COVID-19 vaccine dose sparing: strategies to improve vaccine equity and pandemic preparedness

Roozen, Geert V.T.; Roukens, Anna H E; Roestenberg, Meta

doi:10.1016/s2214-109x(22)00075-4

Cited by 30 publications

(30 citation statements)

References 25 publications

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“…The findings in this study served the resolution of this issue by using fractional doses (1/5) for boosting, via the intradermal technique. The immunogenicity in this study was similar to previous human studies, conducting intradermal coronavirus vaccine trials; including, DNA—ZyCoV-D (Zydus Cadila, Ahmedabad, India), INO-4800 (Inovio Pharmaceuticals, Plymouth Meeting, PA, USA) and mRNA-1273 (Moderna, Cambridge, MA, USA) 23 , 33 , 34 . While all previous studies were conducted as an initial first dose, this study fulfilled the gap of knowledge of the immunogenicity of intradermal vaccines from the perspective of a boosting dose.…”

Section: Discussionsupporting

confidence: 78%

“…The well-established explanation is the abundance of dendritic cells, acting as antigen-presenting cells in the intradermal area. However, the response of local dendritic cells at the injection site can cause local reactions among those receiving fractional intradermal vaccines 22 , 23 . Interestingly, immediate local reaction was doubled in intradermal boosted individuals who received the booster at 8–12 weeks intervals compared to the shorter interval.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the immediate local reaction was potentially found in the latter interval. The explanation for the less systemic reaction among those receiving an intradermal vaccine is unclear, while the postulated explanation is dose-dependent associated systemic reaction 22 , 23 . However, no study has evaluated the immunogenicity and reactogenicity of intradermal viral vector vaccines as a booster dose.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, a 1:5 dose (1 × 10 5 viral particles) of intradermal vaccination-induced good immune responses, which were comparable with a full dose of IM 22 . Recent studies showed intradermal vaccination with fractional doses (1:5 and 1:10) of mRNA-1273 (Moderna) enhanced similar antibody responses compared to full dose IM vaccination 23 . In people with past infection, a high level of anti-spike IgG was detected after mRNA vaccine BNT162b2 (Pfizer–BioNTech) vaccination within a 4–8-week interval; additionally, longer intervals, 8–12 and >12 weeks provided higher humoral responses 24 .…”

Section: Introductionmentioning

confidence: 99%

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Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. Two doses of an inactivated SARS-CoV-2 vaccine (CoronaVac) have been shown to be insufficient to protect against variants of concern (VOCs), while viral vector vaccines remain protective against the infection. Herein, we conducted a preliminary study to evaluate the safety and immunity in an adult population who received the conventional 2 dosage-regimen of inactivated SARS-CoV-2 vaccine; with an additional intradermal ChAdOx1 nCoV-19 reciprocal dosage (1:5). An Intramuscular ChAdOx1 nCoV-19 booster was also included as a control. Immediate and delayed local reactions were frequently observed in the fractional intradermal boost, but systemic side effects were significantly decreased compared to the conventional intramuscular boost. The anti-RBD-IgG levels, the neutralising function against delta variants, and T cell responses were significantly increased after boosting via both routes. Interestingly, the shorter interval elicited higher immunogenicity compared to the extended interval. Taken together, a reciprocal dosage of intradermal ChAdOx1 nCoV-19 booster reduces systemic adverse reactions and enhances non inferiority humoral and cellular immune responses compared to a full dose of intramuscular boosting. These findings provide for an effective vaccine management during the shortages of vaccine supply.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

et al. 2022

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“…These scored especially high in the feasibility/acceptability and potential for translation and implementation criteria. There have been a host of articles published, both in peer-reviewed journals and in newspapers calling for increased vaccine equity [ 32 , 33 ]. As the pandemic has shown, all countries are vulnerable when one is unprotected; the emergence of the Omicron variant, which spread rapidly after its discovery in South Africa, provides a clear illustration of our interdependence [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

et al. 2022

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Background The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients’ needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

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Declaration of Helsinki—Revisions for the 21st Century

Bierer

2024

JAMA

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COVID-19 vaccine dose sparing: strategies to improve vaccine equity and pandemic preparedness

Cited by 30 publications

References 25 publications

Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries

Declaration of Helsinki—Revisions for the 21st Century

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