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Persistence of immune responses after heterologous and homologous third COVID-19 vaccine dose schedules in the UK: eight-month analyses of the COV-BOOST trial

Persistence of immune responses after heterologous and homologous third COVID-19 vaccine dose schedules in the UK: eight-month analyses of the COV-BOOST trial
Persistence of immune responses after heterologous and homologous third COVID-19 vaccine dose schedules in the UK: eight-month analyses of the COV-BOOST trial
Background: COV-BOOST is a multicentre, randomised, controlled, phase 2 trial of seven COVID-19 vaccines used as a third booster dose in June 2021. Monovalent messenger RNA (mRNA) COVID-19 vaccines were subsequently widely used for the third and fourth-dose vaccination campaigns in high-income countries. Real-world vaccine effectiveness against symptomatic infections following third doses declined during the Omicron wave. This report compares the immunogenicity and kinetics of responses to third doses of vaccines from day (D) 28 to D242 following third doses in seven study arms. Methods: The trial initially included ten experimental vaccine arms (seven full-dose, three half-dose) delivered at three groups of six sites. Participants in each site group were randomised to three or four experimental vaccines, or MenACWY control. The trial was stratified such that half of participants had previously received two primary doses of ChAdOx1 nCov-19 (Oxford–AstraZeneca; hereafter referred to as ChAd) and half had received two doses of BNT162b2 (Pfizer–BioNtech, hereafter referred to as BNT). The D242 follow-up was done in seven arms (five full-dose, two half-dose). The BNT vaccine was used as the reference as it was the most commonly deployed third-dose vaccine in clinical practice in high-income countries. The primary analysis was conducted using all randomised and baseline seronegative participants who were SARS-CoV-2 naïve during the study and who had not received a further COVID-19 vaccine for any reason since third dose randomisation. Results: Among the 817 participants included in this report, the median age was 72 years (IQR: 55–78) with 50.7% being female. The decay rates of anti-spike IgG between vaccines are different among both populations who received initial doses of ChAd/ChAd and BNT/BNT. In the population that previously received ChAd/ChAd, mRNA vaccines had the highest titre at D242 following their vaccine dose although Ad26. COV2. S (Janssen; hereafter referred to as Ad26) showed slower decay. For people who received BNT/BNT as their initial doses, a slower decay was also seen in the Ad26 and ChAd arms. The anti-spike IgG became significantly higher in the Ad26 arm compared to the BNT arm as early as 3 months following vaccination. Similar decay rates were seen between BNT and half-BNT; the geometric mean ratios ranged from 0.76 to 0.94 at different time points. The difference in decay rates between vaccines was similar for wild-type live virus-neutralising antibodies and that seen for anti-spike IgG. For cellular responses, the persistence was similar between study arms. Conclusions: Heterologous third doses with viral vector vaccines following two doses of mRNA achieve more durable humoral responses compared with three doses of mRNA vaccines. Lower doses of mRNA vaccines could be considered for future booster campaigns.
Antibodies, Boosters, COVID-19, Immunisation, Immunogenicity, SARS-CoV-2, T-Cells, Vaccination
0163-4453
18-26
Liu, Xinxue
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Maallah, Mina
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Faust, Saul N.
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COV-BOOST study group
et al.
Liu, Xinxue
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Munro, Alasdair P.S.
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Wright, Annie
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Feng, Shuo
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Janani, Leila
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Aley, Parvinder K.
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Babbage, Gavin
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Baker, Jonathan
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Baxter, David
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Bawa, Tanveer
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Bula, Marcin
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Cathie, Katrina
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Chatterjee, Krishna
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Dodd, Kate
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Enever, Yvanne
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Fox, Lauren
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Qureshi, Ehsaan
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Green, Christopher A.
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Haughney, John
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Hicks, Alexander
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Jones, Christine E.
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Kanji, Nasir
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van der Klaauw, Agatha A.
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Libri, Vincenzo
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Llewelyn, Martin J.
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Mansfield, Rebecca
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Maallah, Mina
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McGregor, Alastair C.
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Minassian, Angela M.
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Moore, Patrick
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Belhadef, Hanane Trari
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Pan, Daniel
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Rampling, Tommy
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Regan, Karen
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Saich, Stephen
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Liu, Xinxue, Munro, Alasdair P.S., Wright, Annie, Babbage, Gavin, Cathie, Katrina, Jones, Christine E., Owens, Daniel R., Read, Robert C. and Faust, Saul N. , COV-BOOST study group and et al. (2023) Persistence of immune responses after heterologous and homologous third COVID-19 vaccine dose schedules in the UK: eight-month analyses of the COV-BOOST trial. Journal of Infection, 87 (1), 18-26. (doi:10.1016/j.jinf.2023.04.012).

Record type: Article

Abstract

Background: COV-BOOST is a multicentre, randomised, controlled, phase 2 trial of seven COVID-19 vaccines used as a third booster dose in June 2021. Monovalent messenger RNA (mRNA) COVID-19 vaccines were subsequently widely used for the third and fourth-dose vaccination campaigns in high-income countries. Real-world vaccine effectiveness against symptomatic infections following third doses declined during the Omicron wave. This report compares the immunogenicity and kinetics of responses to third doses of vaccines from day (D) 28 to D242 following third doses in seven study arms. Methods: The trial initially included ten experimental vaccine arms (seven full-dose, three half-dose) delivered at three groups of six sites. Participants in each site group were randomised to three or four experimental vaccines, or MenACWY control. The trial was stratified such that half of participants had previously received two primary doses of ChAdOx1 nCov-19 (Oxford–AstraZeneca; hereafter referred to as ChAd) and half had received two doses of BNT162b2 (Pfizer–BioNtech, hereafter referred to as BNT). The D242 follow-up was done in seven arms (five full-dose, two half-dose). The BNT vaccine was used as the reference as it was the most commonly deployed third-dose vaccine in clinical practice in high-income countries. The primary analysis was conducted using all randomised and baseline seronegative participants who were SARS-CoV-2 naïve during the study and who had not received a further COVID-19 vaccine for any reason since third dose randomisation. Results: Among the 817 participants included in this report, the median age was 72 years (IQR: 55–78) with 50.7% being female. The decay rates of anti-spike IgG between vaccines are different among both populations who received initial doses of ChAd/ChAd and BNT/BNT. In the population that previously received ChAd/ChAd, mRNA vaccines had the highest titre at D242 following their vaccine dose although Ad26. COV2. S (Janssen; hereafter referred to as Ad26) showed slower decay. For people who received BNT/BNT as their initial doses, a slower decay was also seen in the Ad26 and ChAd arms. The anti-spike IgG became significantly higher in the Ad26 arm compared to the BNT arm as early as 3 months following vaccination. Similar decay rates were seen between BNT and half-BNT; the geometric mean ratios ranged from 0.76 to 0.94 at different time points. The difference in decay rates between vaccines was similar for wild-type live virus-neutralising antibodies and that seen for anti-spike IgG. For cellular responses, the persistence was similar between study arms. Conclusions: Heterologous third doses with viral vector vaccines following two doses of mRNA achieve more durable humoral responses compared with three doses of mRNA vaccines. Lower doses of mRNA vaccines could be considered for future booster campaigns.

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e-pub ahead of print date: 20 April 2023
Published date: 1 July 2023
Additional Information: Funding Information: The study is funded by the UK Government through the National Institute for Health Research ( NIHR ) and the Vaccine Taskforce ( VTF ). The award ID is NIHR203292 . The study Sponsor is University Hospital Southampton NHS Foundation Trust , Southampton, UK. ChAd, BNT and m1273 used in this study were supplied by the UK Health Security Agency (previously Public Health England). NVX, VLA, Ad26 and CVn were supplied by the manufacturers, without charge. The research is supported by the NIHR Southampton Clinical Research Facility and Biomedical Research Centre , the NIHR Clinical Research Facilities and NIHR Clinical Research Network and the NIHR-funded National Immunisation Schedule Evaluation Consortium ( NISEC , NIHR PR-R17-0916-12001 ). SNF and MDS are NIHR Senior Investigators. KC is a Wellcome Trust Investigator (210755/Z/18/Z) and NIHR Senior Investigator Emeritus. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The investigators would like to thank the UK Medicines and Healthcare products Regulatory Agency (MHRA) and Heath Research Authority (HRA) for their extraordinary efforts in rapidly reviewing submissions, for their attention to detail and input into trial design. Specific thanks go to Drs Kirsty Wydenbach, Lisa Campbell, David Jones, Graham McNaughton, Marie-Christine Bielsky and David Brown at the MHRA; to Drs David Carpenter (Chair) and Mike Proven (Vice-Chair) and all volunteer officers/members of the South Central, Berkshire Research Ethics Committee; and to Kevin Ahmed and all HRA staff who supported the trial. The investigators express their gratitude for the contribution of all trial participants, the UK Vaccine TaskForce (Jacinda Kemps, Kate Taylor, Kate Hilyard) and the invaluable advice of the trial committees. Professors Andrew Ustianowski (Chair) and Chris Rogers, and Dr Andrew Riordan serve as the independent members of the Data Monitoring and Safety Committee and Professor Robert Read is the Chair of the Trial Steering Committee. Funding Information: The study is funded by the UK Government through the National Institute for Health Research (NIHR) and the Vaccine Taskforce (VTF). The award ID is NIHR203292. The study Sponsor is University Hospital Southampton NHS Foundation Trust, Southampton, UK. ChAd, BNT and m1273 used in this study were supplied by the UK Health Security Agency (previously Public Health England). NVX, VLA, Ad26 and CVn were supplied by the manufacturers, without charge. The research is supported by the NIHR Southampton Clinical Research Facility and Biomedical Research Centre, the NIHR Clinical Research Facilities and NIHR Clinical Research Network and the NIHR-funded National Immunisation Schedule Evaluation Consortium (NISEC, NIHR PR-R17-0916-12001). SNF and MDS are NIHR Senior Investigators. KC is a Wellcome Trust Investigator (210755/Z/18/Z) and NIHR Senior Investigator Emeritus. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The investigators would like to thank the UK Medicines and Healthcare products Regulatory Agency (MHRA) and Heath Research Authority (HRA) for their extraordinary efforts in rapidly reviewing submissions, for their attention to detail and input into trial design. Specific thanks go to Drs Kirsty Wydenbach, Lisa Campbell, David Jones, Graham McNaughton, Marie-Christine Bielsky and David Brown at the MHRA; to Drs David Carpenter (Chair) and Mike Proven (Vice-Chair) and all volunteer officers/members of the South Central, Berkshire Research Ethics Committee; and to Kevin Ahmed and all HRA staff who supported the trial. The investigators express their gratitude for the contribution of all trial participants, the UK Vaccine TaskForce (Jacinda Kemps, Kate Taylor, Kate Hilyard) and the invaluable advice of the trial committees. Professors Andrew Ustianowski (Chair) and Chris Rogers, and Dr Andrew Riordan serve as the independent members of the Data Monitoring and Safety Committee and Professor Robert Read is the Chair of the Trial Steering Committee. Publisher Copyright: © 2023 The Authors
Keywords: Antibodies, Boosters, COVID-19, Immunisation, Immunogenicity, SARS-CoV-2, T-Cells, Vaccination

Identifiers

Local EPrints ID: 476989
URI: http://eprints.soton.ac.uk/id/eprint/476989
ISSN: 0163-4453
PURE UUID: 6d9d28a9-dbf0-4d4b-be15-f114a14b904d
ORCID for Christine E. Jones: ORCID iD orcid.org/0000-0003-1523-2368
ORCID for Robert C. Read: ORCID iD orcid.org/0000-0002-4297-6728
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642

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Date deposited: 23 May 2023 16:33
Last modified: 17 Mar 2024 03:45

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Contributors

Author: Xinxue Liu
Author: Alasdair P.S. Munro
Author: Annie Wright
Author: Shuo Feng
Author: Leila Janani
Author: Parvinder K. Aley
Author: Gavin Babbage
Author: Jonathan Baker
Author: David Baxter
Author: Tanveer Bawa
Author: Marcin Bula
Author: Katrina Cathie
Author: Krishna Chatterjee
Author: Kate Dodd
Author: Yvanne Enever
Author: Lauren Fox
Author: Ehsaan Qureshi
Author: Anna L. Goodman
Author: Christopher A. Green
Author: John Haughney
Author: Alexander Hicks
Author: Nasir Kanji
Author: Agatha A. van der Klaauw
Author: Vincenzo Libri
Author: Martin J. Llewelyn
Author: Rebecca Mansfield
Author: Mina Maallah
Author: Alastair C. McGregor
Author: Angela M. Minassian
Author: Patrick Moore
Author: Mehmood Mughal
Author: Yama F. Mujadidi
Author: Hanane Trari Belhadef
Author: Kyra Holliday
Author: Orod Osanlou
Author: Rostam Osanlou
Author: Daniel R. Owens
Author: Mihaela Pacurar
Author: Adrian Palfreeman
Author: Daniel Pan
Author: Tommy Rampling
Author: Karen Regan
Author: Stephen Saich
Author: Dinesh Saralaya
Author: Sunil Sharma
Author: Ray Sheridan
Author: Matthew Stokes
Author: Robert C. Read ORCID iD
Author: Saul N. Faust ORCID iD
Corporate Author: COV-BOOST study group
Corporate Author: et al.

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