Tag Archives: Omicron

Boston University coronavirus experiment reveals new weak spot in omicron

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A controversial coronavirus experiment at Boston University has identified a mutation in the omicron variant that might help explain why it doesn’t appear to be as likely to sicken or kill as the original strain that emerged in China. The finding could offer scientists a new target for designing therapies that limit the severity of covid.

The report, published Wednesday in the journal Nature, comes three months after researchers posted an early version of the study that ignited a media firestorm, as well as confusion over who, exactly, funded the work and whether it required greater government oversight.

In a lab experiment, the researchers combined the spike protein of an early lineage of omicron with the backbone of the original strain that emerged in Wuhan, China. The work, though not significantly different from numerous other experiments, drew media attention and set off fears that such manipulation of the coronavirus could unleash a more dangerous variant.

Proponents of the work counter that this experiment was fairly routine for pathogen research, which often involves the creation of “recombinant” viruses that mimic what happens in nature. The experiment was conducted by researchers wearing many layers of protective gear inside a biosafety Level 3 laboratory at the university’s ultra-secure National Emerging Infectious Diseases Laboratory.

The purpose of creating such a “chimeric” virus, which the scientists dubbed Omi-S, was to try to understand which of the mutations in omicron might be responsible for making it seemingly less pathogenic — that is, less likely to create severe illness — than the original strain.

The chimeric virus grew just like omicron in cell cultures. Omi-S turned out to be only a little less pathogenic in mice than the ancestral strain, with 80 percent mortality rather than 100 percent. It was still deadlier than omicron.

The research showed that omicron’s heavily mutated spike protein plays a role in making the variant less pathogenic than the ancestral strain. But the behavior of Omi-S suggested to lead researcher Mohsan Saeed, an assistant professor of biochemistry at Boston University, and other co-authors of the study that there had to be something else contributing to the phenomenon.

The researchers kept experimenting, and now they claim to have found at least one missing piece of the puzzle: a mutation involving a protein called nsp6.

Unlike the spike protein studded across the surface of the coronavirus, nsp6 is a “nonstructural” protein, as its name suggests. Researchers point out that many proteins encoded by SARS-CoV-2 are not part of the mainframe of the coronavirus but instead interact with the host in ways that are often mysterious.

“The reason that paper is important, it’s the first time where there is another gene that is encoded by the SARS-CoV-2 virus that is shown to be involved in pathogenicity,” said Ronald Corley, chair of microbiology at Boston University Chobanian & Avedisian School of Medicine.

“That represents a target protein for therapeutics,” said Corley, who is not a co-author of the paper but until recently was director of the laboratory.

The research drew widespread attention in October after Saeed posted an early version of the study on the preprint server bioRxiv, where scientists have put thousands of early drafts of their coronavirus research in advance of formal peer review.

Critics of pathogen research have long contended that the field lacks adequate safety reviews and oversight, and that some experiments are far too risky to justify any potential increase in knowledge. The Boston University experiment was seen as an example of “gain of function” research, in which a virus is manipulated in a way that could make it either more transmissible or more pathogenic.

Corley and other defenders of the experiment countered that it actually made the ancestral strain less deadly in mice.

Complicating the debate was uncertainty over whether the National Institutes of Health had funded the experiment. The original preprint version cited NIH as one of the funding sources, but the university said the research was done independently. An NIH spokesperson later confirmed that the agency did not fund the work.

Robert F. Garry, a Tulane University virologist who was not part of the study, said in an email that more research on nsp6 must be done to understand its significance. He also dismissed the fears that such research is too dangerous.

“Just the fact that it passed peer-review should alert everyone to the fact that prior ‘concerns’ were overblown and alarmist,” Garry said.

The National Institutes of Health charged a biosafety review board early last year with revisiting all the guidelines and protocols for research on potential pandemic pathogens, as well as what is known as “dual-use research of concern,” in which research intended to benefit human health could also be weaponized.

The biosafety board has signaled that it will recommend broadening the definition of experiments requiring special review. The board will release its report in the coming weeks, according to NIH.



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Study explores incidence, severity, and long COVID associations of SARS-CoV-2 reinfections

In a recent study posted to the medRxiv* preprint server, a team of researchers from the United States used electronic health records to characterize the incidence, biomarkers, attributes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections and evaluated the association between reinfections and long coronavirus disease (COVID).

Study: SARS-CoV-2 Reinfection is Preceded by Unique Biomarkers and Related to Initial Infection Timing and Severity: an N3C RECOVER EHR-Based Cohort Study. Image Credit: Ralf Liebhold/Shutterstock

Background

The emergent SARS-CoV-2 variants are increasing the incidence of breakthrough infections. Mutations in spike protein regions of these variants that increase immune escape, combined with the waning of the immunity induced by coronavirus disease 2019 (COVID-19) vaccines and previous SARS-CoV-2 infections are resulting in a rise in reinfections. Studies based on whole genome sequences of the SARS-CoV-2 variants isolated from reinfected patients have revealed that the variants responsible for reinfections are distinct from those that caused the earlier infections. However, there is a dearth of information on whether reinfections differ from the initial infection in their incidence, severity, and attributes, as well as on the long COVID complications after SARS-CoV-2 reinfections.

About the study

In the present study, the team used electronic health record data of a cohort exceeding 1.5 million individuals involved in the National COVID Cohort Collaborative (N3C), which is a part of the National Institute of Health’s Researching COVID to Enhance Recovery (RECOVER) initiative. This data was used to evaluate the incidence, biomarkers, and attributes of SARS-CoV-2 reinfections and understand the association between post-acute sequelae of SARS-CoV-2 infection (PASC) and reinfections.

Reinfection was defined based on a positive SARS-CoV-2 antigen or polymerase chain reaction (PCR) test more than 60 days after the index date for the initial SARS-CoV-2 infection. Long COVID was defined based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

Reinfections were also examined according to the epochs of SARS-CoV-2 variants, with the epoch of the wild-type strain spanning the March to November 2020 period, the Alpha, Beta, and Gamma variants dominating the December 2020–May 2021 period, and the Delta variant epoch spanning the June 2021–October 2022 period. The Omicron epoch was divided into two parts for the Omicron variant and the Omicron BA variants, corresponding to November 2021–March 2022 and March–August 2022, respectively.

Biomarkers such as inflammation, coagulopathies, and organ dysfunction can be used to characterize SARS-CoV-2 infections. A wide range of biomarkers, including laboratory measurements of white blood cell counts, erythrocyte sedimentation rates, C-reactive protein, serum creatinine, albumin, and many more, were used to characterize reinfections.

COVID-associated hospitalization data was used to determine the severity of reinfections. Mild infections included those that did not require a visit to the emergency department or hospitalization, while those requiring hospitalization were categorized as moderately severe, and cases requiring hospitalization, invasive mechanical ventilators, vasopressors, or extracorporeal membrane oxygenation were considered severe infections.

The period between reinfection and long COVID diagnoses was compared with that between the initial infection and diagnosis of long COVID to understand the relationship between reinfections and PASC.

Results

The results indicated that most individuals in the cohort had one reinfection, with a small group comprising largely of non-Hispanic White males and older individuals having had three or more reinfections. The largest number of reinfections during the Omicron epoch were among individuals who had initial SARS-CoV-2 infections during the epochs of the wild-type, Alpha, Beta, and Gamma strains, followed by reinfections among those with initial Delta infections.

Analyses of biomarkers revealed that compared to the initial SARS-CoV-2 infection, reinfections showed lower elevation of hepatic inflammation markers such as alanine transaminase (ALT) and aspartate transaminase (AST). However, albumin levels were consistently low in reinfection patients.

Furthermore, the severity of reinfections was found to be associated with the severity of the initial SARS-CoV-2 infections. A majority of the cohort experienced mild symptoms during the initial infections and reinfections and did not require hospitalization or a visit to the emergency department. Compared to the initial infection, the percentage of individuals who required hospitalization or succumbed to the infection after reinfection was marginally lower (14.4% vs. 12.6%). Close to half the patients who experienced a severe initial SARS-CoV-2 infection had moderate symptoms requiring hospitalization or emergency department visits during reinfection. Additionally, 7.4% of the individuals who had a severe initial infection had severe infections, and 5.7% succumbed to the reinfection.

Long COVID diagnoses also occurred in a shorter time frame for infections or reinfections during the Omicron epoch, as compared to infections during the Delta epoch or those with other variants.

Conclusions

Overall, the results indicated that the severity of SARS-CoV-2 reinfections was similar to those of the initial infection, with individuals who experienced mild to moderate symptoms during the first infection having similar symptoms during reinfection, while individuals who experienced a severe initial infection having similar reinfection symptoms or succumbing to the disease after reinfection.

Additionally, the study reported that long COVID diagnoses during the Omicron epoch occurred much closer to the index date of the infection or reinfection, and the number of long COVID diagnoses also showed an increase after reinfections with recent variants.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

  • Emily Hadley, Yun Jae Yoo, Saaya Patel, Andrea Zhou, Bryan Laraway, Rachel Wong, Alexander Preiss, Rob Chew, Hannah Davis, Christopher G Chute, Emily R Pfaff, Johanna Loomba, Melissa Haendel, Elaine Hill, Richard Moffitt. (2023). SARS-CoV-2 Reinfection is Preceded by Unique Biomarkers and Related to Initial Infection Timing and Severity: an N3C RECOVER EHR-Based Cohort Study:  and the N3C and RECOVER consortia. medRxiv. doi: https://doi.org/10.1101/2023.01.03.22284042 https://www.medrxiv.org/content/10.1101/2023.01.03.22284042v1

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New COVID Variant Sends NYC Case Rates Soaring; Hospitalizations High – NBC New York

What to Know

  • You’ve probably heard about the XBB.1.5 variant; it’s the latest “most transmissible COVID variant yet” and appears to be better at binding to human cells, which may make it more adept at infecting
  • There’s no evidence at this point that the strain, a combination of two prior omicron subvariants, is more lethal or more likely to cause COVID complications, but as a top White House official said last week, if you haven’t been vaccinated or infected lately, your protection probably isn’t so good
  • Nowhere is XBB.1.5 more prevalent than in the northeastern United States, according to the CDC — and rolling hospitalization and death rates, along with cases, are climbing accordingly

COVID-19 hospitalizations in New York and New Jersey have soared to 11-month highs as the most transmissible variant yet, a combination of two prior omicron strains, fuels yet another infection wave nearly three full years into the pandemic, the latest federal health data show.

Deaths are also climbing, with weekly fatality reports for both states currently at their highest levels since early last year, according to the CDC. In New York City, the rolling COVID fatality average is the highest it’s been since February 2022, while rolling hospitalizations are at a height not seen since the downswing of the initial omicron wave.

CDC COVID guidelines say face masks should be worn across the board in New York City, Long Island and much of the Hudson Valley, given the high spread rate. And the entire state of New Jersey is at the agency’s highest risk level, its latest data shows. While elected officials and their health departments have advised people to follow those guidelines, especially if they’re more vulnerable in terms of age or underlying conditions, no new mandates have been issued.


CDC

COVID community levels in NY



CDC

COVID community levels in NJ


And no new mandates are expected, either, at this point in the pandemic.

New York Gov. Kathy Hochul and New Jersey Gov. Phil Murphy, both of them Democrats, are each set to deliver their State of the State addresses on Tuesday. It remains to be seen whether the ongoing COVID response will once again play a feature role in those speeches. Given these charts, the odds are fairly likely.

NEW YORK STATE COVID TRENDS (via CDC)

HOSPITALIZATIONS



CDC


CASES AND DEATHS


CDC

COVID cases and deaths in New York via CDC


Last week, New York state’s Department of Health announced the XBB.1.5 variant is far and away the most dominant strain locally, accounting for more than 50% of statewide infections. That share is likely considerably higher, given the relatively low proportion of positive tests that undergo the exhaustive genetic sequencing process to isolate variants.

The same can be said for New Jersey, where the 38.4% share of sequences cases tied to XBB.1.5 reflects data not updated since mid-December. In New York City, where data also lags, XBB.1.5’s prevalence is likely well above the 68% share that the health department last updated on Christmas Eve.

NEW JERSEY COVID TRENDS


CDC

New Jersey COVID hospitalization trends



CDC

New Jersey COVID case and death trends


The latest CDC data suggests that XBB.1.5 is spreading in the northeastern United States at a much higher rate than the rest of the country, accounting for up to 81% of cases in the region comprising New York and New Jersey compared with a 43% high estimate for the nation.

While there is “not yet clear evidence,” according to New York state, that XBB.1.5 significantly affects COVID’s virulence or disease severity, early data does indicate it is more infectious than other circulating variants. The fact it has emerged at a time when both COVID and flu cases remain high is further cause for heightened caution, it says.

New York City positivity rates are bearing out the transmissibility concerns, with more than a third of neighborhoods across the five boroughs seeing those numbers in excess of 20% — and some spots topping 30% positivity.

NYC COVID VARIANT AND HOSPITALIZATION DATA


NYC

This chart represents COVID variants in NYC. The top line is XBB.1.5.



NYC Health Department

NYC COVID hospitalization trends


Omicron is still classified as a variant of concern according to the CDC and the World Health Organization. That strain, which first emerged in South Africa in November 2021, though likely was there earlier, is the only variant of concern currently in circulation, according to WHO.

To be a variant of concern, WHO says a strain must be associated with one or more of the following changes at a degree of global significance:

  • Increase in transmissibility or detrimental change in COVID-19 epidemiology; OR
  • Increase in virulence or change in clinical disease presentation; OR
  • Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, therapeutics

The CDC said the new COVID-19 variant is responsible for 75% of new cases.

Given their level of infectiousness and ongoing mutation, WHO advises each omicron descendant be monitored distinctly. That’s what officials in New York and New Jersey continue to do as they plead with the public to double down on the mitigation factors that have proven to work since the onset of the pandemic, from hand-washing and staying home when sick to vaccination, masking up in crowded areas and getting tested regularly.

Hochul continues to urge New Yorkers — and so does the White House — to get their updated bivalent booster shots if they haven’t already (see vaccine data). The head of the White House Task Force on COVID recently underscored the point, saying if you haven’t been infected lately or had that booster, you’re likely not protected from XBB.1.5.

Overall, experts say that healthy, vaccinated people still are at much lower risk for COVID complications than immunocompromised or un- and undervaccinated people.

As Hochul said in her latest COVID update, “I urge everyone to remain vigilant and continue to use all available tools to keep themselves, their loved ones and their communities safe and healthy. Stay up to date on vaccine doses, and test before gatherings or travel. If you test positive, talk to your doctor about potential treatment options.”


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The ‘Kraken’ COVID subvariant: What to know about quickly rising omicron descendant

Editor’s note: This page will be updated as new data about XBB.1.5 emerges.

A new flavor of the omicron variant of SARS-CoV-2, the virus that causes COVID-19, was identified in October 2022. In the past several weeks, it has steadily gained prominence in the United States. The subvariant is known as XBB.1.5 but has also been given the unofficial nickname “Kraken,” after the mythical sea monster.

Here’s what we know so far about XBB.1.5 so far.

Related: Most widely used COVID-19 vaccines and how they work 

How did XBB.1.5 emerge and where is it spreading?

Scientists first identified XBB.1.5 in New York state in October 2022, The New York Times reported (opens in new tab)

The subvariant stems from a broader branch of the omicron family tree known as “XBB,” which emerged as a result of two earlier versions of omicron — BA.2.10.1 and BA.2.75 — swapping genes, according to the World Health Organization (opens in new tab) (WHO). These closely related omicron subvariants had the opportunity to swap genes when they infected the same person at the same time. 

From their two parents, XBB viruses gained mutations that helped them evade protective antibodies gained through prior COVID-19 infections and through vaccinations. But there was a tradeoff: XBB viruses simultaneously lost some of their ability to bind tightly to cells, a key step in infection, the New York Times reported. This may explain why other versions of omicron initially outcompeted XBB viruses.

However, as XBB viruses spread, they picked up new mutations and XBB.1.5, a.k.a. the “Kraken,” was born. The Kraken harbors a mutation called F486P, which appears to restore the virus’s ability to tightly latch onto cells, researchers reported Jan. 5 in research posted to the preprint database bioRxiv (opens in new tab). (This research has not yet been peer-reviewed or published in a scientific journal.)

In a Jan. 4 news conference (opens in new tab), WHO Director-General Dr. Tedros Adhanom Ghebreyesus (opens in new tab) reported that XBB.1.5 is “on the increase in the U.S. and Europe and has now been identified in more than 25 countries.” Genomic data submitted to the open access database GISAID (opens in new tab) shows that U.S., U.K., Austria, Denmark, Canada, Israel and Germany have detected the most XBB.1.5 sequences so far, and that the subvariant remains relatively rare elsewhere. 

How easily does it spread?

Available evidence suggests that XBB.1.5 is the “most transmissible” omicron descendent yet detected, Maria Van Kerkhove (opens in new tab), the WHO’s COVID-19 technical lead, said at a news conference on Jan. 4, according to The New York Times. In the U.S., XBB.1.5 is beginning to gain dominance over other circulating omicron subvariants. 

In early December, the Kraken made up an estimated 2% of all COVID-19 cases in the U.S., The Washington Post reported (opens in new tab). That figure jumped to 40% in the last week of December, STAT reported (opens in new tab)

The Centers for Disease Control and Prevention (opens in new tab) (CDC) have not yet analyzed all the data from early January 2023, but their current projections suggest that XBB.1.5 accounted for more than 27% of U.S. cases in the first week of the year. In the northeastern U.S., where XBB.1.5 was first detected and remains most common, the subvariant accounts for more than 70% of new cases, according to The Washington Post.

That said, nationwide, other flavors of omicron — namely BQ.1 and BQ.1.1 — were still circulating at comparable levels to XBB.1.5 during the first week of January, the CDC’s projections suggest.

Is XBB.1.5 more likely to cause severe disease?

Scientists will need to see many weeks of hospitalization and death data before determining whether XBB.1.5 is more likely to trigger severe disease compared with earlier versions of SARS-CoV-2, the virus that causes COVID-19. 

As the U.S. experiences a nationwide surge in COVID-19 infections, “we’re seeing hospitalizations have been notching up overall across the country,” Dr. Barbara Mahon (opens in new tab), director of CDC’s Coronavirus and Other Respiratory Viruses Division, told NBC News (opens in new tab). “They don’t appear to be notching up more in the areas that have more XBB.1.5,” which hints that the subvariant isn’t necessarily more likely to cause severe disease than its predecessors. 

How well do boosters and treatments work against XBB.1.5?

Early data suggests that the so-called bivalent boosters — the two recently updated boosters made by Moderna and Pfizer — offer decent protection against XBB viruses, despite the lineage’s ability to evade antibodies, according to a Dec. 21 report in the New England Journal of Medicine (opens in new tab)

“Lab studies suggest that the bivalent vaccine is still effective in protecting against severe disease, though perhaps not as much against infection,” Andy Pekosz (opens in new tab), a professor of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, said in a statement (opens in new tab). “XBB.1.5 is derived from the omicron variant BA.2, and while the current bivalent vaccine was developed for the BA.5 variant, it has been shown to generate antibodies that recognize BA.2,” he said.

“Things like boosters are always beneficial,” Kristian Andersen (opens in new tab), a professor in the department of immunology and microbiology who tracks coronavirus variants at the Scripps Research Institute, told The Washington Post. “Even if you get infected, you are expected to have less viral load, and you are expected to be able to transmit the virus less.”

(Notably, as of Jan. 4, less than 16% of eligible U.S. residents had received a bivalent booster, the CDC reported (opens in new tab).)

Palxovid, an oral antiviral pill used to treat COVID-19, will be effective at treating infections with XBB.1.5, The New York Times reported. The pill may not be prescribed to all COVID-19 patients, as it’s not compatible with certain medications, Pakosz noted, “but overall, for the vast majority of people, Paxlovid is still a good drug to be prescribed if you get COVID-19.”

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XBB.1.5 may be ‘most transmissible subvariant of Omicron to date,’ scientists warn



CNN
 — 

Health experts voiced concern Wednesday over the rapid growth of the new Omicron sublineage XBB.1.5, advising the public to stay informed but not alarmed as they work to learn more.

Over the month of December, the percentage of new Covid-19 infections in the United States caused by XBB.1.5 rose from an estimated 4% to 41%.

“That’s a stunning increase,” Dr. Ashish Jha, the White House Covid-19 response coordinator, wrote in a Twitter thread.

Officials at the World Health Organization shared similar thoughts Wednesday.

“We are concerned about its growth advantage,” said Maria Van Kerkhove, an epidemiologist who is the WHO’s technical lead on Covid-19.

Van Kerkhove noted that XBB.1.5, which was first detected in the United States, has spread to at least 29 countries and “is the most transmissible form of Omicron to date.”

“We do expect further waves of infection around the world, but that doesn’t have to translate into further waves of death because our countermeasures continue to work,” she said.

Jha noted that effective tools to avoid severe Covid-19 infections include rapid tests, high-quality masks, ventilation and filtration of indoor air, oral antiviral pills and updated vaccines.

“We will soon have more data on how well vaccines neutralize XBB.1.5,” Jha said, suggesting that research to determine vaccine effectiveness against the new sublineage is underway.

Jha said XBB.1.5 is probably more able to slip past our immune defenses and may be more contagious. But he said it’s still not clear whether it causes more severe disease, something that was also stressed by Van Kerkhove.

She said WHO is working on a risk assessment for this sublineage and hopes to publish it within the next few days. The group’s technical advisers are looking at both real-world data on hospitalizations and lab studies to assess severity.

Jha said that although he is concerned about XBB.1.5, he doesn’t think it represents a huge setback in the fight against Covid-19.

“And if we all do our part,” he wrote, “We can reduce the impact it will have on our lives.”



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Infectiousness of SARS-CoV-2 breakthrough infections and reinfections during the Omicron wave

Using detailed epidemiologic data from SARS-CoV-2 surveillance within the California state prison system, we found that vaccination and prior infection reduced the infectiousness of SARS-CoV-2 infections during an Omicron-predominant (subvariants BA.1 and BA.2) period. Vaccination and prior infection were each associated with similar reductions in infectiousness during SARS-CoV-2 infection, and, notably, additional doses of vaccination (for example, booster doses) against SARS-CoV-2 and more recent vaccination led to greater reductions in infectiousness. Of note, reductions in transmission risk associated with vaccination and prior infection were found to be additive, indicating an increased benefit conferred by vaccination for reducing cases’ infectiousness even after prior infection. Irrespective of vaccination and/or prior natural infection, SARS-CoV-2 breakthrough infections and reinfections remained highly infectious and were responsible for 80% of transmission observed in the study population, which has high levels of both prior infection and vaccination. This observation underscores that vaccination and prevalent naturally acquired immunity alone will not eliminate risk of SARS-CoV-2 infection, especially in higher-risk settings, such as prisons.

Prior studies during the Delta variant wave and before widespread booster vaccination are mixed on whether SARS-CoV-2 breakthrough infections in vaccinated individuals are potentially less infectious6,7,8 or equally infectious9,10 to primary infections. In more recent household contact studies during the Omicron variant era11,12,13, vaccination often led to reduced SARS-CoV-2 infectiousness. Several factors may have enhanced our ability to observe statistically meaningful findings in the present study. The risk of transmission among close contacts in the prison setting and consistency in contact structure, especially in light of increased transmissibility of the Omicron SARS-CoV-2 variant, may have enhanced statistical power in our sample. Relatedly, a higher proportion of index cases in our sample were previously vaccinated or infected, further enhancing the opportunity to compare transmission risk from vaccinated or unvaccinated index cases and from those who were previously infected or previously uninfected.

A key result is that the vaccine-mediated reduction in infectiousness of SARS-CoV-2 breakthrough infections appears to be dose dependent. Each dose of the vaccine provided an additional average 11% relative reduction in infectiousness, which was mostly driven by residents with a booster dose. The findings of this study support the indirect effects of COVID-19 vaccination (especially booster doses) to slow transmission of SARS-CoV-2 and build on evidence of the direct effects of COVID-19 vaccination23 to emphasize the overall importance of COVID-19 vaccination. The public health implication of these findings is further support for existing policy using booster doses of vaccination24 to achieve the goal of lowering population-level transmission. The impact of additional bivalent vaccine doses, which are now authorized for individuals over 5–6 years of age25, on transmission should be a priority for further study. Additional considerations about the timeliness of vaccine doses are also necessary, as we found that index cases with more distant history of COVID-19 vaccination had a higher risk of transmission of infection to close contacts. Given this finding, this study raises the possibility of timed mass vaccination in incarcerated settings during surges to slow transmission.

The findings from this study have direct implications in addressing COVID-19 inequities in the incarcerated population through additional vaccination. In California state prisons at the time of this study, although 81% of residents and 73% of staff have completed a primary vaccination series, only 59% of residents and 41% of staff have received the number of vaccination doses recommended by the Centers for Disease Control and Prevention based on their age and comorbid medical conditions26. Our findings also provide a basis for additional considerations for housing situations of cases based on prior vaccination and infection history in future surges and can be used alongside other measures, such as depopulation and ventilation interventions, to protect incarcerated populations.

However, this study also underscores the persisting vulnerability to COVID-19 among residents and staff in correctional settings despite widespread vaccination, natural immunity and use of non-pharmaceutical interventions. The overall attack rate of SARS-CoV-2 in the study population (who were generally moved into isolation after symptoms or a positive test) was 30%, and index cases with breakthrough infections or reinfections remained highly infectious, which call into question the ability of high vaccination rates alone to prevent all SARS-CoV-2 transmission in correctional settings. In the United States, which incarcerates more residents per capita than any other country in the world26 and has a quarter of the world’s incarcerated population, correctional settings are characterized by poorly ventilated facilities, populations with increased rates of comorbid health conditions, high-risk dormitory housing and overcrowding18,27,28,29. Given the inability of current efforts to reduce transmission of SARS-CoV-2, decarceration efforts may be the most likely to have substantial effects on reducing cases.

The secondary attack rate in this study was on the lower end of published estimates when comparing to household studies. Of note, the secondary attack rate of the SARS-CoV-2 Omicron variant in recent household studies ranges from 29% to 53%11,12,13, in contrast to a 30% attack rate in this study. The prison environment has distinct epidemiologic differences to households. The dense living environment increases the likelihood of transmission in the prison environment compared to a household, whereas the frequent asymptomatic testing (with isolation of positive cases) in the prisons likely reduced the exposure time and subsequent transmission risk compared to households. The transmission of the prison cell is also likely more uniform than a household.

Strengths of this study include access to detailed records of all residents in the California state prison system, encompassing individuals’ prior COVID-19 vaccine receipt and prior natural infection history (based on frequent testing throughout the pandemic), as well as a social network given record of where residents slept each night over the study period. We use a consistent definition of social contact between the index case of COVID-19 and close contact based on the uniformity of cell type. The frequent testing ensures early identification of infections and systematic capture of asymptomatic and symptomatic infections to avoid bias by participants’ immune status (which could affect temporal onset of symptoms). The risk of misclassification of close contacts is low given that most follow-up testing in close contacts occurred well after first exposure to an index case (Supplementary Notes). The large sample size facilitates analyses of the contribution of combinations of prior vaccination statuses and natural infection on risk of transmission, including analyses examining the impact of booster doses.

Limitations should also be considered. We cannot exclude the possibility of some residual confounding (for example, behavioral differences that affect risk of transmission) between individuals who were vaccinated against SARS-CoV-2 and those who were unvaccinated. There is a possibility that close contacts who test positive for SARS-CoV-2 were not infected by their assigned index case but, instead, by interaction with infectious individuals outside of their cell. However, this misattribution would be expected to dampen apparent associations of transmission risk with index cases’ vaccination status and infection history but not bias the relative estimates. To further address the risk of misattribution, we adjusted for background SARS-CoV-2 incidence and matched contact pairs by facility and time. Our study population is a subset of the entire incarcerated population in California and may not represent all incarcerated settings. Studies of SARS-CoV-2 infectiousness may be subject to biases30,31,32. The strict inclusion and exclusion criteria in this study may introduce bias into the analysis, although we performed sensitivity analyses on these criteria with overall consistent findings. We also adjusted for prior infection in analyses to account for potential concerns about differential susceptibility related to prior infection in vaccinated versus unvaccinated individuals. Given limited SARS-CoV-2 testing capacity early in the pandemic and some residents’ decision to decline testing, it is possible that infections among some residents may not have been captured, although such misclassification would be expected to bias our findings to the null. SARS-CoV-2 testing was variable over time in the prison system, with periods of routine weekly testing and other periods of reactive testing; however, periods without reactive testing align with times during which SARS-CoV-2 was unlikely to be circulating at high levels within the facilities, suggesting that this is unlikely to bias results substantially. The study findings on boosters may also be related to recent vaccination effects. This study design did not provide a basis for identifying effects of vaccination and prior infection on risk of acquiring SARS-CoV-2 among close contacts, although we did adjust for prior infection and vaccination in close contacts in the primary analysis. Of note, vaccine effectiveness against infection among incarcerated persons has been reported within this population during earlier periods33,34. We do not have a detailed record of person-level masking, symptoms, cycle thresholds for polymerase chain reaction (PCR) testing or serologic testing. During the study, the predominant Omicron subvariants in California and California prisons were BA.1 and BA.2 based on genomic surveillance, although we did not genotype every SARS-CoV-2 isolate in this study.

This study demonstrates that breakthrough COVID-19 infections with the Omicron variant remain highly infectious but that both vaccination and natural infection confer reductions in transmission, with benefit of additional vaccine doses. As SARS-CoV-2 breakthrough infections and reinfections become the predominant COVID-19 case, this study supports the importance of booster doses in reducing population-level transmission with consideration of mass timed vaccination during surges, with particular relevance in vulnerable, high-density congregate settings.

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omicron XBB.1.5 is immune evasive, binds better to cells

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The Covid omicron XBB.1.5 variant is rapidly becoming dominant in the U.S. because it is highly immune evasive and appears more effective at binding to cells than related subvariants, scientists say.

XBB.1.5 now represents about 41% of new cases nationwide in the U.S., nearly doubling in prevalence over the past week, according to the data published Friday by the Centers for Disease Control and Prevention. The subvariant more than doubled as a share of cases every week through Dec. 24. In the past week, it nearly doubled from 21.7% prevalence.

Scientists and public health officials have been closely monitoring the XBB subvariant family for months because the strains have many mutations that could render the Covid-19 vaccines, including the omicron boosters, less effective and cause even more breakthrough infections.

XBB was first identified in India in August. It quickly become dominant there, as well as in Singapore. It has since evolved into a family of subvariants including XBB.1 and XBB.1.5.

Andrew Pekosz, a virologist at Johns Hopkins University, said XBB.1.5 is different from its family members because it has an additional mutation that makes it bind better to cells.

“The virus needs to bind tightly to cells to be more efficient at getting in and that could help the virus be a little bit more efficient at infecting people,” Pekosz said.

Yunlong Richard Cao, a scientist and assistant professor at Peking University, published data on Twitter Tuesday that indicated XBB.1.5 not only evades protective antibodies as effectively as the XBB.1 variant, which was highly immune evasive, but also is better at binding to cells through a key receptor.

Scientists at Columbia University, in a study published earlier this month in the journal Cell, warned that the rise of subvariants such as XBB could “further compromise the efficacy of current COVID-19 vaccines and result in a surge of breakthrough infections as well as re-infections.”

The XBB subvariants are also resistant to Evusheld, an antibody cocktail that many people with weak immune systems rely on for protection against Covid infection because they don’t mount a strong response to the vaccines.

The scientists described the resistance of the XBB subvariants to antibodies from vaccination and infection as “alarming.” The XBB subvariants were even more effective at dodging protection from the omicron boosters than the BQ subvariants, which are also highly immune evasive, the scientists found.

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Dr. David Ho, an author on the Columbia study, agreed with the other scientists that XBB.1.5 probably has a growth advantage because it binds better to cells than its XBB relatives. Ho also said XBB.1.5 is about as immune evasive as XBB and XBB.1, which were two of the subvariants most resistant to protective antibodies from infection and vaccination so far.

Dr. Anthony Fauci, who is leaving his role as White House chief medical advisor, has previously said that the XBB subvariants reduce the protection the boosters provide against infection “multifold.”

“You could expect some protection, but not the optimal protection,” Fauci told reporters during a White House briefing in November.

Fauci said he was encouraged by the case of Singapore, which had a major surge of infections from XBB but did not see hospitalizations rise at the same rate. Pekosz said XBB.1.5, in combination with holiday travel, could cause cases to rise in the U.S. But he said the boosters appear to be preventing severe disease.

“It does look like the vaccine, the bivalent booster is providing continued protection against hospitalization with these variants,” Pekosz said. “It really emphasizes the need to get a booster particularly into vulnerable populations to provide continued protection from severe disease with these new variants.”

Health officials in the U.S. have repeatedly called on the elderly in particular to make sure they are up to date on their vaccines and get treated with the antiviral Paxlovid if they have a breakthrough infection.

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BQ, XBB omicron subvariants pose serious threat to boosters

Evusheld injection, a new COVID treatment that people can take before becoming symptomatic, in Chicago on Friday, Feb. 4, 2022.

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The omicron subvariants that have become dominant in recent months present a serious threat to the effectiveness of the new boosters, render antibody treatments ineffective and could cause a surge of breakthrough infections, according to a new study.

The BQ.1, BQ.1.1, XBB and XBB.1 omicron subvariants are the most immune evasive variants of Covid-19 to date, according to scientists affiliated with Columbia University and the University of Michigan. These variants, taken together, are causing 72% of new infections in the U.S. right now, according to data from the Centers for Disease Control and Prevention.

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The scientists, in a study published online Tuesday in the peer-reviewed journal Cell, found that these subvariants are “barely susceptible to neutralization” by the vaccines, including the new omicron boosters. The immune response of people who were vaccinated and had breakthrough infections with prior omicron variants was also weaker against the subvariants.

“Together, our findings indicate that BQ and XBB subvariants present serious threats to current COVID-19 vaccines, render inactive all authorized antibodies, and may have gained dominance in the population because of their advantage in evading antibodies,” the scientists wrote.

Although these subvariants are more likely to cause breakthrough infections, the vaccines have been shown to remain effective at preventing hospitalization and severe disease from omicron, the scientists wrote.

The study examined blood samples from people who received three or four shots of the original vaccines, those who received the new omicron boosters after three shots of the original vaccines, and individuals vaccinated with the original shots who also had breakthrough infections from the BA.2 or BA.5 subvariants.

For people who received the omicron boosters, antibodies that block infection were 24 times lower against BQ.1, 41 times lower against BQ.1.1, 66 times lower against XBB and 85 times lower against XBB.1 compared to their performance against the ancestral strain that emerged in Wuhan, China in 2019.

However, people who received the omicron boosters had modestly higher antibody levels against all of these subvariants compared with people who received three or four shots of the original vaccines, according to the study.

People who were vaccinated and had breakthrough infections had the highest antibody levels of any group in the study, though neutralization was also much lower against the subvariants than the ancestral strain.

The subvariants have evolved away from previous versions of omicron in dramatic fashion. BQ.1.1, for example, is about as different from omicron BA.5 as the latter subvariant is from ancestral Covid strain, according to the study.

“Therefore, it is alarming that these newly emerged subvariants could further compromise the efficacy of current COVID-19 vaccines and result in a surge of breakthrough infections, as well as re-infections,” the scientists wrote.

XBB.1, however, presents the biggest challenge. It is about 49 times more resistant to antibody neutralization than the BA.5 subvariant, according to the study. XBB.1, fortunately, is currently causing no more than 1% of infections in the U.S., according to CDC data.

BQ.1.1 and BQ.1 represent 37% and 31% of new infections respectively, while XBB is causing 4.7% of new infections, according to CDC data.

Antibodies ineffective

Key antibody drugs, Evusheld and bebtelovimab, were “completely inactive” against the new subvariants, according to the study. These antibodies are used primarily by people with weak immune systems.

Evusheld is an antibody cocktail used to prevent Covid in people with weak immune systems who don’t respond strongly to the vaccines. Bebtelovimab is used to prevent Covid from progressing to severe disease in organ transplant patients and other individuals who cannot take other treatments.

“This poses a serious problem for millions of immunocompromised individuals who do not respond robustly to COVID-19 vaccines,” the scientists wrote. “The urgent need to develop active monoclonal antibodies for clinical use is obvious.”

The FDA has already pulled its authorization of bebtelovimab nationwide because it is no longer effective against the dominant omicron variants in the U.S. Evusheld remains authorized as the only option for pre-exposure prophylaxis.

New Covid infections increased by about 50% to 459,000 for the week ending Dec. 7, according to CDC data. Covid deaths increased 61% to nearly 3,000 during the same week. Hospital admissions have plateaued at 4,700 per day on average after rising in November, according to the data.

White House chief medical advisor Dr. Anthony Fauci, in a press briefing last month, said U.S. health officials are hoping there’s enough immunity in the population from vaccination, infection or both to prevent the massive surge of infections and hospitalizations the U.S. suffered last winter when omicron first arrived.

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FDA pulls antibody bebtelovimab because not effective against omicron BQ.1

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An Eli Lilly and Company pharmaceutical manufacturing plant is pictured at 50 ImClone Drive in Branchburg, New Jersey, March 5, 2021.

Mike Segar | Reuters

A key monoclonal antibody used to treat people with weak immune systems who catch Covid is no longer authorized for use in the U.S. because it is not effective against emerging omicron subvariants.

The FDA, in a notice Wednesday, said bebtelovimab is not approved for use because it is not expected to neutralize the omicron BQ.1 and BQ.1.1 subvariants. They are causing 57% of new infections nationally and make up a majority of cases in every U.S. region except one.

The Health and Human Services Department is putting on hold pending requests for bebtelovimab, and the manufacturer Eli Lilliy has also halted commercial distribution of the antibody treatment until further notice, according to the FDA notice.

But bebtelovimab stocks should be kept on hand in the event that Covid variants which the antibody can neutralize become dominant again in the future, according to FDA.

Bebtelovimab is a single-dose injection administered to people who catch Covid and are at high risk of developing severe disease, but cannot take any other FDA-approved treatments such as the oral antiviral Paxlovid. Many people with weak immune systems, such as organ transplant patients, cannot take Paxlovid with other medications they need.

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U.S. health officials have warned that people with weak immune systems face a heightened risk from Covid this winter, because more immune evasive omicron subvariants threaten to knock out antibody treatments they rely on to stay safe from Covid.

Dr. Ashish Jha, the White House Covid coordinator, said in October that the failure of Congress to pass additional Covid funding means treatments will dwindle as new variants render them ineffective.

“We had hoped that over time as the pandemic went along, as our fight against this virus went along, we would be expanding our medicine cabinet,” Jha told reporters. “Because of lack of congressional funding that medicine cabinet has actually shrunk and that does put vulnerable people at risk.”

President Joe Biden has called on people with weak immune systems to consult with their physicians about what extra precautions they should take this winter to stay safe.

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Moderna says new booster increases protection against omicron subvariants

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Vaccine maker Moderna announced Monday that its new omicron-targeted booster shot reinforces a key line of immune defense by increasing levels of coronavirus-fighting antibodies that block BA.5. This omicron subvariant dominated in the United States until recently and still accounts for nearly a third of reported cases.

In blood drawn from people who received the bivalent booster, omicron-blocking antibody levels shot up 15 times higher than their pre-booster levels, Moderna said in a news release. The findings, which are not yet peer-reviewed, are similar to results Pfizer and its German partner, BioNTech, presented this month about their bivalent coronavirus vaccine booster.

The data is encouraging because it shows that the bivalent booster shots, which were updated to match the BA.4 and BA.5 versions of the omicron variant and began to roll out in September, are providing protection against newer coronavirus variants ahead of a possible winter surge of cases.

Moderna also said a preliminary analysis with a small number of subjects showed that the antibodies generated by the bivalent booster lost some potency against the challenging and rapidly growing BQ.1.1 subvariant — but could still block it. BQ.1.1 makes up about a quarter of the cases in the United States, according to the Centers for Disease Control and Prevention.

“Evolution is a dangerous thing to bet against. The virus keeps surprising us, and we need to be ready to update the vaccine,” said Stephen Hoge, Moderna’s president. But he added that he was encouraged by the high antibody levels induced by the booster shot as the country heads into winter.

“I think we’re optimistic this BA.4/BA.5-containing bivalent is going to be sufficient to get us through,” Hoge said.

Moderna’s announcement will intrigue scientists thinking about future booster strategies because the makers of both messenger RNA coronavirus vaccines have now presented convergent results showing their bivalent shots trigger a stronger response than their original formulations.

But the news is somewhat of an artificial comparison to the general public because those original boosters are no longer available. The decision to switch was made over the summer to ensure enough supply to vaccinate people with the updated shots ahead of a potential winter surge of cases.

It is also unclear whether the data will help ignite public interest in the boosters. Only about 10 percent of people 5 and older in the United States have gotten a bivalent booster, according to CDC data.

To measure the effect of the additional shot, scientists compared the virus-blocking antibodies in the blood of 511 people, before and after the bivalent booster or the original one. What these kinds of laboratory experiments cannot predict is how well or how long the higher antibody levels will protect people against infections or severe illness. Most scientists expect the boosters will help shore up protection against the worst outcomes but will not provide as robust protection against infections.

Moderna reported that its bivalent booster created five to six times the level of antibodies compared with the older booster. That is a stronger advantage than the effects of a previous bivalent booster tuned to fight the BA.1 variant. But some scientists have questioned whether differences between the two groups of people that received each type of shot could be partially responsible for some of the advantage.

By contrast, Novavax, a latecomer in the vaccine race, presented data last week suggesting that a bivalent booster of its shot that included the omicron BA.1 subvariant did not offer an advantage over its original booster.

The company did not present data on a BA.4/BA.5-containing bivalent vaccine, but argued that its original shot could continue to offer protection, instead of updating the formula. It is unclear why there are divergent results. Novavax’s chief medical officer, Filip Dubovsky, said last week that the company’s shot may induce a broader response to the variants, which is then strengthened by repeated boosts of the older formulation. Unlike the widely used messenger RNA vaccines from Pfizer-BioNTech and Moderna, the Novavax shot is a protein-based vaccine with an added substance called an adjuvant that’s designed to rev the immune system.

Novavax has said it could update its shot if required by regulatory agencies.

“We’re kind of ready to respond to whatever is required,” Dubovsky said. “But we actually think we have a case that sticking with what we have now, and appears to be working now, is the way to go into the future.”

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