key: cord-0763795-9jy2q1an
authors: Lesho, Emil; Corey, Brendan; Lebreton, Francois; Ong, Ana C; Swierczewski, Brett E; Bennett, Jason W; Walsh, Edward E; Mc Gann, Patrick
title: Emergence of the E484K Mutation in SARS-CoV-2 Lineage B.1.1.345 in Upstate New York
date: 2021-06-04
journal: Clin Infect Dis
DOI: 10.1093/cid/ciab507
sha: 30db31fb22f673573314124eeac04582134ac4f4
doc_id: 763795
cord_uid: 9jy2q1an

A SARS-CoV-2 B.1.1.345 variant carrying the E484K mutation was detected in four patients with no apparent epidemiological association from a hospital network in upstate New York. Subsequent analysis identified an additional eleven B.1.1.345 variants from this region between December 2020 and February 2021.

Over the past six months, the emergence of three variants with mutations in the spike protein has raised serious concerns about the durability of the current suite of vaccines and immunotherapies. The variants, which are colloquially referred to as the United Kingdom [2] . Critically, recent studies have suggested this mutation potentially increases transmission and virulence [3, 4] . Shortly thereafter, this same mutation was identified in B.1.351 and P.1 [5, 6] . Both variants also carried an additional mutation (E484K) in the spike that can increase resistance to neutralization by many monoclonal antibodies (mAb), while most convalescent sera and mRNA vaccine-induced immune sera show reduced inhibitory activity [7, 8] Table S1 ). The average age was 85 years (range 74-92) and, despite advanced age and multiple co-morbidities, all recovered. Three patients had mild courses with no specific anti-SARS-CoV-2 treatments. One patient received Remdesivir and Dexamethasone and did not require intensive care or endotracheal intubation. Notably, three patients lived in separate assisted living facilities with no known connections and the fourth resided at home. All patients reported no significant travel in the preceding 6 months and none had received a SARS-CoV-2 vaccine.

The five strains were initially assigned to Pangolin Lineage B.1.1.220 (NextStrain clade 20B; Figure 1A ) along with an additional 124 SARS-CoV-2 genomes from New York State, including 12 that also carried the E484K mutation ( Figure 1B, Figure 1B and Supplemental Table 1) and all samples from Upstate New York carrying the E484K mutation were assigned to B.1.1.345 ( Figure 1B 

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