Multi-systemic risk of post-acute sequelae associated with SARS-CoV-2 reinfection

Area of Science:

• Infectious Diseases
• Public Health
• Immunology

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections are linked to a higher risk of post-acute sequelae.
• It remains unclear if milder Omicron variant reinfections or reinfections in highly vaccinated populations also elevate post-acute risks.

Purpose of the Study:

• To investigate the association between SARS-CoV-2 reinfection and the risk of developing post-acute sequelae.
• To compare the risk trajectories of post-acute sequelae between reinfected individuals, first-infected individuals, and uninfected controls.
• To assess whether post-acute sequelae risks persist in vaccinated and boosted populations.

Main Methods:

• Utilized national COVID-19 databases and healthcare claims data from Singapore (July 2021-February 2023).
• Constructed cohorts of SARS-CoV-2 infected (reinfected and non-reinfected) and uninfected individuals.
• Compared 300-day incidence and excess burden of new diagnoses across cardiovascular, neuropsychiatric, endocrine, autoimmune, renal, respiratory, and gastrointestinal domains.

Main Results:

• SARS-CoV-2 reinfections were associated with a 21% increased risk of any post-acute sequelae (HR=1.21).
• Elevated risks were observed for cardiovascular, gastrointestinal, neurological, endocrine, respiratory, and renal sequelae.
• Risks were greater in reinfections compared to first infections and persisted in vaccinated and boosted individuals.

Conclusions:

• SARS-CoV-2 reinfection is a significant risk factor for developing post-acute sequelae.
• Strategies to prevent reinfection, including updated vaccines with improved efficacy against infection, are crucial for reducing the burden of post-acute complications.