Severe Acute Respiratory Syndrome Coronavirus 2 P.2 Lineage Associated with Reinfection Case, Brazil, June–October 2020

T he effi ciency and persistence of natural protec- tive immunity caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination are currently unknown.Reinfection cases have been reported in different countries (1), but the differentiation between cases of reinfection and viral persistence remains a challenge.The detection of 2 coronavirus disease (COVID-19) episodes >90 days apart and caused by 2 different lineages of SARS-CoV-2 remains the most reliable evidence of reinfection (2).In this article, we describe a reinfection case and highlight details about the genomic features of the 2 COVID-19 episodes.In addition, we demonstrate that the virus in the second episode was related to the emerging variant of interest (VOI) designated as lineage P.2, which is currently circulating throughout Brazil. Methods Case DescriptionA 37-year-old female physician with no underlying conditions reported 2 episodes of COVID-19 in the state of Rio Grande do Norte in the northeastern region of Brazil.The fi rst episode occurred in June 2020 and the second in October 2020; a total of 116 days occurred between the 2 episodes.On June 17, the case-patient, who lives in Rio Grande do Norte and works in the neighboring state of Paraíba, experienced symptoms such as headache, runny nose, diarrhea, and myalgia, and her illness was classifi ed as a mild COVID-19 case with no complications A 37-year-old healthcare worker from the northeastern region of Brazil experienced 2 clinical episodes of coronavirus disease.Infection with severe acute respiratory syndrome coronavirus 2 was confi rmed by reverse transcription PCR in samples collected 116 days apart.Whole-genome sequencing revealed that the 2 infections were caused by the most prevalent lineage in Brazil, B.1.1.33,and the emerging lineage P.2.The fi rst infection occurred in June 2020; Bayesian analysis suggests reinfection at some point during September 14-October 11, 2020, a few days before the second episode of coronavirus disease.Of note, P.2 corresponds to an emergent viral lineage in Brazil that contains the mutation E484K in the spike protein.The P.2 lineage was initially detected in the state of Rio de Janeiro, and since then it has been found throughout the country.Our fi ndings suggest not only a reinfection case but also geographic dissemination of the emerging Brazil clade P.2.