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Distinct and relatively mild clinical characteristics of SARS-CoV-2 BA.5 infections against BA.2

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Summary: Understanding the dynamics of neutralizing antibody responses in COVID-19 convalescents is crucial for controlling the pandemic and guiding vaccination strategies. This study showed that neutralizing antibody titers in COVID-19 convalescents peaked around 120 days after illness onset and subsequently declined, but detectable levels of antibodies were still present in most convalescents after 400-480 days.

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Summary: SARS-CoV-2 Omicron subvariants BA.2.12.1 and BA.4/5 have become dominant in the United States and South Africa, raising concerns about their ability to evade neutralizing antibodies and compromise the efficacy of COVID-19 vaccines and therapeutic monoclonals. A systematic antigenic analysis reveals that BA.2.12.1 and BA.4/5 have different levels of resistance to antibodies, with BA.2.12.1 being modestly resistant and BA.4/5 being substantially resistant. Certain mutations in the spike protein facilitate antibody escape, but compromise the spike affinity for the viral receptor. Only bebtelovimab retains full potency against both subvariants.

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Virological characteristics of the SARS-CoV-2 Omicron BA.2 subvariants, including BA.4 and BA.5

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Summary: After the global spread of SARS-CoV-2 Omicron BA.2, several BA.2 subvariants, including BA.2.9.1, BA.2.11, BA.2.12.1, BA.4, and BA.5, emerged in multiple countries. Statistical analysis showed that these BA.2 subvariants have higher effective reproduction numbers than the original BA.2. Neutralization experiments revealed that the immunity induced by BA.1/2 infections is less effective against BA.4/5. Cell culture experiments demonstrated that BA.2.12.1 and BA.4/5 replicate more efficiently in human alveolar epithelial cells than BA.2, with BA.4/5 being more fusogenic. The study also provided the structure of the BA.4/5 spike receptor-binding domain and investigated the substitutions in the BA.4/5 spike that play a role in ACE2 binding and immune evasion. Additionally, experiments using hamsters suggested that BA.4/5 is more pathogenic than BA.2. The multiscale investigations suggest that the risk of BA.2 subvariants, particularly BA.4/5, to global health is greater than that of the original BA.2.