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Introduction: Since its isolation in the UK, the SARS-CoV-2 Delta variant has become an epidemic. This study aimed to decipher the viral appearance and genomic characterization of the Delta variant isolated from patients in the Kurdistan region of Iraq., Methodology: Samples were collected from the West Erbil Emergency Hospital, and infection by SARS-CoV2 was confirmed using Real-Time PCR. The sequenced samples were analyzed and compared to the previously published data on Delta variants., Results: The analysis showed that the variant belongs to SARS-CoV2 Delta variant B.1.617.2, including most of the previously detected mutations in India. The variant includes 13 mutations (11 substitutions and 2 deletions) on the spike region. Some substitutions are the same as the previous Delta isolate (T19R, G142D, T478K, D614G, L452R, P681R, and D950N). However, other substitutions (E156G, T250I, T19A, and L861W) were unique in the spike protein of the Delta variant (EPI_ISL_7405941) found in the Iraq variants., Conclusions: The impact of the novel mutations needs more study, but the common ones are shown to enhance transmission and escape from immunity. Future studies need to focus on the impact of the different vaccines in the Kurdish population on the Delta variant and the effect of the novel mutations on transmissibility and escape from immunity., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Sevan O Majed, Suhad A Mustafa, Paywast J Jalal, Mohammed H Fatah, Abdulkarim Y Karim, Sahar Hassannejad, Monika H Miasko.)

Due to several mutations in its genomic sequence, particularly in the spike protein region, the recently-discovered SARS-CoV-2 variant B.5.2.1 has alarmed health policy authorities worldwide. The World Health Organization (WHO) has labelled it "Omicron" and classified it as a worldwide variant of concern (VOC). Following the appearance of Omicron in Iraq, new cases were also detected and analyzed in Kurdistan regions. Two hundred patients were recruited in this study from Erbil/Iraq. The RNA genome samples were extracted,  the qRT-PCR performed, and 10 samples were sequenced. The sample sequence was published (EPI ISL 15921492) in the GISAID international gene bank for COVID-19. When compared to the BA.1 Omicron sublineage, 17 new mutations and five deletions in the  Omicron subvariant BA.5.2.1 sequence were detected. The spike region includes eight of these variations and one deletion. Overall, 30 substitutions were shared between those previously seen in the BA.1 sublineage and the newly-detected BA.5.2.1 Omicron subvariant. We detected eight new substitutions in our BA.5.2.1 subvariants (T112I, A27S, V213G, T376F, D405N, R408S, L452R, F486V), which were not mentioned previously, should be cause for concern and may be related to immune escape or viral oligomerization. Omicron might be more immune-escape-capable than the current VOCs/VOIs. However, the predicted mutational research shows no conclusive evidence that the Omicron variant may be more virulent or fatal than other variations, including Delta. The greater capacity for immunological evasion may cause the current increase in Omicron cases in Erbil/Iraq.

Omicron variants have been classified as Variants of Concern (VOC) by the World Health Organization (WHO) ever since they first emerged as a result of a significant mutation in this variant, which showed to have an impact on transmissibility and virulence of the virus, as evidenced by the ongoing modifications in the SARS-CoV-2 virus. As a global pandemic, the Omicron variant also spread among the Kurdish population. This study aimed to analyze different strains from different cities of the Kurdistan region of Iraq to show the risk of infection and the impact of the various mutations on immune responses and vaccination. A total of 175 nasopharyngeal/oropharyngeal specimens were collected at West Erbil Emergency Hospital and confirmed for SARS-CoV-2 infection by RT-PCR. The genomes of the samples were sequenced using the Illumina COVID-Seq Method. The genome analysis was established based on previously published data in the GISAID database and compared to previously detected mutations in the Omicron variants, and that they belong to the BA.1 lineage and include most variations determined in other studies related to transmissibility, high infectivity and immune escape. Most of the mutations were found in the RBD (receptor binding domain), the region related to the escape from humoral immunity. Remarkably, these point mutations (G339D, S371L, S373P, S375F, T547K, D614G, H655Y, N679K and N969K) were also determined in this study, which were unique, and their impact should be addressed more. Overall, the Omicron variants were more contagious than other variants. However, the mortality rate was low, and most infectious cases were asymptomatic. The next step should address the potential of Omicron variants to develop the next-generation COVID-19 vaccine.

The COVID-19 pandemic has severely affected the entire globe since the first isolation of SARS-CoV-2 from patients with severe respiratory illness in Wuhan, China. Although the global vaccination drive is in full swing, many cases of reinfection have also been reported after vaccination. Currently, there is a scarcity of data available on the reinfection and vaccine breakthrough infections in Iraq. In this letter, we have presented a case report on the SARS-CoV-2 vaccine breakthrough reinfection in a health-care worker after completion of the double-dose vaccination. An increased symptom severity was reported on the second infection, which was confirmed to be of Delta variant. Such vaccine breakthrough infection reports have raised important questions regarding the duration of vaccine-mediated immunity and vaccine effectiveness against all circulating variants. These have further emphasized the importance of following non-pharmaceutical interventions by fully vaccinated individuals, especially at health-care settings.