{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:13:33Z","timestamp":1753877613758,"version":"3.41.2"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Identifying those most susceptible to COVID-19 reinfection and understanding the associated characteristics is essential for developing effective prevention and control strategies. We aimed to evaluate the influence of social determinants, regional disparities, and variant evolution on COVID-19 reinfection rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective cohort study in S\u00e3o Paulo, Brazil, involving laboratory-confirmed COVID-19 patients. Reinfection was defined as a subsequent positive COVID-19 test at least 90 days after the previous confirmed infection. We assessed socioeconomic indicators, demographic factors, and spatial correlations. Reinfection rates were analyzed across different variants and subvariants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 73 741 patients, 5626 (7.6%) experienced reinfections, with most (95.0%) having 1 reinfection. Reinfection rates increased significantly during the Omicron period, particularly with subvariants BA.1, BA.2\/BA.4, BA.5, and XBB\/XBB.1.5\/XBB.1.16. The highest rates were seen in patients initially infected during the BA.2\/BA.4 and BA.5 periods, who were later reinfected by XBB subvariants. Socioeconomic indicators, including lower Human Development Index, higher proportions of informal settlements, and lower employment rates, were significantly associated with higher reinfection rates. Geospatial analysis showed significant clustering of reinfections in areas with higher social vulnerability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>COVID-19 reinfection rates were heavily influenced by socioeconomic disparities and variant-specific factors. Regions with lower Human Development Index and worse socioeconomic conditions experienced higher reinfection rates. These findings highlight the need for targeted public health interventions focused on vulnerable populations, particularly in areas with greater social inequality. As new variants continue to emerge, ongoing surveillance and adaptive public health strategies will be critical to reducing reinfections.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf181","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T06:58:21Z","timestamp":1744786701000},"source":"Crossref","is-referenced-by-count":1,"title":["COVID-19 Reinfections in the City of S\u00e3o Paulo, Brazil: Prevalence and Socioeconomic Factors"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-647X","authenticated-orcid":false,"given":"Daniel Tavares","family":"Malheiro","sequence":"first","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6406-313X","authenticated-orcid":false,"given":"Kau\u00ea Capellato Junqueira","family":"Parreira","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6992-2263","authenticated-orcid":false,"given":"Patricia Deffune","family":"Celeghini","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6694-6569","authenticated-orcid":false,"given":"Gustavo Yano","family":"Callado","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7141-5009","authenticated-orcid":false,"given":"Andr\u00e9 Luis Franco","family":"Cotia","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Cendoroglo Neto","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-4755","authenticated-orcid":false,"given":"Marcelo A S","family":"Bragatte","sequence":"additional","affiliation":[{"name":"Instituto Todos Pela Sa\u00fade , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Instituto Capixaba de Ensino, Pesquisa e Inova\u00e7\u00e3o em Sa\u00fade ICEPi , Esp\u00edrito Santo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4451-3612","authenticated-orcid":false,"given":"Isaac","family":"Negretto Schrarstzhaupt","sequence":"additional","affiliation":[{"name":"Instituto Todos Pela Sa\u00fade , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Instituto Capixaba de Ensino, Pesquisa e Inova\u00e7\u00e3o em Sa\u00fade ICEPi , Esp\u00edrito Santo ,","place":["Brazil"]},{"name":"Faculdade de Sa\u00fade P\u00fablica, Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-8851","authenticated-orcid":false,"given":"Vanderson","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Instituto Todos Pela Sa\u00fade , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4751-6859","authenticated-orcid":false,"given":"Takaaki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Kentucky , Lexington, Kentucky ,","place":["USA"]},{"name":"Department of Internal Medicine, University of Iowa , Iowa City, Iowa ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B","family":"Edmond","sequence":"additional","affiliation":[{"name":"West Virginia University School of Medicine , Morgantown, West Virginia ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7577-7688","authenticated-orcid":false,"given":"Alexandre R","family":"Marra","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Department of Internal Medicine, University of Iowa , Iowa City, Iowa ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"2025052712084706900_ofaf181-B1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s41256-022-00245-3","article-title":"Reinfection in patients with COVID-19: a systematic review","volume":"7","author":"Ren","year":"2022","journal-title":"Glob Health Res Policy"},{"key":"2025052712084706900_ofaf181-B2","doi-asserted-by":"crossref","first-page":"5624","DOI":"10.1038\/s41467-023-41342-2","article-title":"Previous immunity shapes immune responses to SARS-CoV-2 booster vaccination and Omicron breakthrough infection risk","volume":"14","author":"P\u00e9rez-Al\u00f3s","year":"2023","journal-title":"Nat Commun"},{"key":"2025052712084706900_ofaf181-B3","doi-asserted-by":"crossref","first-page":"103031","DOI":"10.1016\/j.healthplace.2023.103031","article-title":"Health disparity in the spread of COVID-19: evidence from social distancing, risk of interactions, and access to testing","volume":"82","author":"Wei","year":"2023","journal-title":"Health Place"},{"key":"2025052712084706900_ofaf181-B4","doi-asserted-by":"crossref","first-page":"1432370","DOI":"10.3389\/fpubh.2024.1432370","article-title":"Mapping vulnerability for increased COVID-19 susceptibility and worse outcomes: a scoping review","volume":"12","author":"Couto","year":"2024","journal-title":"Front Public Health"},{"key":"2025052712084706900_ofaf181-B5","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1007\/s10900-020-00944-3","article-title":"The impact of socioeconomic status on the clinical outcomes of COVID-19; a retrospective cohort study","volume":"46","author":"Little","year":"2021","journal-title":"J Community Health"},{"key":"2025052712084706900_ofaf181-B6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12939-020-01242-z","article-title":"A model of disparities: risk factors associated with COVID-19 infection","volume":"19","author":"Rozenfeld","year":"2020","journal-title":"Int J Equity Health"},{"key":"2025052712084706900_ofaf181-B7","doi-asserted-by":"crossref","first-page":"912099","DOI":"10.3389\/fpubh.2022.912099","article-title":"Individual factors associated with COVID-19 infection: a machine learning study","volume":"10","author":"Ram\u00edrez","year":"2022","journal-title":"Front Public Health"},{"key":"2025052712084706900_ofaf181-B8","doi-asserted-by":"crossref","first-page":"e782","DOI":"10.1016\/S2214-109X(21)00081-4","article-title":"Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis","volume":"9","author":"Rocha","year":"2021","journal-title":"Lancet Glob Health"},{"author":"Centers for Disease Control and Prevention","key":"2025052712084706900_ofaf181-B9"},{"author":"Mapa da Desigualdade (2023)","key":"2025052712084706900_ofaf181-B10"},{"key":"2025052712084706900_ofaf181-B11","doi-asserted-by":"crossref","first-page":"767","DOI":"10.3895\/rbpd.v11n3.13627","article-title":"An\u00e1lise da rela\u00e7\u00e3o entre o \u00edndice IDHM e a densidade demogr\u00e1fica com a incid\u00eancia de COVID-19 no munic\u00edpio de S\u00e3o Paulo-SP","volume":"11","author":"Brito","year":"2022","journal-title":"Revista Brasileira de Planejamento e Desenvolvimento"},{"author":"Indicador Metropolitano","key":"2025052712084706900_ofaf181-B12"},{"author":"Distritos da cidade de S\u00e3o Paulo","key":"2025052712084706900_ofaf181-B13"},{"key":"2025052712084706900_ofaf181-B14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/gch2.1018","article-title":"Data, disease and diplomacy: GISAID's innovative contribution to global health","volume":"1","author":"Elbe","year":"2017","journal-title":"Glob Chall"},{"key":"2025052712084706900_ofaf181-B15","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.54724\/lc.2022.e1","article-title":"Methods for testing statistical differences between groups in medical research: statistical standard and guideline of Life Cycle Committee","volume":"2","author":"Lee","year":"2022","journal-title":"Life Cycle"},{"key":"2025052712084706900_ofaf181-B16","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1538-4632.1995.tb00338.x","article-title":"Local indicators of spatial association\u2014LISA","volume":"27","author":"Anselin","year":"1995","journal-title":"Geogr Anal"},{"author":"Banco Central do Brasil","key":"2025052712084706900_ofaf181-B17"},{"key":"2025052712084706900_ofaf181-B18","first-page":"319","volume-title":"Studies in classification, data analysis, and knowledge organization","author":"Berthold","year":"2007"},{"volume-title":"R: a language and environment for statistical computing","year":"2022","author":"R Core Team","key":"2025052712084706900_ofaf181-B19"},{"key":"2025052712084706900_ofaf181-B20","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.0016-7363.2005.00671.x","article-title":"Geoda: an introduction to spatial data analysis","volume":"38","author":"Anselin","year":"2006","journal-title":"Geogr Anal"},{"key":"2025052712084706900_ofaf181-B21","doi-asserted-by":"crossref","first-page":"1191377","DOI":"10.3389\/fpubh.2023.1191377","article-title":"An ecological study on reinfection rates using a large dataset of RT-qPCR tests for SARS-CoV-2 in Santiago of Chile","volume":"11","author":"Castillo","year":"2023","journal-title":"Front Public Health"},{"key":"2025052712084706900_ofaf181-B22","doi-asserted-by":"crossref","first-page":"884121","DOI":"10.3389\/fpubh.2022.884121","article-title":"Risk of SARS-CoV-2 reinfection 18 months after primary infection: population-level observational study","volume":"10","author":"Flacco","year":"2022","journal-title":"Front Public Health"},{"key":"2025052712084706900_ofaf181-B23","doi-asserted-by":"crossref","first-page":"e0268119","DOI":"10.1371\/journal.pone.0268119","article-title":"The influence of gender on COVID-19 infections and mortality in Germany: insights from age-and gender-specific modeling of contact rates, infections, and deaths in the early phase of the pandemic","volume":"17","author":"Doerre","year":"2022","journal-title":"PLoS One"},{"key":"2025052712084706900_ofaf181-B24","first-page":"147","article-title":"Gender differences in the utilization of health care services","volume":"49","author":"Bertakis","year":"2000","journal-title":"J Fam Pract"},{"key":"2025052712084706900_ofaf181-B25","doi-asserted-by":"crossref","first-page":"683","DOI":"10.15585\/mmwr.mm7225a3","article-title":"Trends in laboratory-confirmed SARS-CoV-2 reinfections and associated hospitalizations and deaths among adults aged \u226518 years\u201418 U.S. jurisdictions, September 2021\u2013December 2022","volume":"72","author":"Ma","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025052712084706900_ofaf181-B26","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.cell.2022.01.019","article-title":"Structural and functional characterizations of infectivity and immune evasion of SARS-CoV-2 omicron","volume":"185","author":"Cui","year":"2022","journal-title":"Cell"},{"author":"Governo do Estado de S\u00e3o Paulo","key":"2025052712084706900_ofaf181-B27"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/4\/ofaf181\/62936209\/ofaf181.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/4\/ofaf181\/62936209\/ofaf181.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T16:09:26Z","timestamp":1748362166000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf181\/8114187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf181","relation":{},"ISSN":["2328-8957"],"issn-type":[{"type":"electronic","value":"2328-8957"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,27]]},"article-number":"ofaf181"}}