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SARS‑COV‑2 INTRA‑HOST DIVERSITY, ANTIBODY RESPONSE, AND DISEASE SEVERITY AFTER REINFECTION BY THE VARIANT OF CONCERN GAMMA IN BRAZIL
Resposta de anticorpos
Gravidade após reinfecção
Pela variante de preocupação
SARS‑CoV‑2 intra-host diversity
Antibody response
Disease severity after reinfection
variant of concern Gamma
Author
Affilliation
Abstract
The rapid spread of the SARS-CoV-2 Variant of Concern (VOC) Gamma in Amazonas during early
2021 fueled a second large COVID-19 epidemic wave and raised concern about the potential role of
reinfections. Very few cases of reinfection associated with the VOC Gamma have been reported to
date, and their potential impact on clinical, immunological, and virological parameters remains largely
unexplored. Here we describe 25 cases of SARS-CoV-2 reinfection in Brazil. SARS-CoV-2 genomic
analysis confirmed that individuals were primo-infected with distinct viral lineages between March and December 2020 (B.1.1, B.1.1.28, B.1.1.33, B.1.195, and P.2) and reinfected with the VOC Gamma
between 3 to 12 months after primo-infection. We found a similar mean cycle threshold (Ct) value and
limited intra-host viral diversity in both primo-infection and reinfection samples. Sera of 14 patients
tested 10–75 days after reinfection displayed detectable neutralizing antibodies (NAb) titers against
SARS-CoV-2 variants that circulated before (B.1.*), during (Gamma), and after (Delta and Omicron)
the second epidemic wave in Brazil. All individuals had milder or no symptoms after reinfection, and
none required hospitalization. These findings demonstrate that individuals reinfected with the VOC
Gamma may display relatively high RNA viral loads at the upper respiratory tract after reinfection,
thus contributing to onward viral transmissions. Despite this, our study points to a low overall risk of
severe Gamma reinfections, supporting that the abrupt increase in hospital admissions and deaths
observed in Amazonas and other Brazilian states during the Gamma wave was mostly driven by
primary infections. Our findings also indicate that most individuals analyzed developed a high anti-
SARS-CoV-2 NAb response after reinfection that may provide some protection against reinfection or
disease by different SARS-CoV-2 variants.
Keywords in Portuguese
Diversidade intra-hospedeiro SARS‑CoV‑2Resposta de anticorpos
Gravidade após reinfecção
Pela variante de preocupação
SARS‑CoV‑2 intra-host diversity
Keywords
SARS-CoV-2 intra-host diversityAntibody response
Disease severity after reinfection
variant of concern Gamma
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