SARS-CoV-2 Variants in Patients with Immunosuppression

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  • Corey, L.
    • Other Affiliation: Fred Hutchinson Cancer Research Center
  • Beyrer, C.
    • Other Affiliation: Johns Hopkins Bloomberg School of Public Health
  • Cohen, M.S.
    • Affiliation: School of Medicine, Institute for Global Health and Infectious Diseases
  • Michael, N.L.
    • Other Affiliation: The Henry M. Jackson Foundation for the Advancement of Military Medicine
  • Bedford, T.
    • Other Affiliation: Fred Hutchinson Cancer Research Center
  • Rolland, M.
    • Other Affiliation: The Henry M. Jackson Foundation for the Advancement of Military Medicine
Abstract
  • Patients with immunosuppression are at risk for prolonged infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In several case reports, investigators have indicated that multimutational SARS-CoV-2 variants can arise during the course of such persistent cases of coronavirus disease 2019 (Covid-19). These highly mutated variants are indicative of a form of rapid, multistage evolutionary jumps (saltational evolution; see Glossary), which could preferentially occur in the milieu of partial immune control. The presence of a large number of mutations is also a hallmark of the variants of concern — including B.1.1.7 (alpha), B.1.351 (beta), P.1 (gamma), and B.1.617.2 (delta) — which suggests that viral evolution in immunocompromised patients may be an important factor in the emergence of such variants. Since a large number of persons globally are living with innate or acquired immunosuppression, the association between immunosuppression and the generation of highly transmissible or more pathogenic SARS-CoV-2 variants requires further delineation and mitigation strategies.
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  • Article
Rights statement
  • In Copyright
Journal title
  • New England Journal of Medicine
Journal volume
  • 385
Journal issue
  • 6
Page start
  • 562
Page end
  • 566
Language
  • English
Funder
  • Henry M. Jackson Foundation, HJF
  • Walter Reed Army Institute of Research, WRAIR
  • University of North Carolina Wilmington, UNCW
  • National Institute of Allergy and Infectious Diseases, NIAID: UM1AI068614, UM1AI068635
  • Johns Hopkins Bloomberg School of Public Health, JHSPH
ISSN
  • 0028-4793
Publisher
  • Massachussetts Medical Society

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