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Abstract
SARS-CoV-2 reinfections increased substantially after Omicron variants emerged. Large-scale community-based comparisons across multiple Omicron waves of reinfection characteristics, risk factors, and protection afforded by previous infection and vaccination, are limited. Here we studied ~45,000 reinfections from the UK’s national COVID-19 Infection Survey and quantified the risk of reinfection in multiple waves, including those driven by BA.1, BA.2, BA.4/5, and BQ.1/CH.1.1/XBB.1.5 variants. Reinfections were associated with lower viral load and lower percentages of self-reporting symptoms compared with first infections. Across multiple Omicron waves, estimated protection against reinfection was significantly higher in those previously infected with more recent than earlier variants, even at the same time from previous infection. Estimated protection against Omicron reinfections decreased over time from the most recent infection if this was the previous or penultimate variant (generally within the preceding year). Those 14–180 days after receiving their most recent vaccination had a lower risk of reinfection than those >180 days from their most recent vaccination. Reinfection risk was independently higher in those aged 30–45 years, and with either low or high viral load in their most recent previous infection. Overall, the risk of Omicron reinfection is high, but with lower severity than first infections; both viral evolution and waning immunity are independently associated with reinfection.
The factors influencing risk of reinfection with SARS-CoV-2 are poorly understood. Here, the authors use data from the UK COVID-19 Infection Survey, a community based longitudinal study, to assess characteristics of ~45,000 reinfections compared to initial infections.
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1 University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
2 University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); John Radcliffe Hospital, Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (GRID:grid.8348.7) (ISNI:0000 0001 2306 7492); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, The National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
3 University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The Francis Crick Institute, London, UK (GRID:grid.451388.3) (ISNI:0000 0004 1795 1830); University College London, Division of infection and immunity, London, UK (GRID:grid.83440.3b) (ISNI:0000 0001 2190 1201)
4 Office for National Statistics, Newport, UK (GRID:grid.426100.1) (ISNI:0000 0001 2157 6840)
5 University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); MRC Clinical Trials Unit at UCL, UCL, London, UK (GRID:grid.415052.7) (ISNI:0000 0004 0606 323X)
6 The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, Health Economics Research Centre, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
7 University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); John Radcliffe Hospital, Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (GRID:grid.8348.7) (ISNI:0000 0001 2306 7492); The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948); University of Oxford, The National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
8 MRC Clinical Trials Unit at UCL, UCL, London, UK (GRID:grid.415052.7) (ISNI:0000 0004 0606 323X)
9 University of Oxford, Nuffield Department of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
10 University of Oxford, Big Data Institute, Nuffield Department of Population Health, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
11 Office for Health Improvement and Disparities, London, UK (GRID:grid.4991.5)
12 University of Oxford, Office of the Regius Professor of Medicine, Oxford, UK (GRID:grid.4991.5) (ISNI:0000 0004 1936 8948)
13 Oxford University Hospitals NHS Foundation Trust, Oxford, UK (GRID:grid.410556.3) (ISNI:0000 0001 0440 1440)
14 University of Manchester, Manchester, UK (GRID:grid.5379.8) (ISNI:0000 0001 2166 2407)
15 UK Health Security Agency, London, UK (GRID:grid.5379.8)
16 IQVIA, London, UK (GRID:grid.482783.2)
17 National Biocentre, Milton Keynes, UK (GRID:grid.482783.2)
18 Glasgow Lighthouse Laboratory, London, UK (GRID:grid.482783.2)
19 Department of Health and Social Care, London, UK (GRID:grid.57981.32)
20 Welsh Government, Cardiff, UK (GRID:grid.422594.c) (ISNI:0000 0004 1787 8223)
21 Scottish Government, Edinburgh, UK (GRID:grid.421126.2) (ISNI:0000 0001 0698 0044)
22 Public Health Scotland, Edinburgh, UK (GRID:grid.508718.3)