Delta Variant: The New Challenge of COVID-19 Pandemic, an Overview of Epidemiological, Clinical, and Immune Characteristics

Delta Variant: The New Challenge of COVID-19 Pandemic, an Overview of Epidemiological, Clinical, and Immune Characteristics

Authors

  • Noosha Samieefar
  • Ronak Rashedi
  • Meisam Akhlaghdoust
  • Melika Mashhadi
  • Pouya Darzi
  • Nima Rezaei University of Medical Sciences, Tehran, Iran

Keywords:

COVID-19, SARS-CoV-2, Vaccine, Epidemiology, Immunology

Abstract

 The SARS-CoV-2 genome has undergone several mutations since the beginning of the pandemic in December 2019. A number of these mutants were associated with higher transmissibility, higher mortality, or hospitalization rates, which were named the variants of concern.

B.1.617.2 or the Delta variant has made a lot of concern as it has been responsible for the most recent COVID-19 outbreaks throughout the world. Higher transmissibility, a 60 percent increase in hospitalization rates compared to the wild type, higher viral loads, and reduced response to available vaccines are among the key factors why this variant has become a variant of concern. 148 countries are currently fighting with this variant, hoping to better understand the epidemiological, immunological, and clinical characteristics of this disease in order to find the best way to overcome these new outbreaks.

Although reduced efficiency of vaccines on this variant and its higher pre-symptomatic transmissibility have made it complicated to control the disease, higher vaccination coverage and following sanitation rules can help control the outbreaks. 

References

Samieefar N, Yari Boroujeni R, Jamee M, Lotfi M, Golabchi MR, Afshar A, et al. Country Quarantine During COVID-19: Critical or Not? Disaster Med Public Health Prep. 2020 Oct;1–2.

WHO. WHO Coronavirus (COVID-19) Dashboard [Internet]. 2021 [cited 2021 Aug 28]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?adgroupsurvey=%7Badgroupsurvey%7D&gclid=CjwKCAjw3_KIBhA2EiwAaAAlijaREiGSq7xH7SvKbZscvbOa5e43mkuK11AixkrzkMXYlqCrin42hBoCQ38QAvD_BwE

Mishra SK, Tripathi T. One year update on the COVID-19 pandemic: Where are we now? Acta Trop. 2021 Feb;214:105778.

Giovanetti M, Benedetti F, Campisi G, Ciccozzi A, Fabris S, Ceccarelli G, et al. Evolution patterns of SARS-CoV-2: Snapshot on its genome variants. Biochem Biophys Res Commun. 2021 Jan;538:88–91.

van Dorp L, Acman M, Richard D, Shaw LP, Ford CE, Ormond L, et al. Emergence of genomic diversity and recurrent mutations in SARS-CoV-2. Infect Genet Evol. 2020 Sep;83:104351.

Janik E, Niemcewicz M, Podogrocki M, Majsterek I, Bijak M. The Emerging Concern and Interest SARS-CoV-2 Variants. Pathog (Basel, Switzerland). 2021 May;10(6).

Jogalekar MP, Veerabathini A, Gangadaran P. SARS-CoV-2 variants: A double-edged sword? Exp Biol Med (Maywood). 2021 Aug;246(15):1721–6.

Sanyaolu A, Okorie C, Marinkovic A, Haider N, Abbasi AF, Jaferi U, et al. The emerging SARS-CoV-2 variants of concern. Ther Adv Infect Dis. 2021;8:20499361211024372.

Bian L, Gao F, Zhang J, He Q, Mao Q, Xu M, et al. Effects of SARS-CoV-2 variants on vaccine efficacy and response strategies. Expert Rev Vaccines. 2021 Apr;20(4):365–73.

Chaqroun A, Hartard C, Schvoerer E. Anti-SARS-CoV-2 Vaccines and Monoclonal Antibodies Facing Viral Variants. Viruses. 2021 Jun;13(6).

Dougherty K, Mannell M, Naqvi O, Matson D, Stone J. SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility - Oklahoma, April-May 2021. MMWR Morb Mortal Wkly Rep. 2021 Jul;70(28):1004–7.

Kirola L. Genetic emergence of B.1.617.2 in COVID-19. New microbes new Infect. 2021 Sep;43:100929.

Alexandar S, Ravisankar M, Kumar RS, Jakkan K. A Comprehensive Review on Covid-19 Delta variant. 2021;5(2):83–5.

Challen R, Dyson L, Overton CE, Guzman-Rincon LM, Hill EM, Stage HB, et al. Early epidemiological signatures of novel SARS-CoV-2 variants: establishment of B.1.617.2 in England. medRxiv [Internet]. 2021;2021.06.05.21258365. Available from: https://doi.org/10.1101/2021.06.05.21258365

CDC. Delta Variant: What We Know About the Science [Internet]. 2021 [cited 2021 Aug 28]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, et al. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med. 2021 Aug;385(7):585–94.

Jagadeesh Kumar V, Sowpati DT, Munigela A, Banu S, Siva AB, Sasikala M, et al. Clinical outcomes in vaccinated individuals hospitalized with Delta variant of SARS-CoV-2. medRxiv [Internet]. 2021;2021.07.13.21260417. Available from: http://medrxiv.org/content/early/2021/07/16/2021.07.13.21260417.abstract

Davis C, Logan N, Tyson G, Orton R, Harvey W, Haughney J, et al. Reduced neutralisation of the Delta (B.1.617.2) SARS-CoV-2 variant of concern following vaccination. medRxiv [Internet]. 2021;2021.06.23.21259327. Available from: https://www.medrxiv.org/content/10.1101/2021.06.23.21259327v1%0Ahttps://www.medrxiv.org/content/10.1101/2021.06.23.21259327v1.abstract

Mishra S, Mindermann S, Sharma M, Whittaker C, Mellan TA, Wilton T, et al. Changing composition of SARS-CoV-2 lineages and rise of Delta variant in England. EClinicalMedicine. 2021 Sep;39:101064.

Riley S, Wang H, Eales O, Haw D, Walters CE, Ainslie KEC, et al. REACT-1 round 12 report: resurgence of SARS-CoV-2 infections in England associated with increased frequency of the Delta variant. medRxiv [Internet]. 2021 Jan 1;2021.06.17.21259103. Available from: http://medrxiv.org/content/early/2021/06/21/2021.06.17.21259103.abstract

Hetemäki I, Kääriäinen S, Alho P, Mikkola J, Savolainen-Kopra C, Ikonen N, et al. An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021. Eurosurveillance [Internet]. 2021;26(30):2100636. Available from: https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.30.2100636

Moona AA, Daria S, Asaduzzaman M, Islam MR. Bangladesh reported delta variant of coronavirus among its citizen: Actionable items to tackle the potential massive third wave. Infect Prev Pract [Internet]. 2021 Sep;3(3):100159. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2590088921000482

Chang SL, Cliff OM, Zachreson C, Prokopenko M. Nowcasting transmission and suppression of the Delta variant of SARS-CoV-2 in Australia. 2021;2. Available from: http://arxiv.org/abs/2107.06617

Chen H, Mao Y, Duan Z, Wang L, Cheng Y, Dai Y, et al. Three Cases of COVID-19 Variant Delta With and Without Vaccination — Chengdu City, Sichuan Province, April–May, 2021. China CDC Wkly [Internet]. 2021;3(25):544–6. Available from: http://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2021.137

Vaughan A. Delta to dominate world. New Sci [Internet]. 2021 Jul;250(3341):9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0262407921011210

WHO. Tracking SARS-CoV-2 variants [Internet]. 2021 [cited 2021 Aug 28]. Available from: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

Pung R, Mak TM, Kucharski AJ, Lee VJ. Serial intervals in SARS-CoV-2 B.1.617.2 variant cases. Lancet [Internet]. 2021 Aug 18; Available from: https://doi.org/10.1016/S0140-6736(21)01697-4

Zhang M, Xiao J, Deng A, Zhang Y, Zhuang Y, Hu T, et al. Transmission Dynamics of an Outbreak of the COVID-19 Delta Variant B.1.617.2 — Guangdong Province, China, May–June 2021. China CDC Wkly [Internet]. 3(27):584–6. Available from: http://weekly.chinacdc.cn//article/id/eb772589-1584-4ef9-beac-cac3ab2fbb12

Burki TK. Lifting of COVID-19 restrictions in the UK and the Delta variant. Lancet Respir Med [Internet]. 2021 Aug;9(8):e85. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213260021003283

Li B, Deng A, Li K, Hu Y, Li Z, Xiong Q, et al. Viral infection and transmission in a large well-traced outbreak caused by the Delta SARS-CoV-2 variant. medRxiv [Internet]. 2021 Jan 1;2021.07.07.21260122. Available from: http://medrxiv.org/content/early/2021/07/12/2021.07.07.21260122.abstract

Bolze A, Cirulli ET, Luo S, White S, Wyman D, Rossi AD, et al. SARS-CoV-2 variant Delta rapidly displaced variant Alpha in the United States and led to higher viral loads. medRxiv [Internet]. 2021 Jan 1;2021.06.20.21259195. Available from: http://medrxiv.org/content/early/2021/07/30/2021.06.20.21259195.abstract

Subbaraman N. How do vaccinated people spread Delta? What the science says. Nature [Internet]. 2021 Aug 19;596(7872):327–8. Available from: https://www.nature.com/articles/d41586-021-02187-1

Muniz-Rodriguez K, Chowell G, Cheung C-H, Jia D, Lai P-Y, Lee Y, et al. Doubling Time of the COVID-19 Epidemic by Chinese Province. medRxiv Prepr Serv Heal Sci [Internet]. 2020 Apr 24;2020.02.05.20020750. Available from: https://pubmed.ncbi.nlm.nih.gov/32511421

Alizon S, Haim-Boukobza S, Foulongne V, Verdurme L, Trombert-Paolantoni S, Lecorche E, et al. Rapid spread of the SARS-CoV-2 Delta variant in some French regions, June 2021. Eurosurveillance [Internet]. 2021;26(28):1–5. Available from: http://dx.doi.org/10.2807/1560-7917.ES.2021.26.28.2100573

Salvatore M, Bhattacharyya R, Purkayastha S, Zimmermann L, Ray D, Hazra A, et al. Resurgence of SARS-CoV-2 in India: Potential role of the B.1.617.2 (Delta) variant and delayed interventions. medRxiv [Internet]. 2021 Jan 1;2021.06.23.21259405. Available from: http://medrxiv.org/content/early/2021/06/30/2021.06.23.21259405.abstract

Sheikh A, McMenamin J, Taylor B, Robertson C. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. Lancet [Internet]. 2021 Jun;397(10293):2461–2. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673621013581

Number of SARS-CoV-2 Delta variant cases worldwide as of August 13, 2021, by country or territory. Available from: https://www.statista.com/statistics/1245971/number-delta-variant-worldwide-by-country/

Mallapaty S. Delta’s rise is fuelled by rampant spread from people who feel fine. Nature [Internet]. 2021 Aug 19; Available from: https://www.nature.com/articles/d41586-021-02259-2

Torjesen I. Covid-19: Delta variant is now UK’s most dominant strain and spreading through schools. BMJ [Internet]. 2021 Jun 4;n1445. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.n1445

Sen M, Honavar S, Sharma N, Sachdev M. COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19. Indian J Ophthalmol [Internet]. 2021;69(3):488. Available from: http://www.ijo.in/text.asp?2021/69/3/488/309403

Dyer O. Covid-19: India sees record deaths as “black fungus” spreads fear. BMJ [Internet]. 2021 May 13;n1238. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.n1238

Bhatia M. The rise of mucormycosis in Covid-19 patients in India. Expert Rev Anti Infect Ther [Internet]. 2021 Jul 30;1–2. Available from: https://www.tandfonline.com/doi/full/10.1080/14787210.2021.1960822

Gambhir RS, Aggarwal A, Bhardwaj A, Kaur A, Kaur R, Sohi, et al. Covid-19 and Mucormycosis (Black Fungus): an Epidemic Within the Pandemic. Rocz Panstw Zakl Hig. 2021;72(3):1–6.

Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India. Diabetes Metab Syndr Clin Res Rev [Internet]. 2021 Jul;15(4):102146. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1871402121001570

Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia [Internet]. 2021 May 5;186(2):289–98. Available from: https://link.springer.com/10.1007/s11046-021-00528-2

WHO. Weekly epidemiological update on COVID-19 - 10 August 2021 [Internet]. 2021 [cited 2021 Aug 20]. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---10-august-2021

WHO. COVID-19 new variants: Knowledge gaps and research [Internet]. 2021 [cited 2021 Aug 28]. Available from: https://www.who.int/publications/m/item/covid-19-new-variants-knowledge-gaps-and-research

Ong SWX, Chiew CJ, Ang LW, Mak T-M, Cui L, Toh MPH, et al. Clinical and Virological Features of SARS-CoV-2 Variants of Concern: A Retrospective Cohort Study Comparing B.1.1.7 (Alpha), B.1.315 (Beta), and B.1.617.2 (Delta). SSRN Electron J [Internet]. 2021; Available from: https://www.ssrn.com/abstract=3861566

Kang M, Xin H, Yuan J, Ali ST, Liang Z, Zhang J, et al. Transmission dynamics and epidemiological characteristics of Delta variant infections in China. medRxiv [Internet]. 2021 Jan 1;2021.08.12.21261991. Available from: http://medrxiv.org/content/early/2021/08/13/2021.08.12.21261991.abstract

Variants of concern or under investigation: data up to 9 June 2021 [Internet]. [cited 2021 Aug 28]. Available from: https://www.gov.uk/government/publications/covid-19-variants-genomically-confirmed-case-numbers/variants-distribution-of-case-data-11-june-2021

Mahase E. Delta variant: What is happening with transmission, hospital admissions, and restrictions? BMJ [Internet]. 2021 Jun 15;n1513. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.n1513

Fisman DN, Tuite AR. Progressive Increase in Virulence of Novel SARS-CoV-2 Variants in Ontario, Canada. medRxiv [Internet]. 2021 Jan 1;2021.07.05.21260050. Available from: http://medrxiv.org/content/early/2021/07/12/2021.07.05.21260050.abstract

Farinholt T, Doddapaneni H, Qin X, Menon V, Meng Q, Metcalf G, et al. Transmission event of SARS-CoV-2 Delta variant reveals multiple vaccine breakthrough 1 infections 2.

Dougherty K, Mannell M, Naqvi O, Matson D, Stone J. Morbidity and Mortality Weekly Report SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility-Oklahoma, April-May 2021.

Nowroozi A, Rezaei N. SARS-CoV-2 delta variant of concern breakthrough infections: Are vaccines failing us? Infect Control Hosp Epidemiol. 2021 Aug;1–4.

WHO. Weekly epidemiological update on COVID-19 - 17 August 2021 [Internet]. 2021 [cited 2021 Aug 28]. Available from: Weekly epidemiological update on COVID-19 - 17 August 2021

2021.07.24.453631v1.full.

Lazarevic I, Pravica V, Miljanovic D, Cupic M. Immune evasion of sars‐cov‐2 emerging variants: What have we learnt so far? Vol. 13, Viruses. MDPI AG; 2021.

Mlcochova P, Kemp S, Shanker Dhar M, Papa G, Meng B, Mishra S, et al. SARS-CoV-2 B.1.617.2 Delta variant emergence and vaccine breakthrough. bioRxiv. 2021;2021.05.08.443253.

Alfaro S, Sen-Crowe B, McKenny M, Elkbuli A. A closer look at U.S COVID-19 vaccination rates and the emergence of new SARS-CoV-2 variants: It’s never late to do the right thing. Ann Med Surg. 2021 Sep;69:102709.

Wesolowski;Kathrin. Fact check: Did COVID vaccines cause the delta variant?

Caffo E, Scandroglio F, Asta L. Debate: COVID‐19 and psychological well‐being of children and adolescents in Italy. Child Adolesc Ment Health. 2020;25(3):167–8.

Cai Y, Zhang J, Xiao T, Peng H, Sterling SM, Walsh RM, et al. Distinct conformational states of SARS-CoV-2 spike protein. Science (80- ). 2020;369(6511):1586–92.

Arora P, Krueger N, Kempf A, Nehlmeier I, Sidarovich A, Graichen L, et al. Increased lung cell entry of B.1.617.2 and evasion of antibodies induced by infection and BNT162b2 vaccination. bioRxiv. 2021;2021.06.23.449568.

Musser JM, Christensen PA, Olsen RJ, Long SW, Subedi S, Davis JJ, et al. Delta variants of SARS-CoV-2 cause significantly increased vaccine breakthrough COVID-19 cases in Houston, Texas. medRxiv. 2021;77030:2021.07.19.21260808.

Liu;Roxanne, Woo;Ryan, Kim;Miyoung. Explainer: Are Chinese COVID-19 shots effective against the Delta variant? reuters. 2021;

Dashdorj NJ, Dashdorj ND, Mishra M, Danzig L, Briese T, Lipkin WI, et al. Molecular and serological investigation of the 2021 COVID-19 case surge in Mongolian vaccinees. medRxiv [Internet]. 2021 Jan 1;2021.08.11.21261915. Available from: http://medrxiv.org/content/early/2021/08/13/2021.08.11.21261915.abstract

Iacobucci G. Covid-19: Are high rates of B.1.617.2 linked to vaccine hesitancy? BMJ. 2021 May;373:n1345.

Planas D, Veyer D, Baidaliuk A, Staropoli I, Guivel-Benhassine F, Rajah MM, et al. Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature. 2021;596(7871):276–80.

Pouwels KB, Pritchard E, Matthews PC, Stoesser N, Eyre DW. Impact of Delta on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK.

Chia PY, Ong S, Chiew CJ, Ang LW, Chavatte JG, Mak TM, et al. Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine-breakthrough infections: a multi-center cohort study. medRxiv. 2021;2021.07.28.21261295.

Tada T, Zhou H, Samanovic MI, Dcosta BM, Cornelius A, Mulligan MJ, et al. Comparison of Neutralizing Antibody Titers Elicited by mRNA and Adenoviral Vector Vaccine against SARS-CoV-2 Variants. bioRxiv Prepr Serv Biol. 2021;(212).

Kumwenda-Mtambo;Olivia, Neely ;Jason. South African study shows high COVID protection from J&J shot. reuters. 2021;

Callaway E. Delta coronavirus variant: scientists brace for impact. Nature [Internet]. 2021 Jul 1;595(7865):17–8. Available from: http://www.nature.com/articles/d41586-021-01696-3

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14-03-2022

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1.
Samieefar N, Rashedi R, Akhlaghdoust M, Mashhadi M, Darzi P, Rezaei N. Delta Variant: The New Challenge of COVID-19 Pandemic, an Overview of Epidemiological, Clinical, and Immune Characteristics. Acta Biomed [Internet]. 2022 Mar. 14 [cited 2024 Jul. 18];93(1):e2022179. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12210