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The rapid development of vaccines with high efficacy against SARS-CoV-2 has brought questions about duration of protection. The answers have been complicated by the equally rapid emergence of variant viruses capable of circumventing the host's immunity. This report documents a case of SARS-CoV-2 reinfection in a patient with no predisposing comorbidities who had mounted an appropriate antibody response to the initial infection.
A 45-year-old female healthcare executive in Brazil had COVID-compatible symptoms of diarrhea, myalgia, and asthenia managed with prednisone and lasting 7 days in May of 2020. In October of 2020 she developed more-severe symptoms including headache, malaise, cough, mild dyspnea, and insomnia. Duration of these symptoms was longer, but hospitalization was not required. Viral RNA analysis revealed SARS-CoV-2 on both occasions, but with a higher viral load in the second episode. IgG antibodies to the S1 protein were present 4 weeks after reinfection. Phylogenetic profiles revealed that the two episodes were caused by different viral lineages: B.1.1.33 in the first and P.2 (i.e., B.1.1.28.2) in the second.
Nonaka CKV et al. Genomic evidence of SARS-CoV-2 reinfection involving E484K spike mutation, Brazil. Emerg Infect Dis 2021 Feb 19; [e-pub]. (https://wwwnc.cdc.gov/eid/article/27/5/21-0191_article)
Comment
Although this is not the first description of a SARS-CoV-2 reinfection, it clearly points to the advent of mutant variants (especially in the spike glycoprotein region) as the culprit. As these variants emerge in many areas, threatening to become the dominant strains, they temper our hopes to terminate the pandemic with the available vaccines.