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Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

Raquel Viana1*, Sikhulile Moyo2,3,4*, Daniel G Amoako5*, Houriiyah Tegally6*, Cathrine Scheepers5,7*, Christian L Althaus8, Ugochukwu J Anyaneji6, Phillip A Bester9,10, Maciej F Boni11, Mohammed Chand12, Wonderful T Choga3, Rachel Colquhoun13, Michaela Davids14, Koen Deforche15, Deelan Doolabh16, Louis du Plessis24,49, Susan Engelbrecht17, Josie Everatt5, Jennifer Giandhari6, Marta Giovanetti18,19, Diana Hardie16,20, Verity Hill13, Nei-Yuan Hsiao16,20,21, Arash Iranzadeh22, Arshad Ismail5, Charity Joseph12, Rageema Joseph16, Legodile Koopile2, Sergei L Kosakovsky Pond23, Moritz UG Kraemer24, Lesego Kuate-Lere25, Oluwakemi Laguda-Akingba26,27, Onalethatha Lesetedi-Mafoko28, Richard J Lessells6, Shahin Lockman2,29, Alexander G Lucaci23, Arisha Maharaj6, Boitshoko Mahlangu5, Tongai Maponga17, Kamela Mahlakwane17,30, Zinhle Makatini31, Gert Marais16,20, Dorcas Maruapula2, Kereng Masupu4, Mogomotsi Matshaba4,32,33, Simnikiwe Mayaphi34, Nokuzola Mbhele16, Mpaphi B Mbulawa35, Adriano Mendes14, Koleka Mlisana36,37, Anele Mnguni5, Thabo Mohale5, Monika Moir38, Kgomotso Moruisi25, Mosepele Mosepele4,39, Gerald Motsatsi5, Modisa S Motswaledi4,40, Thongbotho Mphoyakgosi35, Nokukhanya Msomi41, Peter N Mwangi10,42, Yeshnee Naidoo6, Noxolo Ntuli5, Martin Nyaga10,42, Lucier Olubayo21,22, Sureshnee Pillay6, Botshelo Radibe2, Yajna Ramphal6, Upasana Ramphal6, James E San6, Lesley Scott43, Roger Shapiro2,29, Lavanya Singh6, Pamela Smith-Lawrence25, Wendy Stevens43, Amy Strydom14, Kathleen Subramoney31, Naume Tebeila5, Derek Tshiabuila6, Joseph Tsui24, Stephanie van Wyk38, Steven Weaver23, Constantinos K Wibmer5, Eduan Wilkinson38, Nicole Wolter5,44, Alexander E Zarebski24, Boitumelo Zuze2, Dominique Goedhals10,45, Wolfgang Preiser17,30, Florette Treurnicht31, Marietje Venter14, Carolyn Williamson16,20,21,46, Oliver G Pybus24, Jinal Bhiman5,7, Allison Glass1,47, Darren P Martin21,46, Andrew Rambaut13, Simani Gaseitsiwe2,3**, Anne von Gottberg5,44**, Tulio de Oliveira6,38,48**✉

1Lancet Laboratories, Johannesburg, South Africa

2Botswana Harvard AIDS Institute Partnership, Botswana Harvard HIV Reference Laboratory, Gaborone, Botswana

3Harvard T.H. Chan School of Public Health, Boston, Massachusetts

4Botswana Presidential COVID-19 Taskforce, Gaborone, Botswana

5National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa

6KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

7South African Medical Research Council Antibody Immunity Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

8Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

9Division of Virology, National Health Laboratory Service, Bloemfontein, South Africa

10Division of Virology, University of the Free State, Bloemfontein, South Africa

11Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA, USA

12Diagnofirm Medical Laboratories, Gaborone, Botswana

13Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK

14Zoonotic Arbo and Respiratory Virus Program, Centre for Viral Zoonoses, Department of Medical Virology, University of Pretoria, Pretoria, South Africa

15Emweb bv, Herent, Belgium

16Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

17Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

18Laboratorio de Flavivirus, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil

19Laboratório de Genética Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

20Division of Virology, NHLS Groote Schuur Laboratory, Cape Town, South Africa

21Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa)

22Division of Computational Biology, Faculty of Health Sciences, University of Cape Town

23Institute for Genomics and Evolutionary Medicine, Department of Biology, Temple University, Pennsylvania, USA

24Department of Zoology, University of Oxford, Oxford, UK

25Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana

26NHLS Port Elizabeth Laboratory, Port Elizabeth, South Africa

27Faculty of Health Sciences, Walter Sisulu University, Eastern Cape, South Africa

28Public Health Department, Integrated Disease Surveillance and Response, Ministry of Health and Wellness, Gaborone, Botswana

29Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

30NHLS Tygerberg Laboratory, Tygerberg, Cape Town, South Africa

31Department of Virology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

32Botswana-Baylor Children's Clinical Centre of Excellence

33Baylor College of Medicine, Houston, Texas, USA

34Department of Medical Virology, University of Pretoria, Pretoria, South Africa

35National Health Laboratory, Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana

36National Health Laboratory Service (NHLS), Johannesburg, South Africa

37Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa

38Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa

39Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana

40Department of Medical Laboratory Sciences, School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana

41Discipline of Virology, School of Laboratory Medicine and Medical Sciences and National Health Laboratory Service (NHLS), University of KwaZulu–Natal, Durban, South Africa

42Next Generation Sequencing Unit, Division of Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

43Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa

44School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

45PathCare Vermaak, Pretoria, South Africa

46Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

47Department of Molecular Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

48Department of Global Health, University of Washington, Seattle, WA, USA

49Department of Biosystems Science and Engineering, ETH Zurich, Switzerland

*These authors contributed equally: Raquel Viana, Sikhulile Moyo, Daniel G Amoako, Houriiyah Tegally, Cathrine Scheepers

**These authors jointly supervised the work: Simani Gaseitsiwe, Anne von Gottberg, Tulio de Oliveira

Summary

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants, respectively1–3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity.