Background: Immune dysregulation during and after COVID-19 is known with deleterious effects. Role of reboot system is unknown

Methods: Prospective, observational study, included 300 cases in four different groups of patients in post covid care setting to assess immune dysregulation. Groups includes cases with rheumatological manifestations post-covid, cases with recurrent seasonal viral infections post-covid (never experienced before covid-19 infection), cases with persistent fever in TB and disseminated TB in post covid, and asymptomatic or minimally symptomatic cases with covid vaccination in recent past. Comparison in all groups with asymptomatic cases not received covid vaccine or not infected with covid-19 measured by antibody test. All cases were subjected to TH1/TH2 balance measurement by CD4, CD8, CD4/CD8 ratio, INF-?, & IL-4, IL-5, IL-13 respectively

Results: In post covid setting, Th1/Th2 homeostasis desynchrony (categorised as Th1/Th2 normal, Th1 hyperactive/Th2 suppressed, Th1Supressed andTh2 hyperactive) has been documented in all four study groups, cases with rheumatological manifestations (p<0.00001), cases with cases with recurrent seasonal viral infections post-covid (never experienced before covid-19 infection) (p<0.00001), cases with persistent fever in TB and disseminated TB in post covid (p<0.00001), and asymptomatic or minimally symptomatic cases with covid vaccination in recent past (p<0.00001)

Conclusion: Immune alteration is documented after natural infection & effect of vaccination in restoring Th1/Th2 interplay is not known. The ?reboot system? or time required to restore 'normalcy' is a real concern as documented as our immune phenomenon