France : Severe reinfection with South African variant

France: First case of severe reinfection with the South African variant of the coronavirus worries.

Four months after a mild Sars-CoV-2 infection, spontaneously cured, a man is again diagnosed positive, this time, for the new South African variant, developing an acute respiratory distress syndrome and requiring treatment—resuscitation by intubation and mechanical ventilation. The question of immunity and its duration is far from being resolved.

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The team of the intensive medicine and resuscitation department 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 patient reinfected with the South African variant 501Y.V2 of SARS-CoV-2, a few months after an early 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 as to the duration and robustness of immunity against this coronavirus. Proceedings of reinfection by the virus after an original episode have been described but to date remain relatively rare, and most of the time, 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 further concerns.

The fear of the possibility of reinfection or infections with these new variants despite vaccination is starting to emerge
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 associated with Covid-19. The fear of a possibility of reinfection or infections with these new variants despite vaccination is beginning to emerge.

More certainties on protective immunity
The team of Professor Jean-Damien Ricard, administrator of the intensive medicine and resuscitation service at the Louis-Mourier AP-HP hospital, recently operated on a 58-year-old patient with no significant history who presented in September 2020 the first episode. Mild Covid-19 (moderate fever and respiratory discomfort), confirmed by RT-PCR. This first episode resolved spontaneously, and two negative PCR tests confirmed the cure in December 2020.

In January 2021, the patient was readmitted to Louis-Mourier AP-HP hospital’s emergency room for a recurrence of fever with respiratory discomfort. The SARS-COV-2 PCR test is again positive. 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 mutations characteristic of the South African variant 501Y.V2. The patient quickly evolved 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 early infection occurrence 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 early infection.

France : Reinfections despite the Presence of Antibodies

Doctors Noémie Zucman and Fabrice Uhel, therefore, the report in this work, the first description of severe reinfection by the new South African variant of the SARS-Cov2 virus. While epidemiological and experimental data suggest that an early infection can induce adequate protective immunity for at least six months, Confirmed cases of reinfection despite the significant presence in the blood of neutralizing antibodies have been reported.

The impact of mutations on the effectiveness of vaccines is not yet clearly established. The South African variant 501Y-V2 has rapidly spread throughout the world since December 2020. It is characterized by mutations in the regions encoding the Spike protein, which give it greater contagiousness. The impact of mutations on the efficacy of vaccines is not yet clearly established.

While waiting for additional scientific data to assess better 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 who have been vaccinated or have already had the first episode of Covid-19.