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Coronavirus variants: Facts about omicron, delta and other SARS-CoV-2 mutants

Mar 23 2022

Austria warns against travel to Tirol after Bavaria threatens border closure

Feb 8 2021

Factbox-Coronavirus variants, first found in UK and South Africa, spread worldwide

Jan 8 2021

Names

The variant is also known as the South African variant.

Mutations

There are three mutations of particular interest in the spike region of the lineage B.1.351 genome:¹³

• K417N
• E484K
• N501Y

and a further five spike mutations which have so far generated less concern:¹⁴

• L18F
• D80A
• D215G
• R246I
• A701V

Away from the spike region, it also carries: K1655N, SGF 3675-3677 deletion, P71L, and T205I.¹⁵

Scientists noted that the variant is able to attach more easily to human cells because of three mutations in the receptor-binding domain (RBD) in the spike glycoprotein of the virus: N501Y¹⁶¹⁷ (a change from asparagine (N) to tyrosine (Y)¹⁸ in amino-acid position 501), K417N, and E484K.¹⁹²⁰ Two of these mutations, E484K and N501Y, are within the receptor-binding motif (RBM) of the receptor-binding domain (RBD).²¹²²

The N501Y mutation has also been detected in the United Kingdom.²³²⁴ Two mutations found in the Beta variant, E484K and K417N, are not found in Alpha variant. Also, Beta does not have the 69-70del mutation found in the other variant.²⁵²⁶

Vaccine efficacy

See also: Oxford–AstraZeneca COVID-19 vaccine § Effectiveness, Pfizer–BioNTech COVID-19 vaccine § Effectiveness, Janssen COVID-19 vaccine § Efficacy, Moderna COVID-19 vaccine § Effectiveness, Novavax COVID-19 vaccine § Efficacy, Sinopharm BIBP COVID-19 vaccine § Variants, Sputnik V COVID-19 vaccine § Variants, CoronaVac § Variants, Covaxin § Variants, ZF2001 § Efficacy, and Abdala (vaccine) § Efficacy

On 4 January 2021, UK newspaper The Telegraph reported that Oxford immunologist Sir John Bell believed there was "a big question mark" over the new South African variant's potential resistance to COVID-19 vaccines, raising fears that vaccines might not work as effectively on that variant strain.²⁷ The same day Shabir Madhi, professor of vaccinology at the University of the Witwatersrand, commented to CBS News that "it's not a given" that the new Beta variant (501.V2 variant) would be able to evade the vaccines, but that it should be considered that they "might not have the full efficacy".²⁸ The additional mutations to the spike protein in Beta were raised as a concerning factor by Simon Clarke, an associate professor in cellular microbiology at the University of Reading, in that they "may make the virus less susceptible to the immune response triggered by the vaccines".²⁹ Lawrence Young, a virologist at Warwick University, also noted that the variant's multiple spike mutations "could lead to some escape from immune protection".³⁰

The E484K amino acid change, a receptor-binding-domain (RBD) mutation, was reported to be "associated with escape from neutralising antibodies" which could adversely affect the efficacy of spike protein-dependent COVID vaccines.³¹³² The E484K spike mutation was linked to a case of reinfection with the Beta variant of SARS-CoV-2 in Brazil, believed by researchers to be the first such case of reinfection involving this mutation.³³ The possibility of an alteration in antigenicity was referred to as an "escape mutation" from a monoclonal antibody with the capability of neutralizing the spike protein variants of SARS-CoV-2.³⁴³⁵ This suggests that existing vaccines can and should be updated to counter the new strains without recourse to phased trials.

Janssen

In January, Johnson & Johnson, which held trials for its Janssen (Ad26.COV2.S) vaccine in South Africa, reported the level of protection against moderate to severe COVID-19 infection was 72% in the United States, but 64% in South Africa.³⁶³⁷

Pfizer–BioNTech

On 17 February 2021, Pfizer announced that neutralisation activity was reduced by two thirds for the Beta variant, whilst refraining from making claims about the efficacy of the vaccine in preventing illness as a result of this variant.³⁸

On 16 March 2021, The South African Health Products Regulatory Authority (SAHPRA) approved the Pfizer-BioNTech vaccine (BNT162b2) for section 21 Emergency Use Authorisation.³⁹

On 1 April 2021, an update on a South African vaccine trial stated that the vaccine was 100% effective so far (i.e., vaccinated participants saw no cases), with six of nine infections in the placebo control group being the Beta variant (lineage B.1.351).⁴⁰ However, nine days later, an Israeli study found that the variant was present even in people who had received both shots of the vaccine, its prevalence a disproportionate, eight-fold increase amongst vaccinated individuals in comparison to wild strains.⁴¹

On 5 May 2021, a letter summarizing results from the Qatar National Study Group for COVID-19 Vaccination showed 75% effectiveness against infection, with zero cases of severe disease.⁴²

Oxford–AstraZeneca

On 6 February 2021, The Financial Times reported that provisional trial data from a study undertaken by South Africa's University of the Witwatersrand in conjunction with Oxford University demonstrated reduced efficacy of the Oxford–AstraZeneca COVID-19 vaccine (AZD1222) against the Beta variant. The study found that in a sample size of 2,000 the AZD1222 vaccine afforded only "minimal protection" in all but the most severe cases of COVID-19.⁴³

On 7 February 2021, the South African government suspended the planned deployment of around 1 million doses of the vaccine whilst they examined the data and awaited advice on how to proceed.⁴⁴ The South African government subsequently cancelled the use of the vaccine, selling its supply to other African countries, and switched its vaccination program to use the Janssen COVID-19 vaccine.⁴⁵⁴⁶

In July 2021, following increased incidence of Beta in France, the United Kingdom - a major user of the AstraZeneca vaccine - placed additional restrictions on people travelling to the UK from France. However, the incidence in France is in its Indian Ocean territory of La Réunion,⁴⁷ as pointed out by French politician and doctor Veronique Trillet-Lenoir.⁴⁸

Sinopharm BIBP

Other African countries have begun the roll out the Sinopharm BIBP vaccine, with Morocco, Egypt, The Seychelles and Zimbabwe starting the mass rollout.⁴⁹ So far, the vaccine has proven resistant to the Beta variant, as demonstrated in Zimbabwe.⁵⁰ On 2 February 2021, a preprint paper announced that neutralisation activity was reduced by 1.6 fold for the Beta variant.⁵¹

Moderna

In February, Moderna reported that the current vaccine (mRNA-1273) produced only one sixth of the antibodies in response to the South African variant compared with the original virus. They have even launched a trial of a new vaccine to tackle the Beta variant.⁵²

Sputnik V

The South African Health Products Regulatory Authority (SAHPRA) has confirmed that it has received documentation for the vaccine developed by the Gamaleya Institute in Russia.⁵³

Sputnik V (Gam-COVID-Vac) is one of three Covid vaccines worldwide with an efficacy higher than 90% in symptomatic cases. It was found to be slightly less effective however it worked better than its rivals.[1] A three fold reduction in VNA was found against the beta variant. [2] [3] A small study of 12 samples published in the nature communications journal showed that the neutralising antibody response was about 6.1 times less against the beta variant.⁵⁴

CoronaVac

CoronaVac is yet to be approved for use by the South African Health Products Authority (SAHPRA).⁵⁵ So far, Sinovac has offered to supply South Africa with 5 million doses of the vaccine.⁵⁶

Covaxin

Covaxin has been found to be effective against the beta variant although with a three fold reduction in neutralization.

CoviVac

The CoviVac vaccine Information has not been delivered to the South African government yet.⁵⁷

EpiVacCorona

The EpiVacCorona vaccine Information has not been delivered to the South African government yet.⁵⁸

ZF2001

The ZF2001 vaccine Information is in the process of being delivered to the South African government.⁵⁹

Novavax

A study on the NVX-CoV2373 Novavax vaccine showed 60% efficacy (for HIV-negative participants) in South Africa, compared to 90% efficacy in Britain.⁶⁰

ImmunityBio

The BioVac Institute, a state-backed South African vaccine company, plans to use a deal it won to manufacture coronavirus vaccines. The contract with American based ImmunityBio Inc is currently conducting phase 1 vaccine trials with their hAd5 vaccine in the United States and South Africa.⁶¹

ImmunityBio and BioVac plan to distribute the vaccines throughout South Africa and Africa.⁶²⁶³

Epidemiology

Researchers and officials reported that the prevalence of the variant was higher among young people with no underlying health conditions, and more frequently causes serious illness in such cases than other variants.⁶⁴⁶⁵ The South African health department also indicated that the variant may be driving the second wave of the COVID-19 pandemic in the country, as the variant spreads faster than other earlier variants of the virus.⁶⁶⁶⁷

Statistics

History

A genomics team led by the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) at the University of KwaZulu-Natal discovered the new variant.⁶⁹ It was uncovered by whole genome sequencing. Several genomic sequences from this lineage were submitted to the GISAID sequence database.⁷⁰[better source needed]

On 23 December 2020, UK health minister Matt Hancock announced that two people who had travelled from South Africa to the UK were infected with the Beta variant (501.V2 variant).⁷¹⁷² On 28 December, the variant had been detected in two people in Switzerland⁷³ and in one in Finland.⁷⁴ On 29 December, the strain had been detected in a visitor from South Africa to Japan,⁷⁵ and in one overseas traveller to Queensland, Australia.⁷⁶ On 30 December the variant was detected in Zambia.⁷⁷ On 31 December, it was also detected in France, in a passenger returning from South Africa.⁷⁸ On 2 January 2021, the first case of this variant was detected in South Korea.⁷⁹ Austria reported their first case of this variant, along with four cases of the Alpha variant on 4 January.⁸⁰ The Republic of Botswana also detected their first case on 4 January.⁸¹ The People's Republic of China reported the first case of this variant in southern Guangdong province on 6 January.⁸²

On 8 January 2021, the Republic of Ireland reported the detection of 3 cases, all linked to travel from South Africa.⁸³ On the same day a case of reinfection with the new variant by a woman who had had COVID-19 was reported from Brazil, the first such reinfection reported in the world.⁸⁴ Canada reported the first case of this variant in Alberta on 9 January,⁸⁵ and Israel reported four cases, all of which were imported in people travelling from South Africa.⁸⁶ New Zealand reported the first case of this variant on 10 January.⁸⁷⁸⁸ On 12 January, Germany reported the detection of the mutation in six people from three different households.⁸⁹ The same day, it was reported that the United Kingdom had a total of 29 cases, two of which were previously reported.⁹⁰ The following day, Belgium reported the first case in a person from West Flanders with no travel history,⁹¹ Israel reported four further cases,⁹² and Taiwan reported the first case in a Swazi man in his 30s who had tested positive for COVID-19 on 1 January.⁹³

On 14 January, Germany detected a further case⁹⁴ and the following day, Canada reported a second case of the mutation which was detected in the Canadian province of British Columbia.⁹⁵ A further case was reported in Germany the same day.⁹⁶ Denmark and Réunion reported their first cases on 16 January as Israel discovered a further four cases.⁹⁷⁹⁸⁹⁹ On 17 January, Israel reported another four cases bringing their total number of cases of this variant to 20.¹⁰⁰ Two further cases were reported in The Netherlands on 18 January bringing the country's total to three.¹⁰¹ Ghana reported its first case of the variant on 19 January.¹⁰² On 23 January, Panama detected its first case of the strain in a person from Zimbabwe, who had travelled from South Africa.¹⁰³ Also on 23 January, Belgium reported at least 15 cases of the variant in Ostend,¹⁰⁴ while 6 cases were confirmed in the Comoros.¹⁰⁵ On 26 January, the Republic of Ireland reported the detection of 6 further cases.¹⁰⁶ The United States reported its first cases of the variant on 28 January 2021, in the state of South Carolina.¹⁰⁷ On 27 January, Israel reported 3 more cases which were the first cases of the variant from samples that were collected in the community randomly, without knowing the source of infection.¹⁰⁸ Preliminary data reported by Africa CDC on 29 January indicated that the variant had reached Ghana.¹⁰⁹ On 31 January, Israel reported its first case of reinfection with the new variant by a man who returned from Turkey.¹¹⁰

On 1 February 2021, the United Kingdom Secretary of State for Health and Social Care reported the random detection of 11 cases of the variant where there was no connection to international travel.¹¹¹ The same day, the Canadian province of Ontario reported the first case of the variant in the Peel Region, with a similar absence of travel history and no contact with anyone who had recently been abroad.¹¹² On 8 February, the Republic of Ireland reported the detection of 2 further cases.¹¹³

On 8 February 2021, Austria detected the greatest outbreak of Beta variant in Europe so far. A total of 293 confirmed cases and 200 suspected cases have been identified through sequencing, most of them will be confirmed in all probability. All of the cases were found in the Tirol region, where nearly 9% of the positive PCR tests were identified as the Beta variant by sequencing.¹¹⁴ The active cases were estimated at around 140. After a week of public discussion and political pressure about a possible quarantine of Tirol, the government of Austria abstained from isolating the areas of concern, instead making a formal plea to reduce movement in and out of the region and go for testing after visiting Tirol.¹¹⁵ Tirolean officials stated their intention to relax the lockdown rules in Tirol in keeping with the rest of Austria.¹¹⁶

On 22 February, the Israeli Health Ministry stated that the variant had been genetically sequenced in just under 1% of 3,000 community samples.¹¹⁷ Later on, Israel reported a total of 444 cases of the variant, making it the highest infection rate in the world outside South Africa.¹¹⁸ On 25 February, the Republic of Ireland reported the detection of 4 further cases.¹¹⁹ By late February, Turkey had 49 cases of the Beta variant.¹²⁰

On 3 March 2021, the Philippines confirmed its first 6 new cases of the South African variant, with 3 patients from Pasay with no travel history, and 3 with travel histories from Qatar and UAE.¹²¹ On 5 March 2021, Romania reported its first two cases of the South African variant, coming from two patients in Bucharest and Pitești.¹²²

On 23 March 2021, Lithuania confirmed its first 2 new cases of the South African strain, 1 in Kaunas county and 1 in Vilnius. There are 10 more suspected cases of it. The infected people said, that they didn't travel anywhere.¹²³ On 26 March there were 3 more cases confirmed, which means that virus is successfully spreading inside.

On 1 April 2021, Malaysia detected its first cases of South African variant. The health ministry reported two cases believed to originate from the Jalan Lima cluster, involving an employee based at the Kuala Lumpur International Airport (KLIA), with other reported cases sparsely detected within Selangor.¹²⁴ As of 1 April, a total of nine cases involving the variant is reported.¹²⁵ By 2 May, a total of 48 cases has been detected in least 5 clusters and from contact tracing, of which 20 were found in two clusters in Perak and Kelantan.¹²⁶

On 12 April 2021 Turkey had 285 cases in 11 provinces.¹²⁷

Extinction

In March 2022, the World Health Organization listed the Alpha, Beta and Gamma variants as previously circulating citing lack of any detected cases in the prior weeks and months.¹²⁸

See also

• COVID-19 portal
• Medicine portal
• Viruses portal

• COVID-19 pandemic in South Africa
• COVID-19 vaccination in South Africa
• Variants of SARS-CoV-2: Alpha, Gamma, Delta, Epsilon, Zeta, Eta, Theta, Iota, Kappa, Lambda, Mu, Omicron

Notes

External links

• PANGO lineages: New Variant Report - Report on global distribution of lineage B.1.351
• COG-UK Report on SARS-CoV-2 Spike mutations of interest in the UK

References

1. "GISAID - hCov19 Variants". www.gisaid.org. Retrieved 21 July 2021. https://www.gisaid.org/hcov19-variants/ ↩

2. "Tracking SARS-CoV-2 variants". www.who.int. Retrieved 1 June 2021. https://www.who.int/activities/tracking-SARS-CoV-2-variants ↩

3. Other names include:[3][4]– 20H/501Y.V2 (formerly 20C/501Y.V2)– 501Y.V2 variant– South African COVID-19 variant ↩

4. "Tracking SARS-CoV-2 variants". www.who.int. Retrieved 17 August 2022. https://www.who.int/activities/tracking-SARS-CoV-2-variants ↩

5. "Variants of concern". CDGN. Retrieved 17 August 2022. https://www.cdgn.org.au/variants-of-concern ↩

6. "SA reaches grim milestone of 1 million Covid-19 cases". www.iol.co.za. Retrieved 29 December 2020. https://www.iol.co.za/news/south-africa/kwazulu-natal/sa-reaches-grim-milestone-of-1-million-covid-19-cases-a01906de-5442-451c-932f-84d6fc381b84 ↩

7. "Covid: South Africa passes one million infections as cases surge". BBC News. 28 December 2020. Retrieved 29 December 2020. https://www.bbc.com/news/world-africa-55462863 ↩

8. "South Africa announces a new coronavirus variant". The New York Times. 18 December 2020. Retrieved 20 December 2020. N501Y...has been found in other countries, including the United Kingdom https://www.nytimes.com/2020/12/19/world/south-africa-announces-a-new-coronavirus-variant.html ↩

9. Houriiyah Tegally; et al. (22 December 2020). "Emergence and rapid spread of a new severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) lineage with multiple spike mutations in South Africa". medrxiv. doi:10.1101/2020.12.21.20248640. Retrieved 10 March 2021. Spatiotemporal phylogeographic analysis suggests that the 501Y.V2 lineage emerged in early August (early July – end August 2020, 95% highest posterior density) in Nelson Mandela Bay. https://www.medrxiv.org/content/10.1101/2020.12.21.20248640v1.full-text ↩

10. "Tracking SARS-CoV-2 variants". www.who.int. Retrieved 1 June 2021. https://www.who.int/activities/tracking-SARS-CoV-2-variants ↩

11. TIMESOFINDIA.COM (2 June 2021). "Explained: Why WHO named Covid-19 variants first found in India as 'Kappa' and 'Delta'". The Times of India. Retrieved 2 June 2021. https://timesofindia.indiatimes.com/india/explained-why-who-named-covid-19-variants-found-in-india-as-kappa-and-delta/articleshow/83137667.cms ↩

12. "Tracking SARS-CoV-2 variants". www.who.int. Retrieved 17 August 2022. https://www.who.int/activities/tracking-SARS-CoV-2-variants ↩

13. Corum, Jonathan; Zimmer, Carl (18 January 2021). "Inside the B.1.1.7 Coronavirus Variant (Updated Feb. 18, 2021)". The New York Times. Retrieved 23 February 2021. https://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html ↩

14. Corum, Jonathan; Zimmer, Carl (18 January 2021). "Inside the B.1.1.7 Coronavirus Variant (Updated Feb. 18, 2021)". The New York Times. Retrieved 23 February 2021. https://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html ↩

15. Corum, Jonathan; Zimmer, Carl (24 February 2021). "Coronavirus Variants and Mutations (Section: The B.1.351 Lineage)". www.nytimes.com. Retrieved 25 February 2021. https://www.nytimes.com/interactive/2021/health/coronavirus-variant-tracker.html ↩

16. "South Africa announces a new coronavirus variant". The New York Times. 18 December 2020. Retrieved 20 December 2020. N501Y...has been found in other countries, including the United Kingdom https://www.nytimes.com/2020/12/19/world/south-africa-announces-a-new-coronavirus-variant.html ↩

17. Abdool Karim, Salim (19 December 2020). "The 2nd Covid-19 wave in South Africa: Transmissibility & a 501.V2 variant". Scribd. CAPRISA. p. 11. Retrieved 24 December 2020. https://www.scribd.com/document/488618010/Full-Presentation-by-SSAK-18-Dec ↩

18. For a list of the symbols used for the α-amino acids incorporated into protein under mRNA direction, see: "Nomenclature and Symbolism for Amino Acids and Peptides". IUPAC-IUB Joint Commission on Biochemical Nomenclature. 1983. Archived from the original on 9 October 2008. Retrieved 5 March 2018. https://web.archive.org/web/20081009023202/http://www.chem.qmul.ac.uk/iupac/AminoAcid/AA1n2.html ↩

19. Statement of the WHO Working Group on COVID-19 Animal Models (WHO-COM) about the UK and South African SARS-CoV-2 new variants (PDF), World Health Organization, 22 December 2020, retrieved 23 December 2020 https://www.who.int/docs/default-source/blue-print/who-com-statement_new-variant_rev1.pdf?sfvrsn=b87c0ad8_3&download=true ↩

20. Lowe, Derek (22 December 2020). "The New Mutations". In The Pipeline. American Association for the Advancement of Science. Retrieved 23 December 2020. I should note here that there's another strain in South Africa that is bringing on similar concerns. This one has eight mutations in the Spike protein, with three of them (K417N, E484K and N501Y) that may have some functional role. https://www.science.org/content/blog-post/new-mutations ↩

21. "Expert reaction to South African variant of SARS-CoV-2". Science Media Centre. Retrieved 26 December 2020. https://www.sciencemediacentre.org/expert-reaction-to-south-african-variant-of-sars-cov-2-as-mentioned-by-matt-hancock-at-the-downing-street-press-briefing/ ↩

22. Tegally, Houriiyah; Wilkinson, Eduan; Giovanetti, Marta; Iranzadeh, Arash; Fonseca, Vagner; Giandhari, Jennifer; et al. (2020). Emergence and rapid spread of a new severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) lineage with multiple spike mutations in South Africa (Report). doi:10.1101/2020.12.21.20248640. S2CID 229348551. /wiki/Doi_(identifier) ↩

23. "South Africa announces a new coronavirus variant". The New York Times. 18 December 2020. Retrieved 20 December 2020. N501Y...has been found in other countries, including the United Kingdom https://www.nytimes.com/2020/12/19/world/south-africa-announces-a-new-coronavirus-variant.html ↩

24. "Novel mutation combination in spike receptor binding site" (Press release). GISAID. 21 December 2020. Archived from the original on 22 February 2021. Retrieved 23 December 2020. https://web.archive.org/web/20210222193121/https://www.gisaid.org/references/gisaid-in-the-news/novel-variant-combination-in-spike-receptor-binding-site/ ↩

25. Abdool Karim, Salim (19 December 2020). "The 2nd Covid-19 wave in South Africa: Transmissibility & a 501.V2 variant". Scribd. CAPRISA. p. 11. Retrieved 24 December 2020. https://www.scribd.com/document/488618010/Full-Presentation-by-SSAK-18-Dec ↩

26. "Expert reaction to South African variant of SARS-CoV-2, as mentioned by Matt Hancock at the Downing Street press briefing". Science Media Centre. 23 December 2020. Retrieved 24 December 2020. The South African variant '501.V2' is characterised by N501Y, E484K and K417N mutations in the S protein – so it shares the N501Y mutation with the UK variant, but the other two mutations are not found in the UK variant. Similarly, the South African variant does not contain the 69-70del mutation that is found in the UK variant. https://www.sciencemediacentre.org/expert-reaction-to-south-african-variant-of-sars-cov-2-as-mentioned-by-matt-hancock-at-the-downing-street-press-briefing/ ↩

27. Knapton, Sarah (4 January 2021). "South African variant may evade vaccines and testing, warn scientists". www.telegraph.co.uk. https://www.telegraph.co.uk/news/2021/01/04/south-african-variant-may-evade-vaccines-testing-warn-scientists/ ↩

28. Carter, Sarah (4 January 2021). "COVID vaccines "might not" work as well on South African strain, scientists warn". CBS News. Johannesburg. https://www.cbsnews.com/news/covid-vaccine-new-strain-south-africa/ ↩

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30. "UK scientists worry vaccines may not protect against S.African coronavirus variant". Reuters. 4 January 2021. Retrieved 5 January 2021. https://www.reuters.com/article/us-health-coronavirus-britain-south-afri/uk-scientists-worry-vaccines-may-not-protect-against-safrican-coronavirus-variant-idUSKBN2990T3 ↩

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32. Callaway, Ewen (7 January 2021). "Could new COVID variants undermine vaccines? Labs scramble to find out". Nature. Retrieved 17 January 2021. Chief among those is another receptor-binding-domain mutation, called E484K, that de Oliveira's team has identified in the 501Y.V2 variant. https://www.nature.com/articles/d41586-021-00031-0 ↩

33. "South African coronavirus variant detected in reinfection case in Brazil". www.reuters.com. 8 January 2021. Retrieved 11 January 2021. https://www.reuters.com/article/health-coronavirus-brazil-reinfection/south-african-coronavirus-variant-detected-in-reinfection-case-in-brazil-idUSKBN29D33S ↩

34. Weisblum, Yiska; Schmidt, Fabian; Zhang, Fengwen; Dasilva, Justin; Poston, Daniel; Lorenzi, Julio CC; et al. (20 October 2020). "Escape from neutralizing antibodies by SARS-CoV-2 spike protein variants". eLife. 9. doi:10.7554/eLife.61312. PMC 7723407. PMID 33112236. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723407 ↩

35. "Brief report: New Variant Strain of SARS-CoV-2 Identified in Travelers from Brazil" (PDF) (Press release). Japan: NIID (National Institute of Infectious Diseases). 12 January 2021. Retrieved 16 January 2021. https://www.niid.go.jp/niid/images/epi/corona/covid19-33-en-210112.pdf ↩

36. "Emergency use authorization (EUA) of the Janssen COVID-19 vaccine to prevent coronavirus disease 2019 (COVID-19)" (PDF). Janssen COVID-19 Vaccine (Authorization). Food and Drug Administration. 23 April 2021. Table 8. https://www.fda.gov/media/146304/download ↩

37. "Johnson & Johnson Announces Single-Shot Janssen COVID-19 Vaccine Candidate Met Primary Endpoints in Interim Analysis of its Phase 3 ENSEMBLE Trial". jnj.com. 29 January 2021. Retrieved 29 January 2021. https://www.jnj.com/johnson-johnson-announces-single-shot-janssen-covid-19-vaccine-candidate-met-primary-endpoints-in-interim-analysis-of-its-phase-3-ensemble-trial ↩

38. Liu, Yang; Liu, Jianying; Xia, Hongjie; Zhang, Xianwen; Fontes-Garfias, Camila R.; Swanson, Kena A.; et al. (17 February 2021). "Neutralizing Activity of BNT162b2-Elicited Serum — Preliminary Report". New England Journal of Medicine. doi:10.1056/nejmc2102017. PMC 7944950. PMID 33596352. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944950 ↩

39. Staff Writer. "South Africa approves Pfizer Covid-19 vaccine for emergency use". Retrieved 19 March 2021. https://businesstech.co.za/news/trending/476360/south-africa-approves-pfizer-covid-19-vaccine-for-emergency-use/ ↩

40. "Pfizer and BioNTech Confirm High Efficacy and No Serious Safety Concerns Through Up to Six Months Following Second Dose in Updated Topline Analysis of Landmark COVID-19 Vaccine Study". Pfizer. 1 April 2021. Retrieved 2 April 2021. https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-confirm-high-efficacy-and-no-serious ↩

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