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SARS-CoV-2 Variants of Concern: Omicron sublineages[1-6]

SARS-CoV-2 Variants of Concern: Omicron sublineages[1-6]
Omicron sublineage
(parent sublineage)
Therapeutic/prophylactic monoclonal antibodies
Tixagevimab-cilgavimab
(no longer recommended)
Bebtelovimab
(no longer recommended)
Sotrovimab
(no longer recommended)
Casirivimab-imdevimab
(no longer recommended)
BA.1 Reduced activity Active Active Inactive
BA.2 Active Active Inactive Inactive
BA.4/BA.5 Reduced activity Active Inactive Inactive
BA.4.6 (BA.4) Inactive Likely active Inactive Inactive
BA.2.75.2 (BA.2) Inactive* Likely active Inactive Inactive
BQ.1/BQ.1.1 (BA.5) Inactive Inactive Inactive Inactive
XBB/XBB.1/XBB.1.5 (BA.2.10.1 and BA.2.75 recombinant) Inactive Inactive Inactive Inactive

"Variants of Concern" have evidence of an increase in transmissibility, greater risk of severe disease, a significant reduction in neutralization by antibodies generated during previous infection or vaccination, or reduced effectiveness of treatments or vaccines. Since 2022, Omicron (B.1.1.529) variants within evolving sublineages have been the predominant circulating variants globally. Prior Variants of Concern that are no longer circulating are the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2) variants.

In the United States, the proportion of circulating variants in each state can be found on the CDC website.

Predicted activity of monoclonal antibodies against various SARS-CoV-2 variants is based on neutralizing assays that use pseudoviruses bearing the key spike protein mutations found in each variant. Neutralizing data are emerging for certain Omicron sublineages and are thus uncertain.

CDC: United States Centers for Disease Control and Prevention.

* For a related sublineage, BA.2.75, tixagevimab-cilgavimab appears to retain neutralizing activity.
References:
  1. National Institutes of Health. The COVID-19 Treatment Guidelines Panel's Statement on Omicron Subvariants and Anti-SARS-CoV-2 Monoclonal Antibodies. Available at: https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-omicron-subvariants/ (Accessed on November 9, 2022).
  2. Cao Y, Jian F, Wang J, et al. Imprinted SARS-CoV-2 humoral immunity induces convergent Omicron RBD evolution. BioRxiv 2022.
  3. Takashita E, Yamayoshi S, Fukushi S, et al. Efficacy of Antiviral Agents against the Omicron Subvariant BA.2.75. New Engl J Med 2022; 387:1236.
  4. US Food and Drug Administration. Fact sheet for healthcare providers: Emergency use authorization for bebtelovimab. Available at: https://www.fda.gov/media/156152/download (Accessed on November 9, 2022).
  5. US Food and Drug Administration. FDA Announces Bebtelovimab is Not Currently Authorized in Any US Region. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-bebtelovimab-not-currently-authorized-any-us-region (Accessed December 1, 2022).
  6. Imai M, Ito M, Kiso M, et al. Efficacy of Antiviral Agents against Omicron Subvariants BQ.1.1 and XBB. New Engl J Med 2023; 388:89.
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