Could the Omicron BQ.1 sub-variant threaten to reverse the worldwide decline in COVID cases? Article Swipe

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Mahmoud Tarek Hefnawy , Nour Shaheen , Omar Ahmed Abdelwahab , Rehab Adel Diab , Nishant Parag Soni , Ala’ Abdala Rababah , Youssef Soliman , Muhannad Wael , Almoatazbellah Attalla , Mostafa Meshref · YOU? · · 2023 · Open Access · · DOI: https://doi.org/10.1097/gh9.0000000000000106

Dear Editor, The present evolution of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) pandemic has led to the emergence of several new Omicron sub-variants, including BA.2.75, BA.4.6, XBB, and BQ.1. Recently, more attention is granted globally to the new Omicron sub-variants BQ.1 which has been designated as variant of interest by the European Centre for Disease Prevention and Control (ECDC)1–4. The omicron Q.1 subvariant is currently dominant in the United States and most European countries. It was first detected in early September 2022, and by November 21, it had been detected in 73 different countries and it made up 27.9% of the total SARS‑CoV‑2 cases In the United States5 (Figs. 1, 2). Both BQ.1 and the related BQ.1.1 have surpassed BA.5, which only comprised 19.4% of cases and had been the dominant sub-variant just 2 weeks prior8. Therefore, epidemiologists expect BQ.1 and BQ.1.1 to be the key contributors to the upcoming surge in the United States. According to the Centers for Disease Control and Prevention (CDC), both BQ.1 and BQ.1.1 do not appear to have a clinical picture that sets them apart from earlier variations of SARS‑CoV‑2.9,10. Through modeling estimates, the ECDC predicts that by 2023 these variants could make up more than 80% of circulating SARS‑CoV‑2 cases worldwide, however3,11.FIGURE 1: A map showing the geographical distribution of the Omicron BQ.1 according to its global prevalence6.FIGURE 2: A map showing the geographical distribution of the Omicron BQ.1 according to total viral genetic sequences7.The genetic material of BQ.1 and related sub lineages The Omicron BQ.1 is a sub-variant of BA.5 with additional mutations identified in spike protein antigenic sites, including N460K and K444T as of epidemiological week (October 3–9) from data submitted to Global Initiative on Sharing Avian Influenza Data (GISAID) and reported by the World Health Organization (WHO). Recently the genetic material of BQ.1 is clearer according to data from COVID-19 genome tracking platforms that reported a large number of mutations in ORF1a gene as S135R, Q556K, and L3027F with mutations in the viral S gene as S371F, T19I, and V213G beside mutations in viral M gene as D3N, Q19E, and A63T. Furthermore, the viral N, ORF3a, ORF8, and E genes showed specific amino acid mutations like P13L, E136D, S84L, and T9I according to the recent expert reports of GISAID (Fig. 3)6,12,13. The BQ.1 genome even showed additional mutations that resulted in further sub-lineages such as the BQ.1.1, which carries additional R346T spike mutations, besides other sub-lineages such as the BQ.1.2, BQ.1.3, BQ.1.1.18, and BQ.1.8 as shown in (Fig. 4)13,14.FIGURE 3: A graph showing the mutations of the Omicron BQ.1 sub-variant according to recent data from GISAID6.FIGURE 4: A graph showing the Omicron BQ.1 genome sublineages according to recent data from GISAID3.The immune reaction of BQ.1 and BQ.1.1. Omicron sub-variants with preventative measures The effect of vaccination on the new omicron variants is still under investigation and needs further evidence. Recently, there have been vaccination shoots of omicron boosters designed mainly against omicron BA.4 and BA.5 variants and are expected to give cross-immunity with recent BQ.1 and BQ.1.115. However, the neutralizing resistance of BQ.1 and BQ.1.1 sub-variants with human sera followed by a homologous booster of mRNA vaccination showed that BQ.1 and BQ.1.1 have a high neutralizing resistance compared with other sub variants4. A previous study showed that omicron variants are able to escape the immunity 2-folds more than delta variants with impaired immunity against monoclonal antibodies16. Initial results declared a relation between history of omicron infection and the antibodies level against BQ.1 and BQ1.1 and showed that a history of infection by BA.2, BA.4, BA.5 with full vaccination causes lower reduction of neutralizing antibodies than reduction induced by vaccination history without infection and taking the three shots of the vaccine is better of the effect of neutralizing antibodies than 2 shots as in (Table 1)18. It is anticipated that SARS‑CoV‑2 treatments will continue to work against the new variations19. However, recent studies showed that Bebtelovimab is likely resistant to BQ.1 and BQ.1.1 as well20. Another study showed that BQ.1 and BQ.1.1 could also be resistant to Tixagevimab and Cilgavimab19. TABLE 1 - Shows the reduction of neutralizing antibodies against BQ.1 and BQ.1.1 according to initial results from unpublished data17. Reduction of neutralizing antibodies against BQ.1 Reduction of neutralizing antibodies against BQ.1.1 3 shots (2 shots of mRNA Vaccine and 1 booster) 37-fold 55-fold 4 shots (2 shots of mRNA vaccine and 2 boosters) 43-fold 81-fold 4 shots (3 shots of mRNA vaccine and 1 booster) 24-fold 41-fold Fully vaccinated with the booster and infected by BA.2 20-fold 29-fold Fully vaccinated with the booster and infected by BA.4 or BA.5 13-fold 31-fold However, the expectations about the prevalence of omicron BQ.1 to be increased by 2023, the data available so far is still limited, hence a close monitoring of BQ.1 and further studies to enhance the evidence related to its immune engagement with the current vaccines are strongly required. Ethical approval Not Applicable Sources of funding None. Author contribution All the authors have contributed in writing, Reviewing and figures production Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not Applicable Guarantor Mahmoud Tarek Hefnawy. Provenance and peer review Not commissioned, internally peer reviewed.

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Could the Omicron BQ.1 sub-variant threaten to reverse the worldwide decline in COVID cases?

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Mahmoud Tarek Hefnawy, Nour Shaheen, Omar Ahmed Abdelwahab, Rehab Adel Diab, Nishant Parag Soni, Ala’ Abdala Rababah, Youssef Soliman, Muhannad Wael, Almoatazbellah Attalla, Mostafa Meshref

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Coronavirus disease 2019 (COVID-19), Pandemic, Disease control, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 2019-20 coronavirus outbreak, Demography, Medicine, Geography, Disease, Environmental health, Virology, Internal medicine, Sociology, Infectious disease (medical specialty), Outbreak

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