article
Highly mutated Omicron sub-lineages JN.1 and NB.1.8.1 harbor extensive spike changes, but their impact in preterm infants is poorly documented. We report a preterm male infant with three hospitalizations in seven weeks: severe SARS-CoV-2 ARDS at 39 days requiring ventilation caused by JN.1.16, HCoV-OC43 infection at 62 days, and a mild SARS-CoV-2 reinfection at 87 days due to NB.1.8.1/XDV, the first detection of this variant in Tunisia. Spike analysis showed a shared JN.1 backbone but distinct N-terminal and receptor-binding domain changes, supporting intra-Omicron reinfection driven by antigenic divergence and immature immunity and underscoring the value of pediatric genomic surveillance.
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DOI: 10.22541/au.176459955.57644106/v1
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