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who-covid-19-epidemiological-update-edition-163

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	"1
	COVID -19 Epidemiological Update
	Edition 163 published 19 January 2024
	In this edition:
	• Key highlights
	• Global overview
	• Hospitalizations and ICU admissions
	• SARS -CoV-2 variants of interest and variants under monitoring
	• WHO regional overviews


	Key highlights

	• Globally, during the 28 -day period from 11 December 2023 to 7 January 2024 , 106 countries report ed COVID -
	19 cases and 51 countries report ed COVID -19 deaths. Note that this does not reflect the actual number of
	countries where cases or deaths are occurring , as many countries have stopped or changed frequency of
	reporting .
	• From the available data , the number of reported cases has increased while deaths have decreased during
	the 28 -day period , with over 1.1 million new cases and 8700 new deaths , an increase of 4% and a decrease
	of 26%, respectively, compared to the previous 28 days ( 13 November to 10 December 2023 ). Trends in the
	number of reported new cases and deaths should be interpreted with caution due to decreased testing and
	sequencing, alongside reporting delays in many countries. According to estimates obtained from wastewater
	surveillance, clinical detection of cases underestimates the real burden from 2 to 19 -fold.
	• SARS -CoV-2 PCR percent positivity , as detected in integrated sentinel surveillance as part of the Global
	Influenza Surveillance and Response System ( GISRS ) and reported to FluNet was around 8 % as of 7 January
	2024.
	• During the 28 -day period from 11 December 2023 to 7 January , 53 and 42 countries provided data at least
	once on COVID -19"
	"at least
	once on COVID -19 hospitalizations and admissions to an intensive care unit (ICU) , respectively . From the
	available data, over 173 000 new hospitalizations and over 1900 new ICU admissions were reported during
	the 28 -day period . Amongst the countries reporting these data consistently over the current and past
	reporting period, there was an overall increase of 40% and 13% in new hospitalizations and new ICU
	admissions , respectively .
	• Globally, JN.1 is the most reported VOI (now reported by 71 countries), accounting for 65.5% of sequences
	in week 52 compared to 24.8% in week 48 (Figure 10, Table 6). Its parent lineage, BA.2.86, is stable and
	accounted for 7.8% of sequences in week 52 c ompared to 7.0% in week 48 (Figure 10, Table 6). The initial
	risk evaluation for JN.1 was published on 19 December 2023, with an overall evaluation of low public health
	risk at the global level based on available evidence. WHO is currently tracking several SARS -CoV-2 variants :
	five VOIs – XBB.1.5, XBB.1.16 , EG.5 BA.2.86 and JN.1 ; and five VUMs : DV.7, XBB, XBB.1.9.1, XBB .1.9.2 and
	XBB.2.3
	• The Global WHO Coronavirus (COVID -19) Dashboard has been updated and adapted with a new interface
	on 22 December 2023 to support WHO and Member States’ work to transition from COVID -19 as an
	emergency to longer -term disease management, as outlined in WHO’s 3 May 2023 COVID -19 2023"
	"3 COVID -19 2023 -2025
	Updated Strategic Preparedness and Response Plan . The new dashboard will progressively incorporate more
	components throughout 2024. The previous link of the Global WHO Coronavirus (COVID -19) Dashboard will
	still be active and redirect users to the new one from 22 December onward. Please note that start time of
	the redirection can differ around the world by up to 24 hours.

	2

	For t he latest data and other updates on COVID -19, please see:
	• WHO Monthly Operational Update and past editions of the Weekly Epidemiological Update on COVID -19
	• WHO COVID -19 detailed surveillance data dashboard
	• WHO COVID -19 policy briefs
	• COVID -19 surveillance reporting requirements update for Member States
	• Summary Tables of COVID -19 vaccine effectiveness (VE) studies and results (last updated 11 January
	2024)
	• Forest Plots displaying results of COVID -19 VE studies (last updated 15 January 2024)
	• Special focus WEU on interpreting relative VE (29 June 2022, pages 6 -8)
	• Neutralizat ion p lots (last updated 15 January 2024)
	• WHO COVID -19 VE Resources


	Global overview

	Data as of 7 January 2024
	Globally, the number of new weekly cases remained stable during the 28 -day period of 11 December 2023 to 7
	January 2024 as compared to the previous 28 -day period, with over 1.1 million new cases reported (Figure 1,
	Table 1). The number of new weekly deaths decreased by 26% as compared to the previous 28 -day period, with
	8700 new fatalities"
	"
	8700 new fatalities reported. As of 7 January 2024, over 774 million confirmed cases and over 7 million deaths
	have been reported globally. According to estimates obtained from viral loads in wastewater surveillance, clinical
	detection of cases underestimated the real burden 2 to 19 -fold1,2,3
	Reported cases do not accurately represent infection rates due to the r eduction in testing and reporting globally .
	During this 28 -day period, only 45% (10 6 of 234) of countries reported at least one case to WHO. It is important
	to note that this statistic does not reflect the actual number of countries where cases exist. Additionally, data
	from the previous 28 -day period are continuously being updated to inc orporate retrospective changes made by
	countries regarding reported COVID -19 cases and deaths. Data presented in this report are therefore incomplete
	and should be interpreted considering these limitations. Some countries continue to r eport high burdens of
	COVID -19, including increases in newly reported cases and, more importantly, increases in hospitalizations and
	deaths – the latter of which are considered more reliable indicators given reductions in testing. Global and
	national data on SARS -CoV-2 PCR percent positivity are available on WHO’s integrated influenza and other
	respiratory viruses surveillance dashboard . Recent data (epidemiological week one, 1 to 7 January 2024) from
	sentinel sites show that the SARS -CoV-2 PCR percent positivity from reporting countries averages approximately
	8% (Figure 2).
	As many countries discontinue COVID -19-specific reporting and integrate it into respiratory disease surveillance,
	WHO will use all available sources to continue monitoring the COVID -19 epidemiological situation, especially
	data on morbidity and impact on h ealth systems. COVID -19 remains a major threat, and WHO urges Member
	States to maintain, not dism"
	"
	States to maintain, not dismantle, their established COVID -19 infrastructure. It is crucial to sustain, inter alia ,
	early warning, surveillance and reporting, variant tracking, early clin ical care provision, administration of vaccine
	to high -risk groups, improvements in ventilation, and regular communication.

	1 Show us the data: global COVID -19 wastewater monitoring effectors, equity, and gaps

	2. Capturing the SARS -CoV-2 infection pyramid within the municipality of Rotterdam using longitudinal sewage surveillance

	3. Omicron COVID -19 Case Estimates Based on Previous SARS -CoV-2 Wastewater Load, Regional Municipality of Peel, Ontario, Canada
	3
	Current trends in reported COVID -19 cases and deaths should be interpreted with caution as several countries
	have been progressively changing COVID -19 testing strategies, resulting in lower overall numbers of tests
	performed and consequently lower numbers o f cases detected. Additionally, data from previous weeks are
	continuously updated to retrospectively incorporate changes in reported COVID -19 cases and deaths made by
	countries.


	Figure 1. COVID -19 cases and global deaths by 28 -day intervals reported by WHO Region, as of 7 January 2024 ( A); 26
	June to 17 January 2024 (B)**




	**See Annex 1: Data, table, and figure note

	A
	B 4
	At the regional level, the number of newly reported 28 -day cases decreased across four of the six WHO regions:
	the African Region ( -63%), the Region of the Americas ( -18%), the Eastern Mediterranean Region ( -13%), and
	the European Region ( -13%); while case numbers increased in two WHO regions: the Western Pacific Region
	(+77%), and the South -East"
	"77%), and the South -East Asia Region (+379%). The number of newly reported 28 -day deaths decreased or
	remained stable across five regions: the African Region ( -113%), the Eastern Mediterra nean Region ( -53%), the
	Western Pacific Region ( -45%), the Region of the Americas ( -41%), and the European Region ( -3%); while death
	numbers increased in the South -East Asia Region (+564%).
	At the country level, the highest numbers of new 28 -day cases were reported from the Russian Federation (235
	198 new cases; -30%), Singapore (174 643 new cases; +117%), Italy (163 599 new cases; -18%), Greece (68 590
	new cases; +81%), and Malaysia (67 206 n ew cases; +164%). The highest numbers of new 28 -day deaths were
	reported from Italy (1016 new deaths; -21%), the Russian Federation (679 new deaths; +45%), Poland (543 new
	deaths; +229%), Sweden (446 new deaths; -47%), and Greece (322 new deaths; +79%).

	Table 1. Newly reported and cumulative COVID -19 confirmed cases and deaths, by WHO Region, as of 7 January 2024**
	WHO
	Region New cases in
	last 28 days
	(%) Change in
	new cases in
	last 28 days * Cumulative
	cases (%) New deaths
	in last 28
	days (%) Change in
	new deaths
	in last 28
	days * Cumulative
	deaths (%) Countries
	reporting
	cases in the
	last 28 days Countries
	reporting
	deaths in
	the last 28
	"
	"in
	the last 28
	days
	Europe 701 053
	(63%) -13% 278 615
	939
	(36%) 4 194
	(48%) -3% 2 265 734
	(32%) 34/61
	(56%) 23/61
	(38%)
	Western
	Pacific 338 056
	(30%) 77% 208 014
	763
	(27%) 416
	(5%) -45% 419 274
	(6%) 17/35
	(49%) 8/35
	(23%)
	America
	s 42 330
	(4%) -18% 193 223
	732
	(25%) 3 869
	(44%) -41% 2 992 342
	(43%) 17/56
	(30%) 9/56
	(16%)
	South -
	East
	Asia 26 469
	(2%) 379% 61 241 866
	(8%) 186
	(2%) 564% 808 278
	(12%) 6/10
	(60%) 4/10
	(40%)
	Africa 3 354
	(0%) -63% 9 568 385
	(1%) -2
	(0%) -113% 175 473
	(3%) 28/50
	(56%) 4/50
	(8%)"
	" 4/50
	(8%)
	Eastern
	Mediter
	ranean 2 464
	(0%) -13% 23 409 749
	(3%) 37
	(0%) -53% 351 870
	(5%) 4/22
	(18%) 3/22
	(14%)
	Global 1 113 726
	(100%) 4% 774 075
	198
	(100%) 8 700
	(100%) -26% 7 012 984
	(100%) 106/234
	(45%) 51/234
	(22%)

	*Percent change in the number of newly confirmed cases/deaths in the past 28 days, compared to 28 days prior. Data from previous weeks are
	updated continuously with adjustments received from countries.
	**See Annex 1: Data, table, and figure notes




	5
	Figure 2. SARS -CoV-2 specimens tested and test positivity rates reported to FluNet from sent inel sites ; 5 January
	2020 to 7 January 2024



	Source: Influenza and SARS -CoV-2 surveillance data from GISRS reported to FluNet ; WHO Global Influenza Programme

	6
	Figure 3. Number of confirmed COVID -19 cases reported over the last 28 days per 100 000 population , as of 7 January 2024**

	**See Annex 1: Data, table, and figure notes

	7
	Figure 4. Percentage change in confirmed COVID -19 cases over the last 2"
	"-19 cases over the last 28 days relative to the previous 28 days, as of 7 January 2024**

	**Se e Annex 1: Data, table, and figure notes

	8
	Figure 5. Number of COVID -19 deaths reported over the last 28 days per 100 000 population , as of 7 January 2024 **

	**Se e Annex 1: Data, table, and figure notes

	9
	Figure 6. Percentage change in confirmed COVID -19 deaths over the last 28 days relative to the previous 28 days, as of 7 January 2024**

	**Se e Annex 1: Data, table, and figure notes

	10

	Hospitalizations and ICU admissions

	At the global level, during the past 28 days (11 December 2023 to 7 January 2024), a total of 173 547 new
	hospitalizations and 1 966 new intensive care unit (ICU) admissions were reported from 5 3 and 4 2 countries,
	respectively (Figure 7). This represents 32% increase and 3% decrease, respectively, compared to the previous 28
	days (13 November to 10 December 2023). Note that the absence of reported data from some countries to WHO
	does not imply that there are no COVID -19-related hospitalizations in those countries. The prese nted hospitalization
	data are preliminary and might change as new data become available. Furthermore, hospitalization data are subject
	to reporting delays. These data also likely include both hospitalizations with incidental cases of SARS -CoV-2 infection
	and those due to COVID -19 disease.


	New hospitalizations
	During the past 28 days, 5 3 (23%) countries reported data to WHO on new hospitalizations at least once (Figure 7)."
	"izations at least once (Figure 7).
	The Region of the Americas had the highest proportion of countries reporting data on new hospitalizations (1 9
	countries; 3 4%), followed by the European Region (15 countries; 25%), the African Region (12 countries; 24%), the
	South -East Asia Region (two countries; 20%), and the Western Pacific Region (five countries; 14%). No country in the
	Eastern Mediterranean Region shared1. The number of countries that consistently reported new hospitalizations
	for the period was 9% (22 countries) (Table 2).

	Among the 22 countries consistently reporting new hospitalizations, 8 (36%) countries registered an increase of 20%
	or greater in hospitalizations during the past 28 days compared to the previous 28 -day period: Indonesia (1337 vs
	149; +797%), Malta (79 vs 21; +276%), Brunei Darussalam (588 vs 161; +265%), Malaysia (9312 vs 4137; +125%),
	Greece (6366 vs 3792; +68%), Singapore (2619 vs 1719; +52%), United Sates of America (12 8 073 vs 84 98 1; +51%),
	and Ireland (1353 vs 967; +40%).
	The highest numbers of new hospital admissions were reported from the United States of America (12 8 073 vs 84
	981; +51%), Malaysia (9312 vs 4137; +125%), and Italy (8845 vs 13 857; -36%).










	11

	Table 2. Number of new hospitalization admissions"
	"2. Number of new hospitalization admissions reported by WHO regions, 11 December 2023 to 7 January 2024
	compared to 16 October to 13 November to 10 December 2023
	Region Countries reported at least once in
	the past 28 days Countries reported consistently in the past and
	previous 28 days*
	Number of
	countries
	(percentage)** Number of new
	hospitalizations Number of
	countries
	(percentage)** Number of new
	hospitalizations Percent change in
	new hospitalizations
	Africa 12/50 (24%) 61 3/50 ( 6%) 6 -45%
	Americas 19/56 (3 4%) 134 789 5/56 ( 9%) 129 408 +48%
	Eastern
	Mediterranean 0/22 (<1%) N/A*** 0/22 (<1%) N/A N/A
	Europe 15/61 (25%) 23 039 9/61 (15%) 22 574 -9%
	South -East
	Asia 2/10 (20%) 1358 2/10 (20%) 1358 +690%
	Western
	Pacific 5/35 (14%) 14 300 5/35 (14%) 14 300 +88%
	Global 53/234 (2 3%) 173 547 24/234 ( 10%) 167 646 +40%

	*Percent change is calculated for countries reporting consistently both in the past 28 days and the previous 28 days (compari son period).
	**Number of countries reported / total number of countries in the region ("
	"reported / total number of countries in the region (percentage of reporting).
	*** N/A represents not available or applicable .















	12

	Table 3. Countries that consistently reported new hospitalizations by WHO region, 11 December 2023 to 7 January 2024
	compared to 13 November to 10 December 2023.
	WHO Region Country New Hospitalization in
	past 28 days New Hospitalization in
	previous 28 -day period % Change from
	previous 28 -day
	period
	Africa Mauritania 0 0 N/A
	Africa Mali 0 0 N/A
	Africa Angola 6 11 -45%
	Americas Turks and Caicos Islands 0 0 N/A
	Americas United States of America 128073 84981 51%
	Americas Canada 1335 2685 -50%
	Americas Saint Lucia 0 7 -100%
	Americas Honduras 0 5 -100%
	Europe Malta 79 21 276%
	Europe Greece 6366 3792 68%
	Europe Ireland 1353 967 40%
	Europe Netherlands 2474 2196 13%
	Europe Slovakia 925 1015 -9%
	Europe Czechia 2083 2317 -10%
	Europe Estonia 420 474 -11%
	Europe Italy 8845 13857 -36%
	Europe Portugal 29 57 -49%
	South -East Asia Indonesia 133"
	"East Asia Indonesia 1337 149 797%
	South -East Asia Bangladesh 21 23 -9%
	Western Pacific Brunei Darussalam 588 161 265%
	Western Pacific Malaysia 9312 4137 125%
	Western Pacific Singapore 2619 1719 52%
	Western Pacific New Zealand 1726 1484 16%
	Western Pacific Mongolia 55 106 -48%

	*N/A represents not applicable
	+WHO emphasizes the importance of maintaining reporting and encourages countries to report the absence of new admissions (“zero reporting”) if
	there are no new hospital or ICU admissions during the week.




	13
	New ICU admissions
	Across the six WHO regions, in the past 28 days, a total of 4 2 (19%) countries reported data to WHO on new ICU
	admissions at least once (Figure 8). The African Region had the highest proportion of countries reporting data on
	new ICU admissions (13 countries; 26%), followed by the European Region (12 countries; 20%), the Region of the
	Americas (10 countries, 14%), the Western Pacific Region (six countries; 17%) , and the South -East Asia Region (one
	country; 10%). No country in the Eastern Mediterranean Region reported ICU data during the period. The
	proportion of coun tries that consistently reported new ICU admissions for the period was 8% (1 8 countries).
	Among the 1 8 countries consistently reporting new ICU admissions, eight ( 44%) countries showed an increase of
	20% or greater in new ICU admissions during the past 28 days compared to the previous 28 -day period: Indones"
	"the previous 28 -day period: Indonesia
	(164 vs 18; +811%), Malaysia (135 vs 15; +800%), Singapore (77 vs38; +103%), Estonia (18 vs 10; +80%), Ireland (20
	vs 13; +54%), Netherlands (120 vs 86; +40%), Greece (120 vs 88; +36%), and Czechia (18 2 vs 146; +25%)
	The highest numbers of new ICU admissions were reported from Italy (464 vs 492; -6%), Czechia (182 vs 146;
	+25%), and Indonesia (164 vs 18; +811%).

	Table 4. Number of new ICU admissions reported by WHO regions, 11 December 2023 to 7 January 2024 compared to
	13 November to 10 December 2023
	WHO Region Countries reported at least once
	in the past 28 days Countries reported consistently in the past and previous 28
	days*
	Number of
	countries
	(percentage)** Number of
	new ICU
	admissions Number of
	countries
	(percentage)** Number of
	new ICU
	admissions Percent change in
	new ICU admissions
	Africa 13/50 (26%) 6 1/50 ( 2%) 0 N/A
	Americas 10/56 (1 8%) 386 2/56 (16%) 99 -55%
	Eastern
	Mediterranean 0/22 (<1%) N/A*** 0/22 (<1%) N/A N/A
	Europe 12/61 (20%) 1097 8/61 (1 3"
	"7 8/61 (1 3%) 1032 +3%
	South -East
	Asia 1/10 (10%) 164 1/10 (10%) 164 +811%
	Western
	Pacific 6/35 (17%) 313 6/35 ( 14%) 256 +86%
	Global 42/235 (1 9%) 1966 18/235 ( 8%) 1551 +13%

	*Percent change is calculated for countries report ing consistently both in the past 28 days and the previous 28 days (comparison period).
	**Number of countries reported / total number of countries in the region (percentage of reporting).
	*** N/A represents data not available or applicable .
	+ WHO emphasizes the importance of maintaining reporting and encourages countries to report the absence of new admissions (“zero re porting”) if
	there are no new hospital or ICU admissions during the week.

	14
	Table 5. Countries that consistently reported new ICU admissions by WHO regions, 11 December 2023 to 7 January 2024
	compared to 13 November to 10 December 2023.
	WHO Region Country New ICU admissions in
	past 28 days New ICU admissions in
	previous 28 days % Change in ICU
	admissions from
	previous 28 -day period
	Africa Mauritania 0 0 N/A
	Americas Canada 99 221 -55%
	Americas Honduras 0 0 N/A
	Europe Italy 464 492 -6%
	Europe Czechia 182 146 25%
	Europe Netherlands 120 86 40%
	Europe Greece 120 88 36%"
	"120 88 36%
	Europe Sweden 101 158 -36%
	Europe Ireland 20 13 54%
	Europe Estonia 18 10 80%
	Europe Slovakia 7 9 -22%
	South -East Asia Indonesia 164 18 811%
	Western Pacific Malaysia 135 15 800%
	Western Pacific Singapore 77 38 103%
	Western Pacific New Zealand 39 38 3%
	Western Pacific Brunei Darussalam 5 5 0%
	Western Pacific Mongolia 0 0 N/A
	Western Pacific Australia 163 220 -26%

	* N/A represents not applicable + WHO emphasizes the importance of maintaining reporting and encourages countries to report the absence of new
	admissions (“zero reporting”) if there are no new hospital or ICU admissions during the week.









	15
	Figure 7. 28 -day global COVID -19 new hospitalizations and ICU admissions, from 3 February 2020 to 7 January
	2024 (A); and from 1 May 2023 to 7 January 2024 (B)
	A


	B



	Note: Recent weeks are subject to reporting delays and data might not be complete, thus the data should be interpret ed with caution. Cases included
	in grey bars are only from countries reporting hospitalizations or ICU admissions, respectively.


	16
	Severity indicators

	The ICU -to-hospitalization ratio and death -to-hospitalization ratio have been key indicators for understanding
	COVID -19 severity throughout the pandemic. The ICU -to-hospitalization ratio is used"
	"U -to-hospitalization ratio is used to assess the proportion of
	patients requiring ICU admission in relation to the total number of hospitalizations. The death -to-hospitalization ratio
	is used to assess the proportion of death s in relation to hospitalized patients.

	These indicators are subject to the same limitations mentioned above and their calculations are limited to the
	countries reporting all relevant data elements (hospitalizations , ICU admissions and deaths) in a given reporting
	period . It should be noted that there may be differences in reporting among countries. For instance, in some
	countries, hospitalization data may include ICU admissions, whereas in others, ICU admissions may be reported
	separately. Furthermore, it is important to consider that some death s might have occurred outside of hospital
	facilities.

	Overall, the ICU -to-hospitalization ratio has been decreasing since the peak in July 2021 when the ratio was 0.2 6,
	dropping below 0.15 since the beginning of 2022, and around 0.05 since the start of 2023 (Figure 8) . The trend has
	been stable in recent wee ks. This suggests that a decreasing proportion of new hospitalizations require intensive
	care.

	Similarly, the death -to-hospitalization ratio has been showing a general decline since July 2021. Since January 2023,
	it has remained under 0.15 , varying between 0.06 to 0.14. This is an encouraging trend indicating a lower mortality
	risk among hospitalized individuals.

	Please n ote that the causes for these decreases cannot be directly interpreted from these data, but likely include a
	combination of increases in infection -derived or vaccine -derived immunity, improvements in early diagnosis and
	clinical care, reduced strain on hea lth systems, and other factors. It is not possible to infer a decreased intrinsic
	virulence amongst newer SARS -CoV-2 variants"
	"newer SARS -CoV-2 variants from these data.





















	17
	Figure 8. COVID -19 ICU -to-hospitalization ratio and death -to-hospitalization ratio, from 27 April 2020 to 7 January
	2023 (A), and 22 May to 7 January 2024 (B)

	A


	B





	Note: Recent weeks are subject to reporting delays and should not be interpreted as a declining trend. The ICU ratio figure is created from the data of the countries
	reported both new hospitalizations and new ICU admissions. The d eath ratio figure is created from the data of the countries that reported both new hospitalization
	and new deaths.
	Source : WHO COVID -19 Detailed Surveillance Dashboard

	18
	SARS -CoV-2 variants of interest and variants under monitoring

	Geographic spread and prevalence
	Globally, during the 28 -day period from 11 December 2023 to 7 January 2024, 33 659 SARS -CoV-2 sequences were
	shared through GISAID. In comparison, in the two previous 28 -day periods, there were 112 909 and 192 222
	sequences shared, respectively. The data are periodically retrospectively updated to include sequences w ith earlier
	collection dates, so the number of submissions in a given time period may change.

	WHO is currently tracking several SARS -CoV-2 variants, including:
	• Five variants of interest (VOIs): XBB.1.5, XBB.1.16, EG.5, BA.2.86 and JN.1
	• Five variants under monitoring (V"
	"
	• Five variants under monitoring (VUMs): DV.7, XBB, XBB.1.9.1, XBB.1.9.2 and XBB.2.3

	Table 6 shows the number of countries reporting VOIs and VUMs, and their prevalence from epidemiological week
	48 (27 November to 3 December 2023) to week 52 (25 December to 31 December 2023). The VOIs and VUMs
	exhibiting increasing trends are highlighted i n yellow, those that have remained stable are highlighted in blue, and
	those with decreasing trends are highlighted in green.

	Globally, JN.1 is currently the dominant circulating VOI (reported by 71 countries), accounting for 65.5% of sequences
	in week 52 compared to 24.8% in week 48 (Figure 10, Table 6). Its parent lineage, BA.2.86, is stable and accounted
	for 7.8% of sequences in week 52 compared to 7.0% in week 48 (Figure 10, Table 6 ). The initial risk evaluation for
	JN.1 was published on 19 December 2023, with an overall evaluation of low public health risk at the global level
	based on available evidence.

	The other VOIs, XBB.1.5, XBB.1.16 and EG.5, have decreased in global prevalence during the same period: XBB.1.5
	accounted for 3.3% of sequences in week 52, a decrease from 8.3% in week 48; XBB.1.6 accounted for 1.5% of
	sequences in week 52, a decrease from 6.3% in week 48; EG.5 accounted for 16.6% of sequences in week 52, a
	decrease from 43.6% in week 48 (Fig"
	".6% in week 48 (Figure 10, Table 6).

	All VUMs have shown a decreasing trend over the reporting period (Table 6).

	Sufficient sequencing data to calculate variant prevalence at the regional level during weeks 48 to 52 were available
	from four WHO regions: the Region of the Americas, the Western Pacific Region, the South -East Asia Region, and the
	European Region (Table 7). Among the VOIs, JN.1 was the most reported variant and showing an increasing trend in
	all the four regions. Except for XBB.1.16 that showed a small increase in the Western Pacific Region, the other VOIs
	and all the VUMs in all four regions observed dec reasing or stable trends.

	With declining rates of testing and sequencing globally (Figure 10), it is increasingly challenging to estimate the
	severity impact of emerging SARS -CoV-2 variants. There are currently no reported laboratory or epidemiological
	reports indicating any associ ation between VOIs/VUMs and increased disease severity. As shown in Figure 9 and
	Figure 10, low and unrepresentative levels of SARS -CoV-2 genomic surveillance continue to pose challenges in
	adequately assessing the variant landscape.










	19
	Table 6. Weekly prevalence of SARS -CoV-2 VOIs and VUMs, week 48 to week 52 of 202 4



	§ Number of countries and sequences are since the emergence of the variants.
	* Includes descendant lineages, except those individually specified elsewhere in the table. For example, XBB* does not includ e
	XBB.1.5, XBB.1.16, EG.5, XBB.1.9.1, XBB.1.9.2, and XBB.2.3.

	"
	".2.3.


	Table 7. Weekly prevalence of SARS -CoV-2 VOIs and VUMs by WHO regions, week 48 to week 52 of 2023



	* Includes descendant lineages, except those individually specified elsewhere in the table. For example, XBB* does not includ e
	XBB.1.5, XBB.1.16, EG.5, XBB.1.9.1, XBB.1.9.2, and XBB.2.3.
	¥ due to the small numbers of sequences submitted in these regions, it has not been possible to determine trends for the VOIs and
	VUMs in these regions; this is also represented by the shaded cells in the table .


	20
	Figure 9. Global 28 -day prevalence of EG.5, XBB.1.5, XBB.1.16, BA.2.86, and JN.1, from 11 December 2023 to 7 January
	2024 *+


	* Reporting period to account for delay in sequence submission to GISAID.
	+ Historical presence indicates countries previously reporting sequences of VOIs but have not reported within the period from 4
	November to 3 December 2023






















	21
	Figure 10. The (A) number and (B) percentage of SARS -CoV-2 sequences, from 3 July to 31 December 2023







	Figure 10. Panel A shows the number, and Panel B the percentage, of all circulating variants since July to December 2023. The variants
	shown here include descendent lineages, except for the descendent lineage(s)"
	"except for the descendent lineage(s) listed here. The Unassigned category includes lineages
	pending for a PANGO lineage name designation, whereas the Other category includes lineages that are assigned but not listed here.
	Source: SARS -CoV-2 sequence data and metadata from GISAID, from 3 July to 31 December 2023.




	A
	B
	22
	Additional resources

	• Tracking SARS -CoV-2 Variants
	• WHO statement on updated tracking system on SARS -CoV-2 variants of concern and variants of interest
	• SARS -CoV-2 variant risk evaluation framework, 30 August 2023
	• WHO JN.1 Initial Risk Evaluation, 1 3 December 2023
	• WHO BA.2.86 Initial Risk Evaluation, 21 November 2023
	• WHO EG.5 Updated Risk Evaluation, 21 November 2023
	• WHO XBB.1.5 Updated Risk Assessment, 20 June 2023
	• WHO XBB.1.16 Updated Risk Assessment, 5 June 2023
	22 WHO regional overviews
	Data for 11 December 2023 to 7 January 2024

	African Region
	The African Region reported over 3354 new cases, a 63% decrease as compared to the previous 28 -day period. Five (10%) of the 50 countries for which data are
	available reported increases in new cases of 20% or greater, with the highest proportional increases observed in Mauritania ( 30 vs six new cases; +400%), Senegal
	(17 vs six new cases ; +183%), Mali (two vs one new case; +100%), Burundi (78 vs 51 new cases; +53%), and Angola ("
	"; +53%), and Angola (417 vs 316 new cases; +32%). The highest
	numbers of new cases were reported from Mauritius (3228 new cases; 253.8 new cases per 100 000; -57%), Angola (417 new cas es; 1.3 new cases per 100 000;
	+32%), and Burundi (78 new cases; <1 new case per 100 000; +53%).
	The number of new 28 -day deaths in the Region decreased by 113% as compared to the previous 28 -day period, with no new deaths reported. The highest numbers
	of new deaths were reported from Mauritius (1 new death; <1 new death per 100 000; -50%), and Namibi a (1 new death; <1 new death per 100 000; -67%).


	Updates from the African Region

	22 Region of the Americas
	The Region of the Americas reported over 42 000 new cases, an 18% decrease as compared to the previous 28 -day period. Seven (12%) of the 56 countries for
	which data are available reported increases in new cases of 20% or greater, with the highest proportio nal increases observed in Panama (822 vs 180 new cases;
	+357%), Barbados (33 vs 14 new cases; +136%), Plurinational State of Bolivia (1563 vs 670 new cases; +133%), Guyana (six vs three new cases; +100%), Colombia
	(1 680 vs 1 266 new cases; +33%), Paraguay (92 vs 73 new cases; +26%), and Jamaica (32 vs 26 new cases; +23%). The highest numbers of new cases were reported
	from"
	"highest numbers of new cases were reported
	from Canada (18 947 new cases; 50.2 new cases per 100 000; -18%), Chile (9693 new cases; 50.7 new cases per 100 000; -25%), and Peru (4657 new cases; 14.1
	new cases per 100 000; -38%).
	The number of new 28 -day deaths in the Region decreased by 41% as compared to the previous 28 -day period, with 3869 new deaths reported. The highest
	numbers of new deaths were reported from the United States of America (3552 new deaths; 1.1 new deaths per 100 000; -40%), Canada (128 new deaths; <1 new
	death per 100 000; -60%), and Chile (114 new deaths; <1 new death per 100 000; -46%).




	Updates from the Region of the Americas

	23 Eastern Mediterranean Region
	The Eastern Mediterranean Region reported over 2464 new cases, a 13% decrease as compared to the previous 28 -day period. One (5%) of the 22 countries for
	which data are available reported increases in new cases of 20% or greater, with the highest proportional increases observed in Kuwait (102 vs 39 new cases;
	+162%). The highest numbers of new cases were reported from Afghanistan (1256 new cas es; 3.2 new cases per 100 000; +14%), the Islamic Republic of Iran (663
	new cases; <1 new case per 100 000; -48%), and Morocco (443 new cases; 1.2 new cases per 100 000; +6%).
	The number of new 2"
	"6%).
	The number of new 28 -day deaths in the Region decreased by 53% as compared to the previous 28 -day period, with 37 new deaths reported. The highest numbers
	of new deaths were reported from the Islamic Republic of Iran (27 new deaths; <1 new death per 100 00 0; -63%), Afghanistan (8 new deaths; <1 new death per
	100 000; +60%), and Morocco (2 new deaths; <1 new death per 100 000; +100%).

	Updates from the Eastern Mediterranean Region





	23 European Region
	The European Region reported over 701 000 new cases, a 13% decrease as compared to the previous 28 -day period. 10 (16%) of the 62 countries for which data
	are available reported increases in new cases of 20% or greater, with the highest proportional increases observed in Malta (310 vs 75 new cases; +313%), Republic
	of Moldova (2 951 vs 1 485 new cases; +99%), Ireland (3 433 vs 1 856 new cases; +85%), Greece (68 590 vs 37 925 new cases; +81%), the United Kingdom (37 787 vs
	22 791 new cases; +66%), Romania (7 380 vs 4 916 new cases; +50%), Portugal (4 451 vs 3 103 new cases; +43%), Belgium (10 653 vs 8 623 new cases; +24%),
	Luxembourg (2 054 vs 1 696 new cases; +21%), and Netherlands (5 330 vs 4 442 new cases; +20%). The highest numbers of new"
	"; +20%). The highest numbers of new cases were reported from the
	Russian Federation (235 198 new cases; 161.2 new cases per 100 000; -30%), Italy (163 599 new cases; 274.3 new cases per 100 000; -18%), and Greece (68 590
	new cases; 639.9 new c ases per 100 000; +81%).
	The number of new 28 -day deaths in the Region decreased by 3% as compared to the previous 28 -day period, with 4194 new deaths reported. The highest numbers
	of new deaths were reported from Italy (1016 new deaths; 1.7 new deaths per 100 000; -21%), the Russ ian Federation (679 new deaths; <1 new death per 100
	000; +45%), and Poland (543 new deaths; 1.4 new deaths per 100 000; +229%).




	Updates from the European Region

	25
	South -East Asia Region
	The South -East Asia Region reported over 26 000 new cases, a 379% increase as compared to the previous 28 -day period. Five (45%) of the 11 countries for which
	data are available reported increases in new cases of 20% or greater, with the highest proportion al increases observed in India (15 079 vs 1 599 new cases; +843%),
	Myanmar (110 vs 20 new cases; +450%), Indonesia (8 610 vs 1 727 new cases; +399%), Bangladesh (276 vs 141 new cases; +96%), and Sri Lanka (67 vs 42 new
	cases; +"
	"vs 42 new
	cases; +60%). The highest numbers of new cases were reported from India (15 079 new cases; 1.1 new cases per 100 000; +843%), Indonesia (8610 new cases; 3.1
	new cas es per 100 000; +399%), and Thailand (2327 new cases; 3.3 new cases per 100 000; +17%).
	The number of new 28 -day deaths in the Region increased by 564% as compared to the previous 28 -day period, with 186 new deaths reported. The highest
	numbers of new deaths were reported from India (86 new deaths; <1 new death per 100 000; +682%), Indonesia (72 new deaths; <1 new death per 100 000;
	+1340%), and Thailand (21 new deaths; <1 new death per 100 000; +91%).



	Updates from the South -East Asia Region

	26
	Western Pacific Region
	The Western Pacific Region reported over 338 000 new cases, a 77% increase as compared to the previous 28 -day period. Ten (29%) of the 35 countries for which
	data are available reported increases in new cases of 20% or greater, with the highest proportional increases observed in Niu e (98 vs six new cases; +1533%), Palau
	(16 vs two new cases; +700%), Tonga (62 vs 12 new cases ; +417%), Cook Islands (29 vs six new cases; +383%), Cambodia (76 vs 16 new cases; +375%), Brunei
	Darussalam (16 648 vs 4 207 new cases; +296%), Malaysia (67"
	"296%), Malaysia (67 206 vs 25 484 new cases; +164%), the Philippines (10 262 vs 4 672 new cases; +120%), Singapore
	(174 643 vs 80 296 new cases; +117%), and China (2 514 vs 1 674 new cases; +50%). The highest numbers of new cases were repor ted from Singapore (174 643
	new cases; 2985.2 new cases per 100 000; +117%), Malaysia (67 206 new cases; 207.6 new cases per 100 000; +164%), and Australia (41 965 new cases; 164.6
	new cases per 100 000; -18%).
	The number of new 28 -day deaths in the Region decreased by 45% as compared to the previous 28 -day period, with 416 new deaths reported. The highest numbers
	of new deaths were reported from Australia (185 new deaths; <1 new death per 100 000; -67%), Malaysi a (97 new deaths; <1 new death per 100 000; +259%),
	and New Zealand (54 new deaths; 1.1 new deaths per 100 000; -49%).


	Updates from the Western Pacific Region

	25
	Annex 1. Data, table, and figure notes
	Data presented are based on official laboratory -confirmed COVID -19 cases and deaths reported to WHO by
	coun try/territories/areas, largely based upon WHO case definitions and surveillance guidance . While steps are taken to
	ensure accuracy and reliability, all data are subject to continuous verification and change, and caution must be taken when
	interpreting these"
	"must be taken when
	interpreting these data as several factors influence the counts presented, with variable underestimation o f true case and
	death incidences, and variable delays to reflecting these data at the global level. Case detection, inclusion criteria, testi ng
	strategies, reporting practices, and data cut -off and lag times differ between countries/territories/areas. Dif ferences are
	to be expected between information products published by WHO, national public health authorities, and other sources.
	A record of historic data adjustment is available upon request by emailing epi-data [email protected] . Please specify the
	countries of interest, time period, and purpose of the request/intended usage. Prior situation reports will not be edited;
	see covid19.who.int for the most up -to-date data.
	‘Countries’ may refer to countries, territories, areas or other jurisdictions of similar status. The designations employed,
	and the presentation of these materials , do not imply the expression of any opinion whatsoever on the part of WHO
	concerning the legal status of any country, territory, or area or of its authorities, or concerning the delimitation of its
	frontiers or boundaries. Dotted and dashed lines on maps r epresent approximate border lines for which there may not
	yet be full agreement. Countries, territories, and areas are arranged under the administering WHO region. The mention
	of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by
	WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted; the names of
	proprietary products are distinguished by initial capital letters.






















	26
	Annex 2. SARS -CoV-2 variants assessment and classification

	WHO, in collaboration with national authorities, institutions and researchers, routinely assesses if variants of S"