Clinical, immunological and virological characterization of COVID-19 patients that test re-positive for SARS-CoV-2 by RT-PCR
Jing Lu,
Jinju Peng,
Qianling Xiong,
Zhe Liu,
Huifang Lin,
Xiaohua Tan,
Min Kang,
Runyu Yuan,
Lilian Zeng,
Pingping Zhou,
Chumin Liang,
Lina Yi,
Louis du Plessis,
Tie Song,
Wenjun Ma,
Jiufeng Sun,
Oliver G Pybus,
Changwen Ke
Affiliations
Jing Lu
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China
Jinju Peng
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China
Qianling Xiong
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China
Zhe Liu
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Huifang Lin
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Xiaohua Tan
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Min Kang
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Runyu Yuan
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Lilian Zeng
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Pingping Zhou
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Chumin Liang
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Lina Yi
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Louis du Plessis
Department of Zoology, University of Oxford, Oxford, United Kingdom
Tie Song
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Wenjun Ma
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China
Jiufeng Sun
Guangdong Provincial Institution of Public Health, Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Rd, Dashi Town, Panyu District, Guangdong Province, Guangzhou 511430, China; Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
Oliver G Pybus
Department of Zoology, University of Oxford, Oxford, United Kingdom
Changwen Ke
Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China; Corresponding author.
Background: Some COVID-19 cases test positive again for SARS-CoV-2 RNA following negative test results and discharge, raising questions about the meaning of virus detection. Better characterization of re-positive cases is urgently needed. Methods: Clinical data were obtained through Guangdong's COVID-19 surveillance network. Neutralization antibody titre was determined using microneutralization assays. Potential infectivity of clinical samples was evaluated by cell inoculation. SARS-CoV-2 RNA was detected using three different RT-PCR kits and multiplex PCR with nanopore sequencing. Findings: Among 619 discharged COVID-19 cases, 87 re-tested as SARS-CoV-2 positive in circumstances of social isolation. All re-positive cases had mild or moderate symptoms at initial diagnosis and were younger on average (median, 28). Re-positive cases (n = 59) exhibited similar neutralization antibodies (NAbs) titre distributions to other COVID-19 cases (n = 218) tested here. No infectious strain could be obtained by culture and no full-length viral genomes could be sequenced from re-positive cases. Interpretation: Re-positive SARS-CoV-2 cases do not appear to be caused by active reinfection and were identified in ~14% of discharged cases. A robust NAb response and potential virus genome degradation were detected in almost all re-positive cases, suggesting a substantially lower transmission risk, especially through respiratory routes.
