What do we know about XBB.1.5 and should we be worried?The XBB.1.5 omicron variant of SARS-CoV-2 has been making headlines for weeks. Elisabeth Mahase reports what we know so far Elisabeth MahaseWhat is XBB.1.5? XBB.1.5 is yet another omicron subvariant, and follows on from XBB and XBB.1. Scientists have nicknamed it "kraken" to distinguish it from the "variant soup" we are all navigating three years into the pandemic. 1 The X signifies that these subvariants came about through a recombination of two or more sublineages-in this case BA.2.10.1 and BA.2.75. 2 According to UCL Genetics Institute director Francois Balloux, a professor of computational systems biology, XBB.1.5 differs from XBB.1 through the addition of a F486P mutation in the spike protein."This mutation makes it slightly less immune evasive than its XBB.1 ancestor but more infectious, probably because it increases binding affinity to the human cell receptor ACE-2," he said.
The world is no more prepared for the next pandemic than it was for the covid-19 pandemic, a leading expert on infectious diseases has warned.Carlos del Rio, president of the Infectious Diseases Society of America (IDSA), said that irrespective of whether the World Health Organization decides to downgrade the status of covid-19 from a pandemic, the real focus of public health action should now be on building pandemic preparedness."My advice is, if we close the chapter on covid-19, [that] we don't close the book on public health, and we really think about building pandemic preparedness as a true strategy going forward. If we don't do that, we would have really missed a huge opportunity. We cannot be caught the same way we were with covid," he told a joint press briefing between the IDSA and the European Society of Clinical Microbiology and Infectious Diseases on 24 January.
Excellence (NICE) has decided not to recommend Evusheld for adults who are unlikely to have an adequate immune response or cannot have the vaccine against covid-19, citing a lack of evidence that it is effective against circulating variants. 1In its draft guidance NICE said that it would not be approving Evusheld, a combination of the long acting antibodies tixagevimab and cilgavimab, as a pre-exposure prophylactic for vulnerable adults. However, it is still reviewing whether the antibody drug could be used to prevent covid-19 infection in adults at the highest risk of severe illness, including people with immunodeficiency, people who have had a solid organ transplant, and people with cancer.The recommendation comes after the US Food and Drug Administration withdrew its emergency use authorisation for Evusheld in January. At the time it said that the treatment was unlikely to be effective against the XBB.1.5 subvariant of omicron dominating the country. The FDA had authorised the drug in late 2021 to prevent covid infection in clinically extremely vulnerable people. 2
Are we still tracking covid cases?Although the UK significantly scaled back its covid surveillance earlier this year, 1 the Office for National Statistics' coronavirus infection survey, 2 which involves an online questionnaire and swab and blood samples, and the Real-time Assessment of Community Transmission (REACT-1) study both continue. 3 The ZOE covid study was also given additional funding by the Department of Health and Social Care for England in June this year to continue its work on tracking cases and symptoms. This study relies on a smartphone app in which members of the public can log their symptoms daily. 4
NICE has recommended three drugs-nirmatrelvir plus ritonavir (Paxlovid), tocilizumab (RoActemra), and baricitinib (Olumiant)-for the treatment of covid-19 in adults, as part of draft guidance. 1 The review of the efficacy and cost effectiveness of drugs currently being used in the NHS to treat covid-19 considered treatments in the context of routine commissioning, rather than their use in exceptional circumstances, such as during a pandemic.NICE has not recommended other covid-19 treatments, including casirivimab plus imdevimab (Ronapreve), molnupiravir (Lagevrio), remdesivir (Veklury), sotrovimab (Xevudy), and tixagevimab plus cilgavimab (Evusheld).Currently, access to covid-19 drugs is guided by the UK wide clinical access policies agreed by the UK chief medical officers. Once the final NICE guidance is published, however, it will inform routine commissioning decisions for these treatments.
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