-Omicron period, three doses of vaccine reduced risk of reinfection by 89% (95% CI: 87-90), prior infection reduced risk by 90% (95% CI: 88-91), while two doses and infection reduced risk by 98% (95% CI: 96-99). In the Omicron BA.1 period, protection estimates were 53% (95% CI: 52-55), 9% (95% CI: 4-14) and 76% (95% CI: 74-77). Before Omicron, protection from reinfection remained above 80% for up to 15 months; with Omicron BA.1, protection decreased from 71% (95% CI: 65-76) at 5 months to 21% (95% CI: 10-30) at 22 months from the first infection. Omicron BA.1 reinfections showed 48% (95% CI: 10-57) lower risk of severe disease than first infections.ConclusionsNatural immunity acquired with previous variants showed low protection against Omicron BA.1. Combined vaccination and natural immunity seems to be more protective against reinfection than either alone. Vaccination of people with prior infection reduced the risk of severe disease.
Author	Zerbini, Alessandro Bedeschi, Emanuela Bisaccia, Eufemia Vicentini, Massimo Massari, Marco Giorgi Rossi, Paolo Mancuso, Pamela Cossarizza, Andrea De Biasi, Sara Venturelli, Francesco Pezzotti, Patrizio
AuthorAffiliation	The working group members are listed under Collaborators
AuthorAffiliation_xml	– name: The working group members are listed under Collaborators
Author_xml	– sequence: 1 givenname: Massimo surname: Vicentini fullname: Vicentini, Massimo organization: Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy – sequence: 2 givenname: Francesco surname: Venturelli fullname: Venturelli, Francesco organization: Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy – sequence: 3 givenname: Pamela surname: Mancuso fullname: Mancuso, Pamela organization: Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy – sequence: 4 givenname: Eufemia surname: Bisaccia fullname: Bisaccia, Eufemia organization: Public Health Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy – sequence: 5 givenname: Alessandro surname: Zerbini fullname: Zerbini, Alessandro organization: Unit of Clinical Immunology, Allergy and Advanced Biotechnologies, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy – sequence: 6 givenname: Marco surname: Massari fullname: Massari, Marco organization: Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy – sequence: 7 givenname: Andrea surname: Cossarizza fullname: Cossarizza, Andrea organization: National Institute for Cardiovascular Research, Bologna, Italy, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy – sequence: 8 givenname: Sara surname: De Biasi fullname: De Biasi, Sara organization: Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia School of Medicine, Modena, Italy – sequence: 9 givenname: Patrizio surname: Pezzotti fullname: Pezzotti, Patrizio organization: Dipartimento Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy – sequence: 10 givenname: Emanuela surname: Bedeschi fullname: Bedeschi, Emanuela organization: Public Health Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy – sequence: 11 givenname: Paolo surname: Giorgi Rossi fullname: Giorgi Rossi, Paolo organization: Epidemiology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
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Copyright	Copyright Centre Europeen pour la Surveillance Epidemiologique du SIDA (European Centre for the Epidemiological Monitoring of AIDS) Mar 30, 2023 This article is copyright of the authors or their affiliated institutions, 2023. 2023 The authors or their affiliated institutions
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Snippet	BackgroundUnderstanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period.AimTo evaluate the risk of SARS-CoV-2 reinfection... Background Understanding the epidemiology of reinfections is crucial for SARS-CoV-2 control over a long period. Aim To evaluate the risk of SARS-CoV-2...
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SubjectTerms	Antibodies Cohort analysis Cohort Studies COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 vaccines Humans Immunization Italy - epidemiology Reinfection - epidemiology Reinfection - prevention & control Risk factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Surveillance Vaccination
Title	Risk of SARS-CoV-2 reinfection by vaccination status, predominant variant and time from prior infection: a cohort study, Reggio Emilia province, Italy, February 2020 to February 2022
URI	https://www.ncbi.nlm.nih.gov/pubmed/36995374 https://www.proquest.com/docview/2799790233 https://www.proquest.com/docview/2792903509 https://pubmed.ncbi.nlm.nih.gov/PMC10064646
Volume	28
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