高疫苗接种率和自然感染率可提高免疫力并重新定向病毒的选择性适应。安装了更新的助推器来应对漂移的病毒，但缺乏在现实世界中不断增加的免疫压力下适应性进化的数据。 表征 SARS-CoV-2 突变动态和超过 1 年选择性适应的横断面研究疫苗状态、病毒系统发育以及相关的临床和人口统计学变量。2021 年 7 月至 2022 年 8 月期间纽约大都会区超过 5400 例 SARS-CoV-2 感染的研究描绘了从 Delta 到 Omicron BA.1-BA.5 的进化转变变体。在 Delta 浪潮期间实施了加强疫苗接种，但加强突破感染和 SARS-CoV-2 再次感染几乎是 Omicron 所独有的。在调整后的逻辑回归分析中，与 BA.2.12.1 或 BA.4 不同，BA.1、BA.2 和 BA.5 相对于增强群体中的共存谱系具有显着的生长优势。加强注射的选择压力转化为 Delta 刺突中的弥漫性适应性进化，与 BA.2-BA.5 刺突中强烈的、以受体结合基序为中心的适应性进化形成鲜明对比（Fisher 精确测试；每个位点的非同义/同义突变率） 。趋同进化在 Omicron 中已变得很常见，涉及对免疫逃逸、受体结合或裂解至关重要的尖峰位置。需要加强注射来应对免疫缺陷。它们的区别性免疫压力有助于其有效性，但也需要监测选择性病毒适应过程。 Omicron BA.2 和 BA.5 在加强疫苗接种压力下具有选择性优势，有助于在 2023 年占主导地位的 BA.2 和 BA.5 亚系和重组形式的进化。该研究得到了纽约大学机构基金的支持，部分得到了劳拉和艾萨克珀尔穆特癌症中心癌症中心支持拨款 P30CA016087。版权所有 © 2023 作者。由 Elsevier B.V. 出版。保留所有权利。

High rates of vaccination and natural infection drive immunity and redirect selective viral adaptation. Updated boosters are installed to cope with drifted viruses, yet data on adaptive evolution under increasing immune pressure in a real-world situation are lacking.Cross-sectional study to characterise SARS-CoV-2 mutational dynamics and selective adaptation over >1 year in relation to vaccine status, viral phylogenetics, and associated clinical and demographic variables.The study of >5400 SARS-CoV-2 infections between July 2021 and August 2022 in metropolitan New York portrayed the evolutionary transition from Delta to Omicron BA.1-BA.5 variants. Booster vaccinations were implemented during the Delta wave, yet booster breakthrough infections and SARS-CoV-2 re-infections were almost exclusive to Omicron. In adjusted logistic regression analyses, BA.1, BA.2, and BA.5 had a significant growth advantage over co-occurring lineages in the boosted population, unlike BA.2.12.1 or BA.4. Selection pressure by booster shots translated into diffuse adaptive evolution in Delta spike, contrasting with strong, receptor-binding motif-focused adaptive evolution in BA.2-BA.5 spike (Fisher Exact tests; non-synonymous/synonymous mutation rates per site). Convergent evolution has become common in Omicron, engaging spike positions crucial for immune escape, receptor binding, or cleavage.Booster shots are required to cope with gaps in immunity. Their discriminative immune pressure contributes to their effectiveness but also requires monitoring of selective viral adaptation processes. Omicron BA.2 and BA.5 had a selective advantage under booster vaccination pressure, contributing to the evolution of BA.2 and BA.5 sublineages and recombinant forms that predominate in 2023.The study was supported by NYU institutional funds and partly by the Cancer Center Support Grant P30CA016087 at the Laura and Isaac Perlmutter Cancer Center.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.