Introduction and expansion of the SARS-CoV-2 B.1.1.7 variant and reinfections in Qatar: A nationally representative cohort study
Open accessAbstract
Background: The epidemiology of the SARS-CoV-2 B.1.1.7 (or Alpha) variant is insufficiently understood. This study’s objective was to describe the introduction and expansion of this variant in Qatar and to estimate the efficacy of natural infection against reinfection with this variant. Methods and findings: Reinfections with the B.1.1.7 variant and variants of unknown status were investigated in a national cohort of 158,608 individuals with prior PCR-confirmed infections and a national cohort of 42,848 antibody-positive individuals. Infections with B.1.1.7 and variants of unknown status were also investigated in a national comparator cohort of 132,701 antibody-negative individuals. B.1.1.7 was first identified in Qatar on 25 December 2020. Sudden, large B.1.1.7 epidemic expansion was observed starting on 18 January 2021, triggering the onset of epidemic’s second wave, 7 months after the first wave. B.1.1.7 was about 60% more infectious than the original (wild-type) circulating variants. Among persons with a prior PCR-confirmed infection, the efficacy of natural infection against reinfection was estimated to be 97.5% (95% CI: 95.7% to 98.6%) for B.1.1.7 and 92.2% (95% CI: 90.6% to 93.5%) for variants of unknown status. Among antibody-positive persons, the efficacy of natural infection against reinfection was estimated to be 97.0% (95% CI: 92.5% to 98.7%) for B.1.1.7 and 94.2% (95% CI: 91.8% to 96.0%) for variants of unknown status. A main limitation of this study is assessment of reinfections based on documented PCR-confirmed reinfections, but other reinfections could have occurred and gone undocumented. Conclusions: In this study, we observed that introduction of B.1.1.7 into a naïve population can create a major epidemic wave, but natural immunity in those previously infected was strongly associated with limited incidence of reinfection by B.1.1.7 or other variants.
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S-gene target failure is a well-established proxy for BA.1 infection, and non-S-gene target failure is a proxy for BA.2 infection.
“An S-gene target failure was used as a proxy for BA.1 infection, and a non–S-gene target failure was used as a proxy for BA.2 infection.”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [29]
Ascertainment of BA.1 and BA.2 infections used proxy criteria, but this method is well established.
“Ascertainment of BA.1 and BA.2 infections was based on proxy criteria, but this method of ascertainment is well established.24,29,30”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [29]
The method of ascertaining BA.1 and BA.2 using S-gene target failure (SGTF) with the TaqPath PCR assay is well established for Omicron subvariants and for other variants such as Alpha.
“BA.1 and BA.2 ascertainment was based on proxy criteria, presence or absence of an S-gene “target failure” using the TaqPath PCR assay (Methods), but this method of ascertainment is well established not only for Omicron subvariants, but also for other variants such as Alpha27–29.”
From Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar (2022) · cites this paper as [28]
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ResultSARS-CoV-2 Infection Is at Herd Immunity in the Majority Segment of the Population of Qatar
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Self-citationAbu-Raddad, L. J., Chemaitelly, H. S., Ayoub, H. H., Tang, P., Coyle, P. V., Hasan, M. R., Yassine, H. M., Benslimane, F. M., Al-Khatib, H. A., Kanaani, Z. A., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-28199-7 · Cited by 79 · see citing works
Self-citationCovid-19 Vaccine Protection among Children and Adolescents in Qatar
Chemaitelly, H. S., AlMukdad, S., Ayoub, H. H., Altarawneh, H. N., Coyle, P. V., Tang, P., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Hasan, M. R., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2210058 · Cited by 71 · see citing works
Self-citationDifferential protection against SARS-CoV-2 reinfection pre- and post-Omicron
Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2025) · Nature · doi:10.1038/s41586-024-08511-9 · Cited by 59 · see citing works
“Further details on this type of cohort study design can be found in our previous publications, which used also the same national databases to estimate the effectiveness of infection against reinfection or the effectiveness of vaccination against infection 4,8,10,14,15,30,32,33,45,59,61,62,71,81–83 .”
Self-citationAltarawneh, H. N., Chemaitelly, H. S., Ayoub, H. H., Tang, P., Hasan, M. R., Yassine, H. M., Al-Khatib, H. A., Thani, A. A. A., Coyle, P. V., Kanaani, Z. A., et al. (2023) · EBioMedicine · doi:10.1016/j.ebiom.2023.104734 · Cited by 55 · see citing works
Self-citationQassim, S. H., Chemaitelly, H. S., Ayoub, H. H., AlMukdad, S., Tang, P., Hasan, M. R., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Rahim, H. F. A., et al. (2022) · Journal of Travel Medicine · doi:10.1093/jtm/taac068 · Cited by 47 · see citing works
Self-citationBiological Properties of SARS-CoV-2 Variants: Epidemiological Impact and Clinical Consequences
Hoteit, R., & Yassine, H. M. (2022) · Vaccines · doi:10.3390/vaccines10060919 · Cited by 45 · see citing works
“Rt can also be calculated using another method [45].”
BackgroundMethodInfluentialSelf-citationAll-cause and COVID-19 mortality in Qatar during the COVID-19 pandemic
Al-Nuaimi, A. A., Chemaitelly, H. S., Semaan, S., AlMukdad, S., Kanaani, Z. A., Kaleeckal, A. H., Latif, A. N., Al‐Romaihi, H. E., Butt, A. A., Al‐Thani, M. H., et al. (2023) · BMJ Global Health · doi:10.1136/bmjgh-2023-012291 · Cited by 42 · see citing works
Self-citationAyoub, H. H., Tomy, M., Chemaitelly, H. S., Altarawneh, H. N., Coyle, P. V., Tang, P., Hasan, M. R., Kanaani, Z. A., Al‐Kuwari, E., Butt, A. A., et al. (2023) · American Journal of Epidemiology · doi:10.1093/aje/kwad239 · Cited by 40 · see citing works
“Various studies have estimated S PE for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants.(1-9) However, there are challenges in estimating S PE using conventional epidemiologic study designs.”
BackgroundSelf-citationTayar, E., Abdeen, S., Alah, M. A., Chemaitelly, H. S., Bougmiza, I. M., Ayoub, H. H., Kaleeckal, A. H., Latif, A. N., Shaik, R. M., Al‐Romaihi, H. E., et al. (2022) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2022.12.016 · Cited by 44 · see citing works
Self-citationProtection afforded by prior infection against SARS-CoV-2 reinfection with the Omicron variantPreprint
Altarawneh, H., Chemaitelly, H., Tang, P., Hasan, M. R., Qassim, S., Ayoub, H., AlMukdad, S., Yassine, H., Benslimane, F., Khatib, H. A., et al. (2022) · medRxiv · doi:10.1101/2022.01.05.22268782 · Cited by 31 · see citing works
Self-citationAyoub, H. H., Tomy, M., Chemaitelly, H., Altarawneh, H. N., Coyle, P., Tang, P., Hasan, M. R., Kanaani, Z. A., Kuwari, E. A., Butt, A. A., et al. (2022) · doi:10.1101/2022.01.02.22268622 · Cited by 41 · see citing works
Self-citationQassim, S. H., Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Yassine, H. M., Thani, A. A. A., Al-Khatib, H. A., Hasan, M. R., Kanaani, Z. A., et al. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.102102 · Cited by 32 · see citing works
Self-citationSARS CoV-2 reinfection rate is higher in the Omicron variant than in the Alpha and Delta variants
Özüdoğru, O., Bahçe, Y. G., & Acer, Ö. (2022) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-022-03060-4 · Cited by 32 · see citing works
Ntziora, F., Kostaki, E. G., Karapanou, Α., Mylona, M., Tseti, I. K., Sipsas, N. V., Paraskevis, D. N., & Sfikakis, P. P. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.09.042 · Cited by 27 · see citing works
“4 Prior infection with an initial COVID-19 variant, regardless of whether this prior infection was ascertained by PCR or antibody testing, was associated with low infection incidence by other circulating variants [5].”
BackgroundSARS-CoV-2 variants of concern in children and adolescents with COVID-19: a systematic review
Wiedenmann, M., Ipekci, A. M., Araujo-Chaveron, L., Prajapati, N., Lam, Y., Alam, M. I., L'Huillier, A. G., Zhelyazkov, I., Heron, L., Low, N., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072280 · Cited by 20 · see citing works
“Interpretation and generalisation of the evidence was limited by inconsistent reporting of age groups and by inadequate reporting of vaccination and other control measures in the included studies.”
BackgroundAltarawneh, H., Chemaitelly, H., Ayoub, H., Hasan, M. R., Coyle, P., Yassine, H., Khatib, H. A., Benslimane, F., Al-Kanaani, Z., Al-Kuwari, E., et al. (2022) · medRxiv · doi:10.1101/2022.07.11.22277448 · Cited by 20 · see citing works
Self-citationAddressing bias in the definition of SARS-CoV-2 reinfection: implications for underestimation
Chemaitelly, H. S., Ayoub, H. H., Tang, P., Yassine, H. M., Thani, A. A. A., Hasan, M. R., Coyle, P. V., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1363045 · Cited by 17 · see citing works
Self-citationChemaitelly, H. S., Ayoub, H. H., Faust, J. S., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Al-Khatib, H. A., Thani, A. A. A., Kanaani, Z. A., et al. (2023) · BMJ Public Health · doi:10.1136/bmjph-2023-000479 · Cited by 26 · see citing works
Self-citationQassim, S. H., Hasan, M. R., Tang, P., Chemaitelly, H. S., Ayoub, H. H., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Rahim, H. F. A., Nasrallah, G. K., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.984784 · Cited by 17 · see citing works
Self-citationBsat, R., Chemaitelly, H. S., Coyle, P. V., Tang, P., Hasan, M. R., Kanaani, Z. A., Al‐Kuwari, E., Butt, A. A., Jeremijenko, A. M., Kaleeckal, A. H., et al. (2022) · Journal of Global Health · doi:10.7189/jogh.12.05004 · Cited by 14 · see citing works
Self-citationHuang, Y., Zhang, L., Fu, J., Wu, Y., Wang, H., Xiao, W., Xin, Y., Dai, Z., Si, M., Chen, X., et al. (2023) · JMIR Public Health and Surveillance · doi:10.2196/42958 · Cited by 14 · see citing works
Hu, W., Cai, H., Yan, H.-C., Wang, H., Sun, H., Wei, Y., & Hao, Y. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1353415 · Cited by 12 · see citing works
Chemaitelly, H., Ayoub, H., Faust, J., Coyle, P., Tang, P., Hasan, M. R., Yassine, H., Khatib, H. A., Thani, A. A., Al-Kanaani, Z., et al. (2023) · medRxiv · doi:10.1101/2023.05.28.23290641 · Cited by 11
“This aligns with earlier studies in Qatar, demonstrating strong protection against severe reinfection among individuals with prior infection and limited waning in protection.(11,27,28) Other factors, such as lower severity in omicron subvariants,(29-32) the overall decreased infection incidence in the postfirst omicro…”
ResultSelf-citationMahmoud, M., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2023) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.13224 · Cited by 12 · see citing works
“25,26 The study analyzed documented infections, but some infections may have gone undocumented, particularly after the major reduction in testing that occurred starting from November 1, 2022.”
BackgroundSelf-citationCOVID-19 vaccination challenges: A mini-review
Afshar, Z. M., Barary, M., Hosseinzadeh, R., Karim, B., Ebrahimpour, S., Nazary, K., Sio, T. T. W., Sullman, M. J. M., Carson‐Chahhoud, K., Moudi, E., et al. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2066425 · Cited by 11 · see citing works
Modeling the population-level impact of treatment on COVID-19 disease and SARS-CoV-2 transmission
Makhoul, M., Abu-Hijleh, F. M., Ayoub, H. H., Seedat, S., Chemaitelly, H. S., & Abu-Raddad, L. J. (2022) · Epidemics · doi:10.1016/j.epidem.2022.100567 · Cited by 5 · see citing works
Self-citationOverlapping Delta and Omicron Outbreaks During the COVID-19 Pandemic: Dynamic Panel Data Estimates
Lundberg, A. L., Lorenzo-Redondo, R., Hultquist, J. F., Hawkins, C., Ozer, E. A., Welch, S. B., Prasad, P. V. V., Achenbach, C. J., White, J. I., Oehmke, J. F., et al. (2022) · JMIR Public Health and Surveillance · doi:10.2196/37377 · Cited by 4 · see citing works
“The original study was the first to compare singular Omicron outbreaks to previous outbreaks driven by the original SARS-CoV-2 variant, Beta, Alpha, and Delta in sub-Saharan Africa.”
BackgroundChen, H.-Q., Zhang, L., Xu, C., Shen, X.-Y., Lou, J., & Wu, S. (2023) · PeerJ · doi:10.7717/peerj.15155 · Cited by 4 · see citing works
Su, S., Jiang, Z., Shi, L., Liu, X., Zhang, Z., Mei, H., Gao, N., Wu, S., Li, M., Zhang, X., et al. (2025) · BMC Medicine · doi:10.1186/s12916-025-04322-5 · Cited by 2 · see citing works
“Additionally, some studies have found effective protection of a previous infection against reinfection with Alpha, Beta, Delta, and Omicron variants of SARS-CoV-2 [8, 33, 34].”
Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127556 · Cited by 2 · see citing works
Self-citationAltarawneh, H. N., Chemaitelly, H. S., Ayoub, H. H., Tang, P., Hasan, M. R., Yassine, H. M., Al-Khatib, H. A., Thani, A. A. A., Coyle, P. V., Kanaani, Z. A., et al. (2023) · medRxiv · doi:10.1101/2023.04.21.23288917 · Cited by 4 · see citing works
Self-citationOmicron variant of COVID-19: A focused review of biologic, clinical, and epidemiological changes
Majlesi, H., Shahsavan, S., Farsi, Y., Tamimi, A., Ilkhani, S., Tajabadi, Z., Naserghandi, A., Fakour, N., Nasiri, M. J., Mojarad, E. N., et al. (2022) · Immunopathologia Persa · doi:10.34172/ipp.2022.34449 · Cited by 2 · see citing works
“Although natural infectioninduced immunity forcefully defends against the Alpha, Beta, and Delta reinfections (60-62), this variant can bring much higher reinfections (63), According to a database investigation in Qatar, a prior infection brought about potent prevention efficacy of virtually 90% towards reinfections w…”
ResultEpidemiological and clinical characteristics of SARS-CoV-2 reinfections in a Spanish region
Yuguero, O., Companys, M., Guzmán, M., Maciel, R., Llobet, C., López, A., Olles, R., Pujol, V., Ruiz, M. J. H., Saura, M., et al. (2022) · SAGE Open Medicine · doi:10.1177/20503121221108556 · Cited by 3 · see citing works
Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2025) · BMC Infectious Diseases · doi:10.1186/s12879-025-11410-7 · Cited by 2 · see citing works
Self-citationPatterns in Repeat Reinfections: Pre and Post Omicron EmergencePreprint
Chemaitelly, H. S., Ayoub, H. H., Tang, P., Coyle, P. V., Yassine, H. M., Thani, A. A. A., Hasan, M. R., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2023) · medRxiv · doi:10.1101/2023.06.29.23292041 · Cited by 2 · see citing works
“Characteristics Primary infections First reinfections Second reinfections N=420,971 N=3,117 N=14 Median age (IQR)—years 33 (25-41) 33 (27-40) 37 (26-45) Age—years 0-9 years 32,661 (7.”
BackgroundSelf-citationProtection against reinfection with SARS-CoV-2 omicron BA.2.75 * sublineagePreprint
Chemaitelly, H. S., Tang, P., Coyle, P. V., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Hasan, M. R., Ayoub, H. H., Altarawneh, H. N., Kanaani, Z. A., et al. (2022) · medRxiv · doi:10.1101/2022.10.29.22281606 · Cited by 4 · see citing works
Self-citationChemaitelly, H., AlMukdad, S., Ayoub, H., Altarawneh, H., Coyle, P., Tang, P., Yassine, H., Khatib, H. A., Smatti, M., Hasan, M. R., et al. (2022) · medRxiv · doi:10.1101/2022.07.26.22278045 · Cited by 2 · see citing works
Self-citationChemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2025) · PLoS ONE · doi:10.1371/journal.pone.0331654 · Cited by 1 · see citing works
“The country has undergone several phases of the SARS-CoV-2 pandemic, starting with the ancestral virus wave [26], followed by consecutive alpha [27] and beta [28] waves, a low-incidence phase dominated by delta [29], a massive omicron BA.1 and BA.2 wave [30], and subsequently a series of waves…”
Self-citationNasrallah, G. K., Ali, F. H., Younes, S., Khatib, H. A., Thani, A. A., & Yassine, H. (2022) · medRxiv · doi:10.1016/j.heliyon.2023.e17179 · Cited by 1
“Alpha samples were selected based on the collection date when the 112 Alpha variant was the most prevalent between May and June 2020 [21, 22] 113”
Self-citationAishaq, M., Nafady‐Hego, H., Abid, F. B., Ajmi, J. A. A., Hamdi, W. S., Vinoy, S., Thomas, A. G., Alrwashdh, S., Shaheen, M. Z., Mathew, T. E., et al. (2024) · Global Epidemiology · doi:10.1016/j.gloepi.2024.100149
“These phases included the following: the ancestral virus wave (February 28, 2020 - July 31, 2020) [3] a prolonged low incidence ancestral virus phase (August 1, 2020 - January 17, 2021) [4] the alpha wave (January 18, 2021 - March 7, 2021) [5] the beta wave (March 8, 2021 -”
BackgroundInfluentialSelf-citationHoldenrieder, S., Ferreira, C. E. D. S., Izopet, J., Theel, E. S., & Wieser, A. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1290402
Wiedenmann, M., Ipekci, A. M., Chaveron, L. A., Prajapati, N., Lam, Y., Alam, M. I., L'Huillier, A., Zhelyazkov, I., Heron, L., Low, N., et al. (2023) · medRxiv · doi:10.1101/2023.01.12.23284434
- Authors
- Abu-Raddad, L. J., Chemaitelly, H., Ayoub, H. H., Coyle, P., Malek, J. A., Ahmed, A. A., Mohamoud, Y. A., Younuskunju, S., Tang, P., Al Kanaani, Z., Al Kuwari, E., Butt, A. A., Jeremijenko, A., Kaleeckal, A. H., Latif, A. N., Shaik, R. M., Abdul Rahim, H. F., Nasrallah, G. K., Yassine, H. M., Al Kuwari, M. G., Al Romaihi, H. E., Al-Thani, M. H., Al Khal, A., & Bertollini, R.
- Affiliations
- Cornell University (US)
- Qatar University (QA)
- Queen's University Belfast (GB)
- Sidra Medical and Research Center (QA)
- Hamad Medical Corporation (QA)
- Ministry of Public Health (QA)
- Corresponding author
- Abu-Raddad, Laith J.
- ORCID
- Abu-Raddad, Laith J.
- Chemaitelly, Hiam
- Ayoub, Houssein H.
- Coyle, Peter
- Malek, Joel A.
- Mohamoud, Yasmin A.
- Younuskunju, Shameem
- Tang, Patrick
- Butt, Adeel A.
- Jeremijenko, Andrew
- Kaleeckal, Anvar Hassan
- Latif, Ali Nizar
- Shaik, Riyazuddin Mohammad
- Abdul Rahim, Hanan F.
- Nasrallah, Gheyath K.
- Yassine, Hadi M.
- Al Kuwari, Mohamed Ghaith
- Al Romaihi, Hamad Eid
- Al Khal, Abdullatif
- Bertollini, Roberto
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-12-16
- Volume
- 18
- Issue
- 12
- Pages
- e1003879
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC8726501
- OpenAlex
- W4200553670
- Cited by
- 54
- References
- 59
- Citations by year
- 2025: 5 · 2024: 4 · 2023: 19 · 2022: 24 · 2021: 2
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Update notices
- new_version (2022-01-04)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
- Qatar University QSpace (Qatar University) (submittedVersion, cc-by)
- Funders
- Qatar Genome Programme
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- SARS-CoV-2, B.1.1.7 variant, Alpha variant, reinfection, natural immunity, prior infection, epidemic waves, infectiousness, Qatar
- MeSH terms
- Reinfection, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Aged, 80 and over, Child, Female, Humans, Immunity, Innate, Male, Middle Aged, Models, Theoretical, Qatar, Retrospective Studies, Time Factors, Polymerase Chain Reaction, Basic Reproduction Number, Young Adult
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