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Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults

Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults
Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults

Since its emergence in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused hundreds of millions of cases and continues to circulate globally. To establish a novel SARS-CoV-2 human challenge model that enables controlled investigation of pathogenesis, correlates of protection and efficacy testing of forthcoming interventions, 36 volunteers aged 18-29 years without evidence of previous infection or vaccination were inoculated with 10 TCID50 of a wild-type virus (SARS-CoV-2/human/GBR/484861/2020) intranasally in an open-label, non-randomized study (ClinicalTrials.gov identifier NCT04865237 ; funder, UK Vaccine Taskforce). After inoculation, participants were housed in a high-containment quarantine unit, with 24-hour close medical monitoring and full access to higher-level clinical care. The study's primary objective was to identify an inoculum dose that induced well-tolerated infection in more than 50% of participants, with secondary objectives to assess virus and symptom kinetics during infection. All pre-specified primary and secondary objectives were met. Two participants were excluded from the per-protocol analysis owing to seroconversion between screening and inoculation, identified post hoc. Eighteen (~53%) participants became infected, with viral load (VL) rising steeply and peaking at ~5 days after inoculation. Virus was first detected in the throat but rose to significantly higher levels in the nose, peaking at ~8.87 log10 copies per milliliter (median, 95% confidence interval (8.41, 9.53)). Viable virus was recoverable from the nose up to ~10 days after inoculation, on average. There were no serious adverse events. Mild-to-moderate symptoms were reported by 16 (89%) infected participants, beginning 2-4 days after inoculation, whereas two (11%) participants remained asymptomatic (no reportable symptoms). Anosmia or dysosmia developed more slowly in 15 (83%) participants. No quantitative correlation was noted between VL and symptoms, with high VLs present even in asymptomatic infection. All infected individuals developed serum spike-specific IgG and neutralizing antibodies. Results from lateral flow tests were strongly associated with viable virus, and modeling showed that twice-weekly rapid antigen tests could diagnose infection before 70-80% of viable virus had been generated. Thus, with detailed characterization and safety analysis of this first SARS-CoV-2 human challenge study in young adults, viral kinetics over the course of primary infection with SARS-CoV-2 were established, with implications for public health recommendations and strategies to affect SARS-CoV-2 transmission. Future studies will identify the immune factors associated with protection in those participants who did not develop infection or symptoms and define the effect of prior immunity and viral variation on clinical outcome.

1078-8956
1031-1041
Killingley, Ben
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Mann, Alex J.
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Kalinova, Mariya
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Boyers, Alison
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Goonawardane, Niluka
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Zhou, Jie
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Lindsell, Kate
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Hare, Samanjit S.
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Brown, Jonathan
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Frise, Rebecca
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Smith, Emma
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Hopkins, Claire
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Noulin, Nicolas
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Löndt, Brandon
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Wilkinson, Tom
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McShane, Helen
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Gilbert, Anthony
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Jacobs, Michael
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Charman, Christine
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Mande, Priya
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Read, Robert C
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Ferguson, Neil M.
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Mann, Alex J.
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Kalinova, Mariya
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Boyers, Alison
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Goonawardane, Niluka
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Zhou, Jie
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Lindsell, Kate
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Brown, Jonathan
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Frise, Rebecca
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Smith, Emma
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Hopkins, Claire
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Noulin, Nicolas
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Löndt, Brandon
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Wilkinson, Tom
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Harden, Stephen
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Jacobs, Michael
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Charman, Christine
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Mande, Priya
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Read, Robert C
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Openshaw, Peter J.
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Rapeport, Garth
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Catchpole, Andrew P.
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Chiu, Christopher
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Killingley, Ben, Mann, Alex J., Kalinova, Mariya, Boyers, Alison, Goonawardane, Niluka, Zhou, Jie, Lindsell, Kate, Hare, Samanjit S., Brown, Jonathan, Frise, Rebecca, Smith, Emma, Hopkins, Claire, Noulin, Nicolas, Löndt, Brandon, Wilkinson, Tom, Harden, Stephen, McShane, Helen, Baillet, Mark, Gilbert, Anthony, Jacobs, Michael, Charman, Christine, Mande, Priya, Nguyen-Van-Tam, Jonathan S, Semple, Malcolm G, Read, Robert C, Ferguson, Neil M., Openshaw, Peter J., Rapeport, Garth, Barclay, Wendy S., Catchpole, Andrew P. and Chiu, Christopher (2022) Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults. Nature Medicine, 28 (5), 1031-1041. (doi:10.1038/s41591-022-01780-9).

Record type: Article

Abstract

Since its emergence in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused hundreds of millions of cases and continues to circulate globally. To establish a novel SARS-CoV-2 human challenge model that enables controlled investigation of pathogenesis, correlates of protection and efficacy testing of forthcoming interventions, 36 volunteers aged 18-29 years without evidence of previous infection or vaccination were inoculated with 10 TCID50 of a wild-type virus (SARS-CoV-2/human/GBR/484861/2020) intranasally in an open-label, non-randomized study (ClinicalTrials.gov identifier NCT04865237 ; funder, UK Vaccine Taskforce). After inoculation, participants were housed in a high-containment quarantine unit, with 24-hour close medical monitoring and full access to higher-level clinical care. The study's primary objective was to identify an inoculum dose that induced well-tolerated infection in more than 50% of participants, with secondary objectives to assess virus and symptom kinetics during infection. All pre-specified primary and secondary objectives were met. Two participants were excluded from the per-protocol analysis owing to seroconversion between screening and inoculation, identified post hoc. Eighteen (~53%) participants became infected, with viral load (VL) rising steeply and peaking at ~5 days after inoculation. Virus was first detected in the throat but rose to significantly higher levels in the nose, peaking at ~8.87 log10 copies per milliliter (median, 95% confidence interval (8.41, 9.53)). Viable virus was recoverable from the nose up to ~10 days after inoculation, on average. There were no serious adverse events. Mild-to-moderate symptoms were reported by 16 (89%) infected participants, beginning 2-4 days after inoculation, whereas two (11%) participants remained asymptomatic (no reportable symptoms). Anosmia or dysosmia developed more slowly in 15 (83%) participants. No quantitative correlation was noted between VL and symptoms, with high VLs present even in asymptomatic infection. All infected individuals developed serum spike-specific IgG and neutralizing antibodies. Results from lateral flow tests were strongly associated with viable virus, and modeling showed that twice-weekly rapid antigen tests could diagnose infection before 70-80% of viable virus had been generated. Thus, with detailed characterization and safety analysis of this first SARS-CoV-2 human challenge study in young adults, viral kinetics over the course of primary infection with SARS-CoV-2 were established, with implications for public health recommendations and strategies to affect SARS-CoV-2 transmission. Future studies will identify the immune factors associated with protection in those participants who did not develop infection or symptoms and define the effect of prior immunity and viral variation on clinical outcome.

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Accepted/In Press date: 9 March 2022
e-pub ahead of print date: 31 March 2022
Published date: May 2022
Additional Information: Funding Information: We thank the study participants for their time and commitment. The authors gratefully acknowledge support from the UK Vaccine Taskforce of the Department for Business, Energy and Industrial Strategy (BEIS) of Her Majesty’s Government. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish or preparation of the manuscript. We thank the following individuals and organizations for their invaluable contributions to the development and implementation of the SARS-CoV-2 human challenge project: A. Anandakumar, K. Baillie, S. Casserly, S. Cleiff, C. Chu and the NIHR Clinical Research Network staff at the Royal Bolton Hospital; K. Fenton, B. Flutter and the team at the Zayed Centre for Research at Great Ormond Street Hospital; G. Gainsborough, F. Gleason, L. Grey, R. Heyderman, J. Hippisley-Cox, M. Johnson, K. Khunti, M. Mayer, M. Moshe, M. Ocampo, C. Skinner, C. Steves, P. Subudhi, D. Thomas, G. Towers, H. Ward, O. Watson and J. Zhou; the Royal Free London NHS Foundation Trust; the North Central London Critical Care Network (clinical leads D. Howell, G. Smith and G. Bellingan); the Human Infection Challenge Network for Vaccine Development; and ISARIC4C investigators ( https://isaric4c.net/about/authors/ ). We are grateful to Gilead for providing remdesivir for the study. We thank the members of the independent data and safety monitoring board (S. Gordon (chair, Liverpool School of Tropical Medicine), P. Smith (chair, London School of Hygiene and Tropical Medicine), A. Durbin (Johns Hopkins University), F. Hayden (University of Virginia School of Medicine) and D. Dockrell (University of Edinburgh)) and the Medical Oversight Committee/Trial Steering Committee (R.C.R. (chair), D. Ferreira (Liverpool School of Tropical Medicine), H.M., P.O. and A.C.) for their invaluable advice. C. Chiu and P.O. are supported by the NIHR Imperial Biomedical Research Centre award to Imperial College Healthcare NHS Trust and Imperial College London. P.O. is supported by an NIHR Senior Investigator Award (NIHR201385) and a UKRI MRC CIC Award (MR/V028448/1). H.M. is supported by the NIHR Oxford Biomedical Research Centre (NIHR-BRC-1215-20008). R.C.R. is supported by an NIHR Senior Investigator Award (NF-SI-0617-10010) and by the NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004). The viral swab from which the challenge virus was grown was provided by ISARIC4C, which is funded by the NIHR (award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059) and the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, in partnership with Public Health England and in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford (NIHR award 200907). The Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research (grant reference C18616/A25153). This work was also supported by the NIHR Health Protection Research Unit in Respiratory Infections (NIHR award 200927). N.M.F. acknowledges funding from the NIHR Health Protection Research Unit in Modelling and Health Economics, the MRC Centre for Global Infectious Disease Analysis and the Jameel Institute. J.S.N.-V.-T. is seconded to the Department of Health and Social Care (DHSC), England. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, the DHSC or BEIS. Funding Information: We thank the study participants for their time and commitment. The authors gratefully acknowledge support from the UK Vaccine Taskforce of the Department for Business, Energy and Industrial Strategy (BEIS) of Her Majesty’s Government. The funder had no role in the conceptualization, design, data collection, analysis, decision to publish or preparation of the manuscript. We thank the following individuals and organizations for their invaluable contributions to the development and implementation of the SARS-CoV-2 human challenge project: A. Anandakumar, K. Baillie, S. Casserly, S. Cleiff, C. Chu and the NIHR Clinical Research Network staff at the Royal Bolton Hospital; K. Fenton, B. Flutter and the team at the Zayed Centre for Research at Great Ormond Street Hospital; G. Gainsborough, F. Gleason, L. Grey, R. Heyderman, J. Hippisley-Cox, M. Johnson, K. Khunti, M. Mayer, M. Moshe, M. Ocampo, C. Skinner, C. Steves, P. Subudhi, D. Thomas, G. Towers, H. Ward, O. Watson and J. Zhou; the Royal Free London NHS Foundation Trust; the North Central London Critical Care Network (clinical leads D. Howell, G. Smith and G. Bellingan); the Human Infection Challenge Network for Vaccine Development; and ISARIC4C investigators (https://isaric4c.net/about/authors/). We are grateful to Gilead for providing remdesivir for the study. We thank the members of the independent data and safety monitoring board (S. Gordon (chair, Liverpool School of Tropical Medicine), P. Smith (chair, London School of Hygiene and Tropical Medicine), A. Durbin (Johns Hopkins University), F. Hayden (University of Virginia School of Medicine) and D. Dockrell (University of Edinburgh)) and the Medical Oversight Committee/Trial Steering Committee (R.C.R. (chair), D. Ferreira (Liverpool School of Tropical Medicine), H.M., P.O. and A.C.) for their invaluable advice. C. Chiu and P.O. are supported by the NIHR Imperial Biomedical Research Centre award to Imperial College Healthcare NHS Trust and Imperial College London. P.O. is supported by an NIHR Senior Investigator Award (NIHR201385) and a UKRI MRC CIC Award (MR/V028448/1). H.M. is supported by the NIHR Oxford Biomedical Research Centre (NIHR-BRC-1215-20008). R.C.R. is supported by an NIHR Senior Investigator Award (NF-SI-0617-10010) and by the NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004). The viral swab from which the challenge virus was grown was provided by ISARIC4C, which is funded by the NIHR (award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059) and the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, in partnership with Public Health England and in collaboration with the Liverpool School of Tropical Medicine and the University of Oxford (NIHR award 200907). The Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research (grant reference C18616/A25153). This work was also supported by the NIHR Health Protection Research Unit in Respiratory Infections (NIHR award 200927). N.M.F. acknowledges funding from the NIHR Health Protection Research Unit in Modelling and Health Economics, the MRC Centre for Global Infectious Disease Analysis and the Jameel Institute. J.S.N.-V.-T. is seconded to the Department of Health and Social Care (DHSC), England. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, the DHSC or BEIS. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

Identifiers

Local EPrints ID: 470080
URI: http://eprints.soton.ac.uk/id/eprint/470080
ISSN: 1078-8956
PURE UUID: e740e727-be0f-4e5c-affb-46c8919582fb
ORCID for Robert C Read: ORCID iD orcid.org/0000-0002-4297-6728

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Date deposited: 03 Oct 2022 16:36
Last modified: 17 Mar 2024 07:15

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Contributors

Author: Ben Killingley
Author: Alex J. Mann
Author: Mariya Kalinova
Author: Alison Boyers
Author: Niluka Goonawardane
Author: Jie Zhou
Author: Kate Lindsell
Author: Samanjit S. Hare
Author: Jonathan Brown
Author: Rebecca Frise
Author: Emma Smith
Author: Claire Hopkins
Author: Nicolas Noulin
Author: Brandon Löndt
Author: Tom Wilkinson
Author: Stephen Harden
Author: Helen McShane
Author: Mark Baillet
Author: Anthony Gilbert
Author: Michael Jacobs
Author: Christine Charman
Author: Priya Mande
Author: Jonathan S Nguyen-Van-Tam
Author: Malcolm G Semple
Author: Robert C Read ORCID iD
Author: Neil M. Ferguson
Author: Peter J. Openshaw
Author: Garth Rapeport
Author: Wendy S. Barclay
Author: Andrew P. Catchpole
Author: Christopher Chiu

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