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Persistence of immune response in heterologous COVID vaccination schedules in the Com-COV2 study: A single-blind, randomised trial incorporating mRNA, viral-vector and protein-adjuvant vaccines

Persistence of immune response in heterologous COVID vaccination schedules in the Com-COV2 study: A single-blind, randomised trial incorporating mRNA, viral-vector and protein-adjuvant vaccines
Persistence of immune response in heterologous COVID vaccination schedules in the Com-COV2 study: A single-blind, randomised trial incorporating mRNA, viral-vector and protein-adjuvant vaccines

Background: Heterologous COVID vaccine priming schedules are immunogenic and effective. This report aims to understand the persistence of immune response to the viral vectored, mRNA and protein-based COVID-19 vaccine platforms used in homologous and heterologous priming combinations, which will inform the choice of vaccine platform in future vaccine development. Methods: Com-COV2 was a single-blinded trial in which adults ≥ 50 years, previously immunised with single dose ‘ChAd’ (ChAdOx1 nCoV-19, AZD1222, Vaxzevria, Astrazeneca) or ‘BNT’ (BNT162b2, tozinameran, Comirnaty, Pfizer/BioNTech), were randomised 1:1:1 to receive a second dose 8–12 weeks later with either the homologous vaccine, or ‘Mod’ (mRNA-1273, Spikevax, Moderna) or ‘NVX’ (NVX-CoV2373, Nuvaxovid, Novavax). Immunological follow-up and the secondary objective of safety monitoring were performed over nine months. Analyses of antibody and cellular assays were performed on an intention-to-treat population without evidence of COVID-19 infection at baseline or for the trial duration. Findings: In April/May 2021, 1072 participants were enrolled at a median of 9.4 weeks after receipt of a single dose of ChAd (N = 540, 45% female) or BNT (N = 532, 39% female) as part of the national vaccination programme. In ChAd-primed participants, ChAd/Mod had the highest anti-spike IgG from day 28 through to 6 months, although the heterologous vs homologous geometric mean ratio (GMR) dropped from 9.7 (95% CI (confidence interval): 8.2, 11.5) at D28 to 6.2 (95% CI: 5.0, 7.7) at D196. The heterologous/homologous GMR for ChAd/NVX similarly dropped from 3.0 (95% CI:2.5,3.5) to 2.4 (95% CI:1.9, 3.0). In BNT-primed participants, decay was similar between heterologous and homologous schedules with BNT/Mod inducing the highest anti-spike IgG for the duration of follow-up. The adjusted GMR (aGMR) for BNT/Mod compared with BNT/BNT increased from 1.36 (95% CI: 1.17, 1.58) at D28 to 1.52 (95% CI: 1.21, 1.90) at D196, whilst for BNT/NVX this aGMR was 0.55 (95% CI: 0.47, 0.64) at day 28 and 0.62 (95% CI: 0.49, 0.78) at day 196. Heterologous ChAd-primed schedules produced and maintained the largest T-cell responses until D196. Immunisation with BNT/NVX generated a qualitatively different antibody response to BNT/BNT, with the total IgG significantly lower than BNT/BNT during all follow-up time points, but similar levels of neutralising antibodies. Interpretation: Heterologous ChAd-primed schedules remain more immunogenic over time in comparison to ChAd/ChAd. BNT-primed schedules with a second dose of either mRNA vaccine also remain more immunogenic over time in comparison to BNT/NVX. The emerging data on mixed schedules using the novel vaccine platforms deployed in the COVID-19 pandemic, suggest that heterologous priming schedules might be considered as a viable option sooner in future pandemics. ISRCTN:27841311 EudraCT:2021-001275-16.

Adenovirus vector, Antibody, Heterologous, mRNA lipid nanoparticle, Persistence, SARS-CoV2, T-cell, Vaccine
0163-4453
574-583
Shaw, Robert H.
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Greenland, Melanie
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Collins, Andrea M.
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Darton, Tom
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Dinesh, Tanya
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Duncan, Christopher J.A.
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Finn, Adam
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Goodman, Anna L.
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Green, Christopher A.
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Hallis, Bassam
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Heath, Paul T.
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Hill, Helen
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Lambe, Teresa
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Libri, Vincenzo
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Lillie, Patrick J.
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Morey, Ella
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Mujadidi, Yama F.
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Payne, Ruth
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Plested, Emma L.
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Provstgaard-Morys, Samuel
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Ramasamy, Maheshi N.
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Ramsay, Mary
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Robinson, Hannah
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Screaton, Gavin R.
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Singh, Nisha
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Turner, Paul J.
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White, Rachel
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Nguyen-Van-Tam, Jonathan S.
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the Com-COV2 Study Group
Shaw, Robert H.
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Greenland, Melanie
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Aley, Parvinder K.
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Andrews, Nick J.
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Cameron, J. Claire
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Charlton, Sue
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Clutterbuck, Elizabeth A.
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Collins, Andrea M.
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Darton, Tom
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Dinesh, Tanya
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Duncan, Christopher J.A.
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Finn, Adam
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Goodman, Anna L.
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Green, Christopher A.
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Hallis, Bassam
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Heath, Paul T.
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Hill, Helen
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Lambe, Teresa
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Libri, Vincenzo
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Morey, Ella
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Mujadidi, Yama F.
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Payne, Ruth
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Plested, Emma L.
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Provstgaard-Morys, Samuel
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Ramasamy, Maheshi N.
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Ramsay, Mary
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Read, Robert C.
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Singh, Nisha
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Turner, Paul J.
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White, Rachel
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Nguyen-Van-Tam, Jonathan S.
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Liu, Xinxue
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Snape, Matthew D.
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Shaw, Robert H., Greenland, Melanie, Stuart, Arabella S.V., Aley, Parvinder K., Andrews, Nick J., Cameron, J. Claire, Charlton, Sue, Clutterbuck, Elizabeth A., Collins, Andrea M., Darton, Tom, Dinesh, Tanya, Duncan, Christopher J.A., Faust, Saul N., Ferreira, Daniela M., Finn, Adam, Goodman, Anna L., Green, Christopher A., Hallis, Bassam, Heath, Paul T., Hill, Helen, Lambe, Teresa, Libri, Vincenzo, Lillie, Patrick J., Morey, Ella, Mujadidi, Yama F., Payne, Ruth, Plested, Emma L., Provstgaard-Morys, Samuel, Ramasamy, Maheshi N., Ramsay, Mary, Read, Robert C., Robinson, Hannah, Screaton, Gavin R., Singh, Nisha, Turner, David P.J., Turner, Paul J., White, Rachel, Nguyen-Van-Tam, Jonathan S., Liu, Xinxue and Snape, Matthew D. , the Com-COV2 Study Group (2023) Persistence of immune response in heterologous COVID vaccination schedules in the Com-COV2 study: A single-blind, randomised trial incorporating mRNA, viral-vector and protein-adjuvant vaccines. Journal of Infection, 86 (6), 574-583. (doi:10.1016/j.jinf.2023.03.027).

Record type: Article

Abstract

Background: Heterologous COVID vaccine priming schedules are immunogenic and effective. This report aims to understand the persistence of immune response to the viral vectored, mRNA and protein-based COVID-19 vaccine platforms used in homologous and heterologous priming combinations, which will inform the choice of vaccine platform in future vaccine development. Methods: Com-COV2 was a single-blinded trial in which adults ≥ 50 years, previously immunised with single dose ‘ChAd’ (ChAdOx1 nCoV-19, AZD1222, Vaxzevria, Astrazeneca) or ‘BNT’ (BNT162b2, tozinameran, Comirnaty, Pfizer/BioNTech), were randomised 1:1:1 to receive a second dose 8–12 weeks later with either the homologous vaccine, or ‘Mod’ (mRNA-1273, Spikevax, Moderna) or ‘NVX’ (NVX-CoV2373, Nuvaxovid, Novavax). Immunological follow-up and the secondary objective of safety monitoring were performed over nine months. Analyses of antibody and cellular assays were performed on an intention-to-treat population without evidence of COVID-19 infection at baseline or for the trial duration. Findings: In April/May 2021, 1072 participants were enrolled at a median of 9.4 weeks after receipt of a single dose of ChAd (N = 540, 45% female) or BNT (N = 532, 39% female) as part of the national vaccination programme. In ChAd-primed participants, ChAd/Mod had the highest anti-spike IgG from day 28 through to 6 months, although the heterologous vs homologous geometric mean ratio (GMR) dropped from 9.7 (95% CI (confidence interval): 8.2, 11.5) at D28 to 6.2 (95% CI: 5.0, 7.7) at D196. The heterologous/homologous GMR for ChAd/NVX similarly dropped from 3.0 (95% CI:2.5,3.5) to 2.4 (95% CI:1.9, 3.0). In BNT-primed participants, decay was similar between heterologous and homologous schedules with BNT/Mod inducing the highest anti-spike IgG for the duration of follow-up. The adjusted GMR (aGMR) for BNT/Mod compared with BNT/BNT increased from 1.36 (95% CI: 1.17, 1.58) at D28 to 1.52 (95% CI: 1.21, 1.90) at D196, whilst for BNT/NVX this aGMR was 0.55 (95% CI: 0.47, 0.64) at day 28 and 0.62 (95% CI: 0.49, 0.78) at day 196. Heterologous ChAd-primed schedules produced and maintained the largest T-cell responses until D196. Immunisation with BNT/NVX generated a qualitatively different antibody response to BNT/BNT, with the total IgG significantly lower than BNT/BNT during all follow-up time points, but similar levels of neutralising antibodies. Interpretation: Heterologous ChAd-primed schedules remain more immunogenic over time in comparison to ChAd/ChAd. BNT-primed schedules with a second dose of either mRNA vaccine also remain more immunogenic over time in comparison to BNT/NVX. The emerging data on mixed schedules using the novel vaccine platforms deployed in the COVID-19 pandemic, suggest that heterologous priming schedules might be considered as a viable option sooner in future pandemics. ISRCTN:27841311 EudraCT:2021-001275-16.

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Accepted/In Press date: 31 March 2023
e-pub ahead of print date: 5 April 2023
Published date: 1 June 2023
Additional Information: Funding Information: The study is funded by the UK Government through the National Institute for Health Research (NIHR) - grant ID NIHR202851, the Vaccine Task Force (VTF) and the Coalition for Epidemic Preparedness Innovations (CEPI). This research was supported by the NIHR Oxford Biomedical Research Centre, NIHR Guy's and St Thomas' Biomedical Research Centre, NIHR King's Clinical Research Facility and NIHR Policy Research Programme (PR-R17-0916-22001), the Southampton NIHR Biomedical Research Centre and Southampton NIHR Clinical Research Facility and delivered through the NIHR-funded National Immunisation Schedule Evaluation Consortium (NISEC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care (DHSC). NVX-CoV2373 vaccine was supplied for use in the trial by Novavax, Inc. MDS and SNF are NIHR senior investigators. 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 express their gratitude for the contribution of all trial participants, and for the invaluable advice of the data safety monitoring board. We additionally acknowledge the broader support from the various teams within the University of Oxford, including the Department of Paediatrics, Clinical Trials Research Governance, Research Contracts, and the Public Affairs Directorate. Publisher Copyright: © 2023 The Authors
Keywords: Adenovirus vector, Antibody, Heterologous, mRNA lipid nanoparticle, Persistence, SARS-CoV2, T-cell, Vaccine

Identifiers

Local EPrints ID: 477308
URI: http://eprints.soton.ac.uk/id/eprint/477308
ISSN: 0163-4453
PURE UUID: 23192f2d-d31e-49d3-bb49-980e2fa80a91
ORCID for Saul N. Faust: ORCID iD orcid.org/0000-0003-3410-7642
ORCID for Robert C. Read: ORCID iD orcid.org/0000-0002-4297-6728

Catalogue record

Date deposited: 02 Jun 2023 17:11
Last modified: 11 May 2024 01:45

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Contributors

Author: Robert H. Shaw
Author: Melanie Greenland
Author: Arabella S.V. Stuart
Author: Parvinder K. Aley
Author: Nick J. Andrews
Author: J. Claire Cameron
Author: Sue Charlton
Author: Elizabeth A. Clutterbuck
Author: Andrea M. Collins
Author: Tom Darton
Author: Tanya Dinesh
Author: Christopher J.A. Duncan
Author: Saul N. Faust ORCID iD
Author: Daniela M. Ferreira
Author: Adam Finn
Author: Anna L. Goodman
Author: Christopher A. Green
Author: Bassam Hallis
Author: Paul T. Heath
Author: Helen Hill
Author: Teresa Lambe
Author: Vincenzo Libri
Author: Patrick J. Lillie
Author: Ella Morey
Author: Yama F. Mujadidi
Author: Ruth Payne
Author: Emma L. Plested
Author: Samuel Provstgaard-Morys
Author: Maheshi N. Ramasamy
Author: Mary Ramsay
Author: Robert C. Read ORCID iD
Author: Hannah Robinson
Author: Gavin R. Screaton
Author: Nisha Singh
Author: David P.J. Turner
Author: Paul J. Turner
Author: Rachel White
Author: Jonathan S. Nguyen-Van-Tam
Author: Xinxue Liu
Author: Matthew D. Snape
Corporate Author: the Com-COV2 Study Group

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