{"doi":"10.1093/cid/ciab717","title":"Clinical Spectrum of Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Protection From Symptomatic Reinfection","abstract":"BACKGROUND: There are few data on the full spectrum of disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across the lifespan from community-based or nonclinical settings. METHODS: We followed 2338 people in Managua, Nicaragua, aged <94 years from March 2020 through March 2021. SARS-CoV-2 infection was identified through real-time reverse transcription polymerase chain reaction (RT-PCR) or through enzyme-linked immunosorbent assay. Disease presentation was assessed at the time of infection or retrospectively by survey at the time of blood collection. RESULTS: There was a large epidemic that peaked between March and August 2020. In total, 129 RT-PCR-positive infections were detected, for an overall incidence rate of 5.3 infections per 100 person-years (95% confidence interval [CI], 4.4-6.3). Seroprevalence was 56.7% (95% CI, 53.5%-60.1%) and was consistent from age 11 through adulthood but was lower in children aged ≤10 years. Overall, 31.0% of the infections were symptomatic, with 54.7% mild, 41.6% moderate, and 3.7% severe. There were 2 deaths that were likely due to SARS-CoV-2 infection, yielding an infection fatality rate of 0.2%. Antibody titers exhibited a J-shaped curve with respect to age, with the lowest titers observed among older children and young adults and the highest among older adults. When compared to SARS-CoV-2-seronegative individuals, SARS-CoV-2 seropositivity at the midyear sample was associated with 93.6% protection from symptomatic reinfection (95% CI, 51.1%-99.2%). CONCLUSIONS: This population exhibited a very high SARS-CoV-2 seropositivity with lower-than-expected severity, and immunity from natural infection was protective against symptomatic reinfection.","journal":"Clinical Infectious Diseases","year":2021,"id":159870,"datarank":1.4794300749644025,"base_score":3.6888794541139363,"endowment":3.6888794541139363,"self_citation_contribution":0.5533319181170905,"citation_network_contribution":0.926098156847312,"self_endowment_contribution":0.5533319181170905,"citer_contribution":0.926098156847312,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":21,"citers_with_citation_signal":19,"citers_with_endowment":19,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8625,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":236672,"name":"Guillermina Kuan","orcid":"0000-0002-5251-173X","position":1,"is_corresponding":false},{"id":671858,"name":"Saira Saborío","orcid":null,"position":2,"is_corresponding":false},{"id":236663,"name":"Fausto Andres Bustos Carrillo","orcid":"0000-0002-7263-5625","position":3,"is_corresponding":false},{"id":236669,"name":"Miguel Plazaola","orcid":"0000-0002-4153-2615","position":4,"is_corresponding":false},{"id":671859,"name":"Carlos Barilla","orcid":null,"position":5,"is_corresponding":false},{"id":236668,"name":"Nery Sánchez","orcid":"0000-0002-0070-3895","position":6,"is_corresponding":false},{"id":390629,"name":"Roger López","orcid":"0000-0002-1091-5955","position":7,"is_corresponding":false},{"id":671860,"name":"Matt Smith","orcid":null,"position":8,"is_corresponding":false},{"id":413550,"name":"John Kubale","orcid":"0000-0001-5571-9774","position":9,"is_corresponding":false},{"id":236667,"name":"Sergio Ojeda","orcid":"0000-0003-2512-2306","position":10,"is_corresponding":false},{"id":671377,"name":"Julio C Zuniga-Moya","orcid":"0000-0002-8561-5463","position":11,"is_corresponding":false},{"id":449115,"name":"Bradley F. 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