# Genomic Epidemiology of SARS-CoV-2 in Ukraine from May 2022 to March 2024 Reveals Omicron Variant Dynamics

## TL;DR

This study tracks SARS-CoV-2 variant spread in Ukraine from 2022 to 2024, showing how Omicron subvariants replaced earlier strains amid war and limited resources.

## Contribution

The study provides updated genomic surveillance data on SARS-CoV-2 variant dynamics in Ukraine during a period of war and limited public health infrastructure.

## Key findings

- Omicron subvariants BA.5, XBB, and JN replaced earlier SARS-CoV-2 strains in Ukraine.
- Variant dispersal patterns suggest multiple spatiotemporal introductions from Europe, Asia, and North America.
- The Case Fatality Rate in Ukraine remained modest and consistent compared to global averages during the study period.

## Abstract

In Ukraine, SARS-CoV-2 detection and national genomic surveillance have been complicated by full-scale war, limited resources, and varying levels of public health infrastructure impacted across the country. Following the Spring of 2022, only a paucity of data have been reported describing the prevalence and variant dynamics of SARS-CoV-2 in the country. Comparative whole genome analysis has overtaken diagnostics as the new gold standard for detecting and tracing emerging variants while showing utility to rapidly inform diagnostics, vaccine strategies, and health policy. Herein, we provide an updated report characterizing the dynamics and prevalence of SARS-CoV-2 in Ukraine from 1 May 2022 to 31 March 2024. The present study extends previous reports for disease incidence Waves 1–4 in Ukraine with the addition herein of Waves 5, 6, and 7, occurring from August to November 2022 (Wave 5), February to May 2023 (Wave 6), and October 2023 to January 2024 (Wave 7). During the study period, the national Case Fatality Rate (CFR) fluctuated between 0.46% and 1.74%, indicating a consistent yet modest rate when compared to the global average. The epidemiological dynamics of Variants of Concern (VOCs) in Ukraine reflected global patterns over this period, punctuated by the rise of the BA.5 lineage and its subsequent replacement by the Omicron subvariants XBB and JN.1. Our analysis of variant dispersal patterns revealed multiple potential spatiotemporal introductions into Ukraine from Europe, Asia, and North America. Our results highlight the importance of ongoing genomic surveillance to monitor variant dynamics and support global efforts to control and mitigate COVID-19 disease risks as new variants arise.