The latest variants of COVID-19 can evade vaccine protection, according to new data

nNew laboratory data suggest that vaccines and previous infections may not offer sufficient protection against several new variants of COVID-19 emerging in the United States and around the world.

Dr. David Ho, director of Columbia University’s Aaron Diamond AIDS Research Center, and his team reported the results of a set of studies published in the journal Nature. They showed how well some of the latest variants – BQ.1, BQ.1.1, XBB and XBB.1, which are all derived from Omicron – evade immunity from both vaccine and infection.

All of these new variants have mutations in the region that binds to and infects cells, meaning they are highly transmissible, as previous Omicron variants were. BQ.1 is growing steadily in France, according to the public database of SARS-CoV-2 variants GISAID. By mid-November, European health officials expect the option to appear account for 50% of cases in Europe, and become the dominant strain in this region by early 2023. XBB is growing rapidly in Singapore and India. Both variants gave rise to new strains, each of which received an additional mutation to create BQ.1.1 and XBB.1. Since the beginning of November, BQ.1 and BQ.1.1, combined, now make up about 35% new cases in the US

others studies have found similar declines in anti-BQ.1 antibody protection among vaccinated humans. But Ho’s group has taken perhaps the most comprehensive look yet at BQ.1, BQ.1.1, XBB, and XBB.1 and how existing immunity stands—from the original mRNA vaccines, the new Omicron boosters, and natural infections to them. The scientists took blood sera from 88 people in five groups (below) and exposed them to the four variants in the laboratory. Here’s what they found:

  • Fully vaccinated and once-boosted people (a total of three injections of the original mRNA vaccines) had 37- and 55-fold lower neutralization against BQ.1 and BQ.1.1, respectively, than against the original SARS-CoV-2 virus and about 70-fold lower neutralization against XBB and XBB. 1.
  • Fully vaccinated and twice regenerated people (a total of four injections of the original mRNA vaccines) had 43- and 81-fold lower neutralization against BQ.1 and BQ.1.1, respectively, than against the original virus, and 145- and 155-fold lower neutralization against XBB and XBB.1, respectively.
  • Fully vaccinated and twice regenerated people (three injections of the original vaccine plus one Omicron booster) had 24- and 41-fold lower neutralization against BQ.1 and BQ.1.1, respectively, than against the original virus, and 66- and 85-fold lower neutralization against XBB and XBB.1, respectively.
  • Fully vaccinated people who received the original booster and were infected with BA.2 had 20- and 29-fold lower neutralization against BQ.1 and BQ.1.1, respectively, than against the original virus, and 103- and 135-fold lower neutralization against XBB and XBB.1, respectively.
  • Fully vaccinated people who received the original booster and who were infected with BA.4 or BA.5 had 13- and 31-fold lower neutralization against BQ.1 and BQ.1.1, respectively, than against the original virus, and 86- and 96-fold lower neutralization against XBB and XBB.1, respectively.

The results showed that people who were infected with BA.2, BA.4 or BA.5 generally had the smallest decline in neutralizing antibody levels against BQ.1 and BQ.1.1. But people who had three doses of the original vaccine and one Omicron booster produced only slightly better protection from neutralizing antibodies against XBB and XBB.1 than those who received three doses of the original vaccine. Public health experts say that although the efficacy of vaccines against newer variants may be waning, they continue to protect people from severe COVID-19. There is early evidence that vaccine-induced immunity may also produce a wider array of virus-fighting antibodies over time.

Read more: BQ.1, BQ.1.1, BF.7 and XBB: Why new variants of COVID-19 have such confusing names

Still, these results are a reminder that vaccines and drug treatments must evolve along with the virus. “These new variants are extremely good at evading our antibodies and are very likely to compromise the efficacy of our vaccines,” says Ho. They may also avoid available antibody-based treatments for COVID-19, he says. The National Institutes of Health Guidelines for the Treatment of COVID-19 currently include only one monoclonal antibody therapy, bebtelovimab, because the virus has evaded all previously allowed antibody treatments. But in an October update, NIH scientists acknowledged that “BQ.1 and BQ.1.1 subvariants are likely to be resistant to bebtelovimab.” Therefore, the drug is only recommended if people cannot take the antiviral drugs Paxlovid or remdesivir, or if these drugs are not available. The virus can evade these treatments as well, but they remain the first line of defense against severe SARS-CoV-2.

The good news is that in places where these variants are circulating, they don’t appear to be associated with more severe COVID-19 disease — as measured by hospitalizations and deaths — compared to other iterations of Omicron. However, public health experts say the surge in infections could still strain health care resources, especially as other respiratory infections, including flu and RSV, are also gaining momentum. The combination of several circulating infectious diseases can mean more illnesses overall and, in turn, more people who may become severely ill and require intensive medical care.

The rise of BQ.1, BQ.1.1, XBB and XBB.1 points to the fact that when it comes to immunity, the virus may always be one step ahead, especially when it comes to vaccines. “I would start making these vaccines and start testing them on animals,” says Ho. Even if these efforts begin now, they may still fall behind the virus and the new mutations it continues to acquire. That’s why researchers are working to develop vaccines that would be more universally applicable to a number of different coronaviruses, which could shorten the time it takes for a vaccinated population to build immunity.

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