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January 20, 2023

COVID-19 roundup: New omicron subvariants may be up to 21x more evasive against vaccine antibodies

Daily Briefing

    FDA cautions that Evusheld may not be effective against the XBB.1.5 omicron subvariant, new studies suggest the coronavirus may be able to survive in infected patients even after death, and more in this week's roundup of COVID-19 news.

    • Newer omicron subvariants, such as BQ.1.1 and XBB.1, were up to 21 times more evasive against vaccine antibodies compared to BA.5, according to a new study published in the New England Journal of Medicine. For the study, researchers from Beth Israel Deaconess Medical Center assessed neutralizing antibody titers from 16 patients who had received a monovalent Pfizer-BioNTech booster in 2021, 15 patients who had received a monovalent booster in 2022, and 18 participants who had received an updated bivalent booster in 2022. Among those who had received a monovalent booster in 2021, their antibody titers were three times higher for BA.5 compared to BQ.1.1 and eight times higher compared to XBB.1. Among those who had a monovalent booster in 2022, their antibody titers against BA.5 were seven times higher than BQ.1.1 and 17 times higher than XBB.1. Finally, participants who received a bivalent booster had antibody titers against BA.5 that were seven times higher than BQ.1.1 and 21 times higher than XBB.1. "These findings suggest that the BQ.1.1 and XBB.1 variants may reduce the efficacy of current mRNA vaccines and that vaccine protection against severe disease with these variants may depend on CD8 T-cell responses," the researchers wrote. (Hein, MedPage Today, 1/18)
    • Between Jan. 7 and Jan. 13, the prevalence of the omicron subvariant XBB.1.5 jumped more than 50%, according to CDC data. For the week ending Jan. 7, XBB.1.5 made up roughly 28% of all COVID-19 cases. By Jan. 13, CDC estimated that XBB.1.5 had increased to 43% of all cases. "XBB.1.5 is no slouch," said Eric Topol, founder and director of the Scripps Research Translational Institute. "It is outcompeting a soup of new omicron variants that have arisen in recent months. With XBB.1.5 rapidly spreading across the United States, the country has also seen an uptick in hospitalizations over the last few weeks. As of Jan. 12, there were an average of 45,600 patients hospitalized with COVID-19—an increase of 9% over the past two weeks. Although this number is still far below the levels seen during last year's winter omicron surge, hospitals are still facing significant capacity issues amid staffing shortages and surges of other respiratory viruses. (Carbajal, Becker's Hospital Review, 1/13)
    • FDA earlier this month said AstraZeneca's preventive monoclonal antibody treatment Evusheld is unlikely to be effective against the omicron subvariant XBB.1.5. According to the agency, it does not expect "Evusheld will neutralize XBB.1.5," but is "awaiting additional data to verify that [the drug] is not active against XBB.1.5." Going forward, FDA recommends health care providers inform their patients about the increased risk of infection from variants not neutralized by Evusheld. As new information arises, the agency will provide further updates. Currently, White House officials say that while Evusheld and other monoclonal antibody treatments have not been effective against XBB.1.5, the updated booster and antivirals such as Paxlovid can still be used to combat the new subvariant. (Choi, The Hill, 1/6)
    • Johnson & Johnson (J&J) has significantly scaled back production of its COVID-19 vaccine amid waning global demand. Initially, U.S. regulators cleared J&J's vaccine for use in February 2021, but manufacturing issues, as well as the risk of a rare but serious blood clotting condition, largely limited its use. Still, J&J formed partnerships with several companies, including Catalent, Sanofi, and Merck, to produce doses of its vaccine during the pandemic. However, with waning demand and other production problems emerging, J&J has ended several of its contracts and is currently in arbitration with Merck. According to Prashant Yadav, a supply chain expert and senior fellow at the Center for Global Development, J&J was trying to produce their vaccines in "the best way possible to meet global demand, but all of those plans fell apart." (Hopkins/Loftus, Wall Street Journal, 1/13)
    • The coronavirus may be able to survive in the bodies of infected patients even after their death, according to two new studies from Japan. In the studies, researchers examined samples from the noses and lungs of 11 patients who died from COVID-19 and found that high amounts of the virus were found in six of the 11 corpses, even 13 days after their deaths. "It was surprising that infectious titers were preserved at the same high level as in the clinical patients," wrote Hisako Saitoh, a researcher from Chiba University who led the studies. "What was most surprising, however, were the results of the animal experiments." In the animal experiments, researchers found that hamsters who had died from COVID-19 within a few days of infection were still able to transmit the virus to live animals, suggesting the same could occur among humans. Although the studies have not yet been peer reviewed, outside experts have said the studies were "well done" and that the results were "compelling," the New York Times writes. In general, viral transmission from the deceased is not likely to be a major issue for many people, but pathologists, medical examiners, and health care workers who handle cadavers may be at an increased risk. Experts have also encouraged bereaved family members to take precautions with their deceased loved ones. (Mandavilli, New York Times, 12/20/22)

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