{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:30:51Z","timestamp":1793579451957,"version":"4.5.0"},"reference-count":276,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,10]],"date-time":"2023-04-10T00:00:00Z","timestamp":1681084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National University of Singapore"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>The COVID-19 pandemic caused by SARS-CoV-2 is associated with a lower fatality rate than its SARS and MERS counterparts. However, the rapid evolution of SARS-CoV-2 has given rise to multiple variants with varying pathogenicity and transmissibility, such as the Delta and Omicron variants. Individuals with advanced age or underlying comorbidities, including hypertension, diabetes and cardiovascular diseases, are at a higher risk of increased disease severity. Hence, this has resulted in an urgent need for the development of better therapeutic and preventive approaches. This review describes the origin and evolution of human coronaviruses, particularly SARS-CoV-2 and its variants as well as sub-variants. Risk factors that contribute to disease severity and the implications of co-infections are also considered. In addition, various antiviral strategies against COVID-19, including novel and repurposed antiviral drugs targeting viral and host proteins, as well as immunotherapeutic strategies, are discussed. We critically evaluate strategies of current and emerging vaccines against SARS-CoV-2 and their efficacy, including immune evasion by new variants and sub-variants. The impact of SARS-CoV-2 evolution on COVID-19 diagnostic testing is also examined. Collectively, global research and public health authorities, along with all sectors of society, need to better prepare against upcoming variants and future coronavirus outbreaks.<\/jats:p>","DOI":"10.3390\/v15040944","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T02:02:33Z","timestamp":1681178553000},"page":"944","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":122,"title":["Evolution of SARS-CoV-2 Variants: Implications on Immune Escape, Vaccination, Therapeutic and Diagnostic Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3933-5636","authenticated-orcid":false,"given":"Nur Zawanah","family":"Zabidi","sequence":"first","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8316-4013","authenticated-orcid":false,"given":"Hern Liang","family":"Liew","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6733-844X","authenticated-orcid":false,"given":"Isra Ahmad","family":"Farouk","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwini","family":"Puniyamurti","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-8791","authenticated-orcid":false,"given":"Ashley Jia Wen","family":"Yip","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vindya Nilakshi","family":"Wijesinghe","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6213-6040","authenticated-orcid":false,"given":"Zheng Yao","family":"Low","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian W.","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2634-6213","authenticated-orcid":false,"given":"Vincent T. K.","family":"Chow","sequence":"additional","affiliation":[{"name":"Infectious Diseases Translational Research Program, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3548-4853","authenticated-orcid":false,"given":"Sunil K.","family":"Lal","sequence":"additional","affiliation":[{"name":"School of Science, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia"},{"name":"Tropical Medicine & Biology Platform, Monash University, Subang Jaya 47500, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,10]]},"reference":[{"key":"ref_1","unstructured":"(2023, March 25). Worldometer COVID-19 Coronavirus Pandemic. 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