Misclassification bias in estimating clinical severity of SARS-CoV-2 variants – Authors' reply

Nyberg, Tommy; Ferguson, Neil; Blake, Joshua; Hinsley, Wes; Bhatt, Samir; Angelis, Daniela De; Thelwall, Simon; Presanis, Anne M.

doi:10.1016/s0140-6736(22)01432-5

Cited by 3 publications

(1 citation statement)

References 4 publications

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“…28,29,39 As capture of prior infections in individuals’ electronic health records was likely incomplete for both cases with XBB/XBB.1.5 and non-XBB/XBB.1.5 cases, our study likely underestimates the true magnitude of association of prior infection and individuals’ relative likelihoods of infection with XBB/XBB.1.5 or other SARS-CoV-2 lineages. 40 These results demonstrate the considerable ability of XBB/XBB.1.5 to evade immunity resulting from prior infection, in comparison to SARS-CoV-2 variants that have emerged during earlier phases of the pandemic.…”

Section: Discussionmentioning

confidence: 73%

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

Lewnard

Hong

Kim

et al. 2023

Preprint

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Host immune responses are a key source of selective pressure driving pathogen evolution. Emergence of many SARS-CoV-2 lineages has been associated with improvements in their ability to evade population immunity resulting from both vaccination and infection. Here we show diverging trends of escape from vaccine-derived and infection-derived immunity for the emerging XBB/XBB.1.5 Omicron lineage. Among 31,739 patients tested in ambulatory settings in Southern California from December, 2022 to February, 2023, adjusted odds of prior receipt of 2, 3, 4, and ≥5 COVID-19 vaccine doses were 10% (95% confidence interval: 1-18%), 11% (3-19%), 13% (3-21%), and 25% (15-34%) lower, respectively, among cases infected with XBB/XBB.1.5 than among cases infected with other co-circulating lineages. Similarly, prior vaccination was associated with greater protection against progression to hospitalization among cases with XBB/XBB.1.5 than among non-XBB/XBB.1.5 cases (70% [30-87%] and 48% [7-71%], respectively, for recipients of ≥4 doses). In contrast, cases infected with XBB/XBB.1.5 had 17% (11-24%) and 40% (19-65%) higher adjusted odds of having experienced 1 and ≥2 prior documented infections, respectively, including with pre-Omicron variants. As immunity acquired from SARS-CoV-2 infection becomes increasingly widespread, fitness costs associated with enhanced vaccine sensitivity in XBB/XBB.1.5 may be offset by increased ability to evade infection-derived host responses.

show abstract

Section: Discussionmentioning

confidence: 73%

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

Lewnard

Hong

Kim

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

et al. 2023

View full text Add to dashboard Cite

Host immune responses are a key source of selective pressure driving pathogen evolution. Emergence of many SARS-CoV-2 lineages has been associated with enhancements in their ability to evade population immunity resulting from both vaccination and infection. Here we show diverging trends of escape from vaccine-derived and infection-derived immunity for the emerging XBB/XBB.1.5 Omicron lineage. Among 31,739 patients tested in ambulatory settings in Southern California from December, 2022 to February, 2023, adjusted odds of prior receipt of 2, 3, 4, and ≥5 COVID-19 vaccine doses were 10% (95% confidence interval: 1–18%), 11% (3–19%), 13% (3–21%), and 25% (15–34%) lower, respectively, among cases infected with XBB/XBB.1.5 than among cases infected with other co-circulating lineages. Similarly, prior vaccination was associated with greater point estimates of protection against progression to hospitalization among cases with XBB/XBB.1.5 than among non-XBB/XBB.1.5 cases (70% [30–87%] and 48% [7–71%], respectively, for recipients of ≥4 doses). In contrast, cases infected with XBB/XBB.1.5 had 17% (11–24%) and 40% (19–65%) higher adjusted odds of having experienced 1 and ≥2 prior documented infections, respectively, including with pre-Omicron variants. As immunity acquired from SARS-CoV-2 infection becomes increasingly widespread, fitness costs associated with enhanced vaccine sensitivity in XBB/XBB.1.5 may be offset by increased ability to evade infection-derived host responses.

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SARS-CoV-2 variant biology: immune escape, transmission and fitness

et al. 2023

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In late 2020, after circulating for almost a year in the human population, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibited a major step change in its adaptation to humans. These highly mutated forms of SARS-CoV-2 had enhanced rates of transmission relative to previous variants and were termed ‘variants of concern’ (VOCs). Designated Alpha, Beta, Gamma, Delta and Omicron, the VOCs emerged independently from one another, and in turn each rapidly became dominant, regionally or globally, outcompeting previous variants. The success of each VOC relative to the previously dominant variant was enabled by altered intrinsic functional properties of the virus and, to various degrees, changes to virus antigenicity conferring the ability to evade a primed immune response. The increased virus fitness associated with VOCs is the result of a complex interplay of virus biology in the context of changing human immunity due to both vaccination and prior infection. In this Review, we summarize the literature on the relative transmissibility and antigenicity of SARS-CoV-2 variants, the role of mutations at the furin spike cleavage site and of non-spike proteins, the potential importance of recombination to virus success, and SARS-CoV-2 evolution in the context of T cells, innate immunity and population immunity. SARS-CoV-2 shows a complicated relationship among virus antigenicity, transmission and virulence, which has unpredictable implications for the future trajectory and disease burden of COVID-19.

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Misclassification bias in estimating clinical severity of SARS-CoV-2 variants – Authors' reply

Cited by 3 publications

References 4 publications

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

SARS-CoV-2 variant biology: immune escape, transmission and fitness

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