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. 2022 Aug 24;75(1):e715-e725.
doi: 10.1093/cid/ciab986.

Infection With the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta Variant Is Associated With Higher Recovery of Infectious Virus Compared to the Alpha Variant in Both Unvaccinated and Vaccinated Individuals

Chun Huai Luo  1 , C Paul Morris  1   2 , Jaiprasath Sachithanandham  3 , Adannaya Amadi  1 , David C Gaston  1 , Maggie Li  3 , Nicholas J Swanson  3 , Matthew Schwartz  1 , Eili Y Klein  4   5 , Andrew Pekosz  3   4 , Heba H Mostafa  1
Affiliations

Infection With the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Delta Variant Is Associated With Higher Recovery of Infectious Virus Compared to the Alpha Variant in Both Unvaccinated and Vaccinated Individuals

Chun Huai Luo et al. Clin Infect Dis. .

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of concern (VOC) B.1.617.2 (Delta) displaced B.1.1.7 (Alpha) and is associated with increases in coronavirus disease 2019 (COVID-19) cases, greater transmissibility, and higher viral RNA loads, but data are lacking regarding the infectious virus load and antiviral antibody levels in the nasal tract.

Methods: Whole genome sequencing, cycle threshold (Ct) values, infectious virus, anti-SARS-CoV-2 immunoglobulin G (IgG) levels, and clinical chart reviews were combined to characterize SARS-CoV-2 lineages circulating in the National Capital Region between January and September 2021 and differentiate infections in vaccinated and unvaccinated individuals by the Delta, Alpha, and B.1.2 (the predominant lineage prior to Alpha) variants.

Results: The Delta variant displaced the Alpha variant to constitute 99% of the circulating lineages in the National Capital Region by August 2021. In Delta infections, 28.5% were breakthrough cases in fully vaccinated individuals compared to 4% in the Alpha infected cohort. Breakthrough infections in both cohorts were associated with comorbidities, but only Delta infections were associated with a significant increase in the median days after vaccination. More than 74% of Delta samples had infectious virus compared to <30% from the Alpha cohort. The recovery of infectious virus with both variants was associated with low levels of local SARS-CoV-2 IgG.

Conclusions: Infection with the Delta variant was associated with more frequent recovery of infectious virus in vaccinated and unvaccinated individuals compared to the Alpha variant but was not associated with an increase in disease severity in fully vaccinated individuals. Infectious virus was correlated with the presence of low amounts of antiviral IgG in the nasal specimens.

Keywords: Alpha; Delta; IgG; SARS-CoV-2; cell culture.

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Figures

Figure 1.
Figure 1.
SARS-CoV-2 positivity and variant trends. Abbreviation: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Delta and Alpha variants Ct values in upper respiratory samples. Abbreviations: Ct, cycle threshold; unvax, unvaccinated; vax, vaccinated.
Figure 3.
Figure 3.
Recovery of infectious virus in Delta versus Alpha groups. Abbreviation: CPE, cytopathic effect; Ct, cycle threshold.
Figure 4.
Figure 4.
Localized SARS-CoV-2 IgG in the Delta versus the Alpha groups. Abbreviations: CPE, cytopathic effect; Ct, cycle threshold; IgG, immunoglobulin G; OD, optical density; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; unvax, unvaccinated; vax, vaccinated.
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