The team of the intensive medicine and intensive care unit of the Louis-Mourier AP-HP hospital, headed by Prof. Jean-Damien Ricard, of the University of Paris and Inserm reports the first serious case of a reinfected patient by the South African 501Y.V2 variant of SARS-CoV-2, a few months after a first infection with SARS-CoV-2. This first case of reinfection by the South African variant was the subject of a publication on February 10, 2021 in the journal Clinical Infectious Diseases.
Acquiring collective immunity today seems the only possible way out of the Covid-19 epidemic. However, doubts persist about the duration and robustness of immunity against this coronavirus. Cases of reinfection by the virus after an initial episode have been described but remain relatively rare to this day, and mostly mild. The recent emergence of new variants carrying mutations that give them certain selective advantages (greater contagiousness, increased virulence and the ability to evade the immune system) raises new concerns. These new variants, called “English”, “South African” or “Brazilian” depending on the country in which they were first described, are currently associated with a further increase in the incidence and mortality linked to Covid -19. The fear of a possibility of re-infection or infections with these new variants despite vaccination is beginning to emerge.
The team of Professor Jean-Damien Ricard, head of the intensive medicine and resuscitation service at Louis-Mourier AP-HP hospital recently took care of a 58-year-old patient with no notable history who presented in September 2020 a first episode little severe Covid-19 (moderate fever and respiratory discomfort), confirmed by RT-PCR. This first episode had resolved spontaneously and the cure had been confirmed by two negative PCR tests in December 2020. In January 2021, the patient was readmitted to the emergency room of the Louis-Mourier AP-HP hospital for a recurrence of fever with difficulty breathing. The SARS-COV-2 PCR test is again positive, and the sequencing of the virus, carried out in the virology department headed by Prof. Diane Descamps within the Bichat-Claude-Bernard AP-HP hospital shows the presence mutations characteristic of the South African variant 501Y.V2. The patient quickly developed an acute respiratory distress syndrome requiring intensive care by intubation and mechanical ventilation. He had no biological stigma of immunosuppression. The SARS-CoV-2 serology at the start of hospitalization was positive, suggesting that the immunity developed after the first infection did not prevent reinfection by the South African variant.
The virus responsible for the first infectious episode could not be sequenced. However, the occurrence of the first infection one month before the first description of the 501Y-V2 variant in South Africa, and three months before its first report in France, rules out the possibility of a recurrence of the first infection.
Drs Noémie Zucman and Fabrice Uhel therefore report in this work the first description of a serious reinfection by the new South African variant of the SARS-Cov2 virus. While epidemiological and experimental data suggest that a first infection is capable of inducing satisfactory protective immunity for at least 6 months, confirmed cases of reinfection despite the significant presence in the blood of neutralizing antibodies have been reported. The South African 501Y-V2 variant has rapidly spread throughout the world since December 2020. It is characterized by the presence of mutations in the regions encoding the Spike protein which give it greater contagiousness. The impact of these mutations on the effectiveness of vaccines is not yet clearly established.
While waiting for additional scientific data to better assess the cross-immunity and the efficacy of vaccines against the new variants of SARS-CoV-2, the greatest caution remains in order and strict compliance with the barrier rules remains a rule. essential, including in people vaccinated or having already had a first episode of Covid-19.
Reference:
Severe reinfection with South African SARS-CoV-2 variant 501Y.V2: A case report : Zucman N, Uhel F, Descamps D, Roux D, Ricard JD. Clin Infect Dis 2021:ciab129. Online ahead of print.
https://doi.org/10.1093/cid/ciab129
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