The emergence of novel SARS-CoV-2 variants represents a threat to the long-term control of COVID-19 (Fontanet et al., 2021). Whilst efforts to develop vaccines that protect against severe disease have been successful (Polack et al., 2020; Voysey et al., 2021; Baden et al., 2021), mutations in the viral genome that lead to ability to escape immunity, and increased transmissibility and/or clinical severity, either via intrinsic virulence or reduced vaccine effectiveness (Lopez Bernal et al., 2021), have the potential to cause substantial disease burden despite high vaccine coverage in many countries (Our World in Data, 2021).

These concerns motivated the prompt reporting, initially from South Africa (Wolter et al., 2021; World Health Organization, 2022), of clinical characteristics of infection with the Omicron variant only weeks after its emergence (Wolter et al., 2022; Ulloa et al., 2022; Veneti et al., 2022), which provided key information for risk assessment and health policies worldwide. Early data from South Africa showed reduced severity of Omicron lineage BA.1 and similar results were reported in the United Kingdom and the United States (Wolter et al., 2022; Lewnard et al., 2022; Nyberg et al., 2022). However, the impact, in terms of clinical consequences (i.e. disease severity), of new variants has been shown to be context-specific, due to regional differences in disease epidemiology, including local circulation of previous variants and their cumulative incidences, variable vaccination coverages, and heterogeneity in population-level frequencies of risk factors (e.g. frequency of comorbidities) for severe disease and mortality. For this reason, international studies with standardised protocols are necessary to allow comparative assessments across different countries and epidemiological contexts.

To understand the impact of the emergence of the Omicron variant of SARS-CoV-2 on the clinical epidemiology of COVID-19 at the global level, in this study, we report multi-country data, from all six World Health Organization regions, on clinical characteristics and outcomes of Omicron variant infections in hospitalised patients and compare with infections in patients admitted with other SARS-CoV-2 variants. For that, we use publicly available population-level data on relative frequencies of the Omicron variant to determine periods when infections were likely to be caused by Omicron versus other variants/lineages and compare infections descriptively and using multivariable statistical models. In addition, we present an analysis that only includes patients with individual-level data on the infecting variant and paired clinical information.

When new variants of SARS-CoV-2 emerge during the COVID-19 pandemic, several critical questions are asked by public health authorities as to differences in disease severity and risk factors, and vaccine protection. Here, we leveraged data from multiple sources, from population-level variant frequency information to individual-level data on the clinical journey of hospitalised patients with COVID-19, and from multiple countries, to compare characteristics of patients with infection during periods before Omicron emergence versus when this variant became locally dominant. We observed that when the relative frequency of the Omicron variant was high, the proportions of patients with some of the most common COVID-19 symptoms were lower compared to the pre-Omicron period. In most but not all countries, patients presenting to hospital during the Omicron period had better outcomes (lower fatality risk), compared to those hospitalised before Omicron emergence, which could be related to lower variant virulence, prior immunity or residual confounding. In summary, our approach, which was consistent with analyses that used individual-level variant data from a subset of the study population, suggests clinical differences in patients hospitalised with the Omicron variant versus those admitted before this variant spread, and these differences vary by country.

Our finding that mortality was generally lower during the period when the Omicron variant was dominant is consistent with data from South Africa reported earlier this year (Wolter et al., 2022). In that study, which included more than 30,000 patients with individual-level information on the infecting variant, individuals infected with the Omicron variant had a lower risk of disease progression that required hospital admission than individuals infected with other variants; amongst hospitalised patients, the odds ratio for the association between Omicron variant infection and severe disease was 0.7 (95% confidence interval [CI] 0.3–1.4), which is similar to that observed in this study using death as the outcome. A lower risk of death in Omicron variant-infected versus Delta variant-infected patients was also observed in a recent study in the United Kingdom, although that analysis did not assess risk of death conditional on hospitalisation but rather on infection (Nyberg et al., 2022). In our analyses, statistical models were adjusted for vaccination history, which is a potential confounder of the association between dominant variant period and risk of death. However, the simplistic approach of using vaccination as a binary variable may be subject to residual confounding by time since vaccination, number of doses, or vaccine type. Moreover, as part of the effort to characterise Omicron variant infection, information on whether COVID-19 was the main reason for hospitalisation was collected during the study period and suggests that for a non-negligible proportion of patients other clinical conditions might have prompted hospital admission. All these factors might have contributed to the observed association, possibly to different degrees in different countries, reason for which this result should not be assumed to necessarily relate to the differences in variant virulence previously suggested by mechanistic studies (Shuai et al., 2022; Halfmann et al., 2022). Of note, data from India (see Figure 5) suggest slightly higher fatality risk during the Omicron period compared to the pre-Omicron period for patients older than 60 years, which could be potentially explained by confounding unrelated to age, residual age-related confounding, not controlled by the categorisation used in our analysis, or alternatively by the limited sample size and consequent uncertainty.

During the period of Omicron variant dominance, fewer patients presented with the symptoms most commonly reported earlier. For example, we observed in the United Kingdom that shortness of breath was present in about three-quarters of patients before Omicron variant emergence and in about half of patients during the Omicron period. Notably, a similar pattern was observed in Nepal, where patients were more often recruited from critical care settings. One possible explanation for this finding would be if incidental SARS-CoV-2 infections, that is infections that were not the primary reason for hospitalisation, were more frequent during the Omicron period; the high transmissibility of this variant, and the consequent peaks in numbers of infections, together with its reported association with lower severity, provides support for this hypothesis. However, in the subset of patients with data on the reason for hospitalisation there was no increase in the proportion of admissions thought to be incidental infections and indeed proportions in both study periods were consistent with frequencies of incidental infections in recent studies in the United States (Klann et al., 2022) and the Netherlands (Voor In ’t Holt et al., 2022), although in the latter, non-incidental infections included patients for whom COVID-19 was a contributing but not the main cause of hospitalisation. An alternative and less plausible explanation for the lower frequency of symptoms during the Omicron period would be that some of these patients developed symptoms other than those presented here, and which are severe enough to prompt hospital admission. Finally, it is also possible that the question on the primary reason for hospitalisation might have been interpreted differently in different countries and even in different hospitals in the same country, which would complicate its use in identifying incidental infections.

We also observed that history of COVID-19 vaccination was more frequent during the Omicron period, although for most countries the number of patients with vaccination information was limited, especially after stratification by age. Whilst this pattern would be expected if current vaccines were less effective against the Omicron variant compared to previously circulating variants, as suggested by a recent study in England analysing symptomatic disease (Andrews et al., 2022a), there were changes in vaccination coverage in many settings during the second half of 2021 and early 2022, including in response to the reports of Omicron variant cases. Since non-COVID-19 patients (e.g., patients with respiratory infections caused by other pathogens) were not systematically recruited for this multi-country study, it is not possible to estimate vaccine effectiveness during the two study periods and assess its change (Andrews et al., 2022b).

The major strength of our study relates to inclusion of data from all WHO geographic regions, collected with standardised forms, with over 100,000 records. However, we note that 96.6% of patients were from two countries - South Africa and the United Kingdom - and that the relative contributions of these countries to the study data were different in the two study periods (Appendix 1—table 5); to avoid misinterpretations linked to changes in country-specific contributions to data in the pre-Omicron and Omicron periods, we present descriptive analyses by country and use statistical models that adjust for country-level variation. It is also important to consider the relative contributions of these countries when interpreting descriptive analyses that refer to the combined dataset. Other limitations of our study relate, as mentioned in Appendix 1—table 4, to the use of population-level variant data to define periods when infections were likely caused by Omicron variant. For example, if infection by Omicron variant is associated with lower severity and if samples used to inform population-level frequency were often from community cases, then these aggregated data might not represent variant frequency in the hospitalised population. Another weakness of our study is that recruitment procedure was not standardised and was defined locally. Whilst this likely affected the generalisability of our descriptive estimates (fatality risk and frequencies of symptoms and comorbidities) to local populations of hospitalised COVID-19 cases (Lash et al., 2021; Rothman et al., 2013), it might not have affected the association between study period and fatality risk, at least not beyond the well-described potential for collider bias in hospital-based studies on COVID-19 outcomes (Griffith et al., 2020). Finally, missing information on symptoms for patients from South Africa prevented our descriptive analysis of changes in clinical presentation in an African setting. However, despite potential weaknesses in this approach, our results are consistent with reports from South Africa and elsewhere (Wolter et al., 2022), and individual-level variant data available for this study population often matched the two study periods defined by Omicron variant frequency.

In conclusion, we believe our approach of comparing changes in clinical characteristics of COVID-19 using multi-country standardised data, especially when combined with smaller scale studies that collect individual-level data on infecting variants for validation, will be useful in understanding the impact of new variants in the future. Another application will be in using routinely collected health data for cross-country comparisons of variant characteristics. Equally importantly, the successful conduct of this study, and the lessons learned, including the potential weaknesses discussed above, shows that multi-country efforts to study emerging SARS-CoV-2 variants are feasible, improvable and can generate insights to inform policy decision making.

The data that underpin this analysis are highly detailed clinical data on individuals hospitalised with COVID-19. Due to the sensitive nature of these data and the associated privacy concerns, they are available via a governed data access mechanism following review of a data access committee. Data can be requested via the IDDO COVID-19 Data Sharing Platform (http://www.iddo.org/covid-19). The Data Access Application, Terms of Access and details of the Data Access Committee are available on the website. Briefly, the requirements for access are a request from a qualified researcher working with a legal entity who have a health and/or research remit; a scientifically valid reason for data access which adheres to appropriate ethical principles. The full terms are at https://www.iddo.org/document/covid-19-data-access-guidelines. A small subset of sites who contributed data to this analysis have not agreed to pooled data sharing as above. In the case of requiring access to these data, please contact the corresponding author in the first instance who will look to facilitate access. Code used for statistical analysis and aggregated data used to generate figures are available https://github.com/ISARICDataPlatform/Omicron, (copy archived at swh:1:rev:7ae11685df40e08dc1295bc07658ca5b1cae3265).

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Author details

1. Bronner P Gonçalves

   ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

   Contribution

   Conceptualization, Software, Formal analysis, Investigation, Visualization, Methodology, Writing – original draft, Writing – review and editing

   For correspondence

   bronner.goncalves@ndm.ox.ac.uk

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0002-3329-6050

2. Matthew Hall

   Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom

   Contribution

   Conceptualization, Data curation, Software, Investigation, Methodology, Writing – review and editing

   Competing interests

   No competing interests declared

   "This ORCID iD identifies the author of this article:" 0000-0002-2671-3864

3. Waasila Jassat

   National Institute for Communicable Diseases, South Africa; Right to Care, Johannesburg, South Africa

   Contribution

   Conceptualization, Investigation, Writing – review and editing

   Competing interests

   No competing interests declared

4. Valeria Balan

   ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

   Contribution

   Data curation, Investigation, Project administration, Writing – review and editing

   Competing interests

   No competing interests declared

5. Srinivas Murthy

   Faculty of Medicine, University of British Columbia, Vancouver, Canada

   Contribution

   Conceptualization, Investigation, Writing – review and editing

   Competing interests

   declares receiving salary support from the Health Research Foundation and Innovative Medicines Canada Chair in Pandemic Preparedness Research

6. Christiana Kartsonaki

   MRC Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom

   Contribution

   Conceptualization, Investigation, Methodology, Writing – review and editing

   Competing interests

   No competing interests declared

7. Malcolm G Semple

   1. Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
   2. Respiratory Medicine, Alder Hey Children's Hospital, University of Liverpool, Liverpool, United Kingdom

   Contribution

   Conceptualization, Investigation, Writing – review and editing

   Competing interests

   reports grants from DHSC National Institute of Health Research UK, from the Medical Research Council UK, and from the Health Protection Research Unit in Emerging & Zoonotic Infections, University of Liverpool, supporting the conduct of the study; other interest in Integrum Scientific LLC, Greensboro, NC, USA, outside the submitted work

8. Amanda Rojek

   1. ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
   2. Royal Melbourne Hospital, Melbourne, Australia
   3. Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia

   Contribution

   Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review and editing

   Competing interests

   No competing interests declared

9. Joaquín Baruch

   ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

   Contribution

   Conceptualization, Investigation, Methodology, Writing – original draft, Writing – review and editing

   Competing interests

   No competing interests declared

10. Luis Felipe Reyes

    1. ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
    2. Universidad de La Sabana, Chia, Colombia
    3. Clinica Universidad de La Sabana, Chia, Colombia

    Contribution

    Investigation, Methodology, Writing – review and editing

    Competing interests

    No competing interests declared

11. Abhishek Dasgupta

    1. Department of Computer Science, University of Oxford, Oxford, United Kingdom
    2. Department of Biology, University of Oxford, Oxford, United Kingdom

    Contribution

    Data curation, Software, Investigation, Methodology, Writing – review and editing

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0003-4420-0656

12. Jake Dunning

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Investigation, Methodology

    Competing interests

    No competing interests declared

13. Barbara Wanjiru Citarella

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Data curation, Investigation, Methodology, Project administration, Writing – review and editing

    Competing interests

    No competing interests declared

14. Mark Pritchard

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Investigation, Methodology

    Competing interests

    No competing interests declared

15. Alejandro Martín-Quiros

    Emergency Department. Hospital Universitario La Paz – IdiPAZ, Madrid, Spain

    Contribution

    Investigation, Writing – review and editing

    Competing interests

    declares consulting fees for Gilead and MSD, presentation fees for GILEAD, Pfizer and MSD, support for attending ECCMID from Gilead, and advisory board fees for MSD and Gilead

16. Uluhan Sili

    Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Turkey

    Contribution

    Investigation

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0002-9939-9298

17. J Kenneth Baillie

    1. Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
    2. Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

    Contribution

    Investigation

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0001-5258-793X

18. Diptesh Aryal

    Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal

    Contribution

    Investigation

    Competing interests

    No competing interests declared

19. Yaseen Arabi

    King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Contribution

    Conceptualization, Investigation, Writing – review and editing

    Competing interests

    No competing interests declared

20. Aasiyah Rashan

    Network for Improving Critical care Systems and Training, Colombo, Sri Lanka

    Contribution

    Investigation

    Competing interests

    No competing interests declared

21. Andrea Angheben

    Department of Infectious, Tropical Diseases and Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy

    Contribution

    Investigation, Writing – review and editing

    Competing interests

    declares support from Italian Ministry of Health - "Fondi Ricerca Corrente" Line1 Project 5 to IRCCS Sacro Cuore - Don Calabria Hospital

22. Janice Caoili

    Makati Medical Center, Makati City, Makati, Philippines

    Contribution

    Investigation

    Competing interests

    No competing interests declared

23. François Martin Carrier

    1. Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Canada
    2. Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, Canada
    3. Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
    4. Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Canada

    Contribution

    Investigation

    Competing interests

    declares a grant from the Canadian Institute of Health Research

24. Ewen M Harrison

    Centre for Medical Informatics, The University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom

    Contribution

    Investigation

    Competing interests

    No competing interests declared

25. Joan Gómez-Junyent

    Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain

    Contribution

    Investigation

    Competing interests

    declares support by Pfizer, Angelini and MSD to attend meetings (registration to meetings only)

26. Claudia Figueiredo-Mello

    Instituto de Infectologia Emílio Ribas, São Paulo, Brazil

    Contribution

    Investigation

    Competing interests

    No competing interests declared

27. James Joshua Douglas

    Lions Gate Hospital, North Vancouver, Canada

    Contribution

    Investigation

    Competing interests

    declares personal fees from lectures from Sunovion and Merck and consulting fees from Pfizer

28. Mohd Basri Mat Nor

    International Islamic University Malaysia, Selangor, Malaysia

    Contribution

    Investigation

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0002-5433-6357

29. Yock Ping Chow

    Clinical Research Centre, Sunway Medical Centre, Selangor Darul Ehsan, Selangor, Malaysia

    Contribution

    Investigation

    Competing interests

    No competing interests declared

30. Xin Ci Wong

    Digital Health Research and Innovation Unit, Institute for Clinical Research, National Institutes of Health (NIH), Selangor, Malaysia

    Contribution

    Investigation

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0002-1036-8023

31. Silvia Bertagnolio

    World Health Organization, Genève, Switzerland

    Contribution

    Investigation

    Competing interests

    No competing interests declared

32. Soe Soe Thwin

    World Health Organization, Genève, Switzerland

    Contribution

    Investigation

    Competing interests

    No competing interests declared

33. Anca Streinu-Cercel

    1. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
    2. National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania

    Contribution

    Investigation

    Competing interests

    has been an investigator in COVID-19 clinical trials by Algernon Pharmaceuticals, Atea Pharmaceuticals, Regeneron Pharmaceuticals, Diffusion Pharmaceuticals, Celltrion, Inc and Atriva Therapeutics, outside the scope of the submitted work

34. Leonardo Salazar

    Fundación Cardiovascular de Colombia, Santander, Colombia

    Contribution

    Investigation

    Competing interests

    No competing interests declared

35. Asgar Rishu

    Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

    Contribution

    Investigation

    Competing interests

    No competing interests declared

36. Rajavardhan Rangappa

    Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, India

    Contribution

    Investigation

    Competing interests

    No competing interests declared

37. David SY Ong

    Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands

    Contribution

    Investigation, Writing – review and editing

    Competing interests

    No competing interests declared

38. Madiha Hashmi

    Critical Care Asia and Ziauddin University, Karachi, Pakistan

    Contribution

    Conceptualization, Investigation, Writing – review and editing

    Competing interests

    No competing interests declared

39. Gail Carson

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Investigation, Writing – review and editing

    Competing interests

    No competing interests declared

40. Janet Diaz

    World Health Organization, Genève, Switzerland

    Contribution

    Investigation, Methodology, Writing – review and editing

    Competing interests

    No competing interests declared

41. Rob Fowler

    Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

    Contribution

    Conceptualization, Investigation, Methodology, Writing – review and editing

    Competing interests

    declares a peer reviewed research grant from the Canadian Institutes of Health Research

42. Moritz UG Kraemer

    1. Department of Biology, University of Oxford, Oxford, United Kingdom
    2. Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Data curation, Investigation, Methodology, Writing – review and editing

    Competing interests

    No competing interests declared

43. Evert-Jan Wils

    Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands

    Contribution

    Investigation, Writing – review and editing

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0002-2868-0920

44. Peter Horby

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Funding acquisition, Investigation, Methodology, Writing – original draft

    Competing interests

    No competing interests declared

45. Laura Merson

    1. ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
    2. Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Funding acquisition, Investigation, Writing – original draft

    Competing interests

    No competing interests declared

    "This ORCID iD identifies the author of this article:" 0000-0002-4168-1960

46. Piero L Olliaro

    ISARIC, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom

    Contribution

    Conceptualization, Funding acquisition, Investigation, Methodology, Writing – original draft

    Competing interests

    No competing interests declared

47. ISARIC Clinical Characterisation Group

    Contribution

    Funding acquisition

    Competing interests

    See Appendix 1 for competing interests for group author members

    1. Sheryl Ann Abdukahil
    2. Audrey Dubot-Pérès
    3. José Antonio Lepe
    4. Ali Abbas
    5. Kamal Abu Jabal
    6. Nashat Abu Salah
    7. Francisca Adewhajah
    8. Enrico Adriano
    9. Marina Aiello
    10. Kate Ainscough
    11. Eman Al Qasim
    12. Angela Alberti
    13. Beatrice Alex
    14. Abdulrahman Al-Fares
    15. Phoebe Ampaw
    16. Sophia Ankrah
    17. Ardiyan Apriyana
    18. Yaseen Arabi
    19. Antonio Arcadipane
    20. Patrick Archambault
    21. Lukas Arenz
    22. Christel Arnold-Day
    23. Ana Aroca
    24. Rakesh Arora
    25. Diptesh Aryal
    26. Elizabeth A Ashley
    27. AM Udara Lakshan Attanyake
    28. Benjamin Bach
    29. J Kenneth Baillie
    30. Valeria Balan
    31. Irene Bandoh
    32. Renata Barbalho
    33. Wendy S Barclay
    34. Michaela Barnikel
    35. Joaquín Baruch
    36. Diego Fernando Bautista Rincon
    37. Abigail Beane
    38. John Beca
    39. Netta Beer
    40. Husna Begum
    41. David Bellemare
    42. Anna Berenguera
    43. Hazel Bergin
    44. Amar Bhatt
    45. Claudia Bianco
    46. Moirangthem Bikram Singh
    47. Felwa Bin Humaid
    48. Jonathan Bitton
    49. Catherine Blier
    50. Lucille Blumberg
    51. Debby Bogaert
    52. Patrizia Bonelli
    53. Dounia Bouhmani
    54. Thipsavanh Bounphiengsy
    55. Latsaniphone Bountthasavong
    56. Bianca Boxma
    57. Kathy Brickell
    58. Aidan Burrell
    59. Ingrid G Bustos
    60. Eder Caceres
    61. Caterina Caminiti
    62. João Camões
    63. Cecilia Canepa
    64. Janice Caoili
    65. Francesca Carlacci
    66. Gayle Carney
    67. Inês Carqueja
    68. François Martin Carrier
    69. Gail Carson
    70. Silvia Castañeda
    71. Nidyanara Castanheira
    72. Roberta Cavalin
    73. Muge Cevik
    74. Bounthavy Chaleunphon
    75. Adrienne Chan
    76. Meera Chand
    77. Alfredo Antonio Chetta
    78. Julian Chica
    79. Danoy Chommanam
    80. Yock Ping Chow
    81. Nathaniel Christy
    82. Barbara Wanjiru Citarella
    83. Sara Clohisey
    84. Perren J Cobb
    85. Cassidy Codan
    86. Marie Connor
    87. Graham S Cooke
    88. Mary Copland
    89. Amanda Corley
    90. Gloria Crowl
    91. Paula Custodio
    92. Ana da Silva Filipe
    93. Andrew Dagens
    94. Peter Daley
    95. Heidi Dalton
    96. Jo Dalton
    97. Nick Daneman
    98. Emmanuelle A Dankwa
    99. Frédérick D'Aragon
    100. Thushan de Silva
    101. Jillian Deacon
    102. William Dechert
    103. Emmanuelle Denis
    104. Santi Dewayanti
    105. Pathik Dhanger
    106. Yael Dishon
    107. Annemarie B Docherty
    108. Arjen M Dondorp
    109. Maria Donnelly
    110. Christl A Donnelly
    111. Chloe Donohue
    112. Peter Doran
    113. Phouvieng Douangdala
    114. James Joshua Douglas
    115. Joanne Downey
    116. Tom Drake
    117. Murray Dryden
    118. Susanne Dudman
    119. Jake Dunning
    120. Lucian Durham
    121. Anne Margarita Dyrhol-Riise
    122. Marco Echeverria-Villalobos
    123. Giorgio Economopoulos
    124. Michael Edelstein
    125. Martina Escher
    126. Mariano Esperatti
    127. Lorinda Essuman
    128. Amna Faheem
    129. Arabella Fahy
    130. Cameron J Fairfield
    131. Laura Feeney
    132. Carlo Ferrari
    133. Sílvia Ferreira
    134. Claudia Figueiredo-Mello
    135. Juan Fiorda
    136. Tom Fletcher
    137. Brigid Flynn
    138. Federica Fogliazza
    139. Patricia Fontela
    140. Simon Forsyth
    141. Robert A Fowler
    142. Marianne Fraher
    143. Diego Franch-Llasat
    144. John F Fraser
    145. Christophe Fraser
    146. Ana Freitas Ribeiro
    147. Nora Fuentes
    148. G Argin
    149. Sérgio Gaião
    150. Linda Gail Skeie
    151. Phil Gallagher
    152. Carrol Gamble
    153. Julia Garcia-Diaz
    154. Esteban Garcia-Gallo
    155. Federica Garofalo
    156. Jess Gibson
    157. Michelle Girvan
    158. Geraldine Goco
    159. Joan Gómez-Junyent
    160. Bronner P Gonçalves
    161. Alicia Gonzalez
    162. Patricia Gordon
    163. Margarite Grable
    164. Christopher A Green
    165. William Greenhalf
    166. Fiona Griffiths
    167. Anja Grosse Lordemann
    168. Anne-Marie Guerguerian
    169. Daniel Haber
    170. Hannah Habraken
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