Electronic versions

Documents

DOI

  • Alasdair P S Munro
  • Shuo Feng
  • Leila Janani
  • Victoria Cornelius
  • Parvinder K Aley
  • Gavin Babbage
  • David Baxter
  • Marcin Bula
  • Katrina Cathie
  • Krishna Chatterjee
  • Kate Dodd
  • Yvanne Enever
  • Ehsaan Qureshi
  • Anna L Goodman
  • Christopher A Green
  • Linda Harndahl
  • John Haughney
  • Alexander Hicks
  • Agatha A van der Klaauw
  • Nasir Kanji
  • Vincenzo Libri
  • Martin J Llewelyn
  • Alastair C McGregor
  • Mina Maallah
  • Angela M Minassian
  • Patrick Moore
  • Mehmood Mughal
  • Yama F Mujadidi
  • Kyra Holliday
  • Orod Osanlou
  • Rostam Osanlou
  • Daniel R Owens
  • Mihaela Pacurar
  • Adrian Palfreeman
  • Daniel Pan
  • Tommy Rampling
  • Karen Regan
  • Stephen Saich
  • Tanveer Bawa
  • Dinesh Saralaya
  • Sunil Sharma
  • Ray Sheridan
  • Emma C Thomson
  • Shirley Todd
  • Chris Twelves
  • Robert C Read
  • Sue Charlton
  • Bassam Hallis
  • Mary Ramsay
  • Nick Andrews
  • Teresa Lambe
  • Jonathan S Nguyen-Van-Tam
  • Matthew D Snape
  • Xinxue Liu
  • Saul N Faust
  • Alasdair P S Munro
  • Shuo Feng
  • Leila Janani
  • Victoria Cornelius
  • Parvinder K Aley
  • Gavin Babbage
  • David Baxter
  • Marcin Bula
  • Katrina Cathie
  • Krishna Chatterjee
  • Kate Dodd
  • Yvanne Enever
  • Ehsaan Qureshi
  • Anna L Goodman
  • Christopher A Green
  • Linda Harndahl
  • John Haughney
  • Alexander Hicks
  • Agatha A van der Klaauw
  • Nasir Kanji
  • Vincenzo Libri
  • Martin J Llewelyn
  • Alastair C McGregor
  • Angela M Minassian
  • Patrick Moore
  • Mehmood Mughal
  • Yama F Mujadidi
  • Kyra Holliday
  • Orod Osanlou
  • Rostam Osanlou
  • Daniel R Owens
  • Mihaela Pacurar
  • Adrian Palfreeman
  • Daniel Pan
  • Tommy Rampling
  • Karen Regan
  • Stephen Saich
  • Tanveer Bawa
  • Dinesh Saralaya
  • Sunil Sharma
  • Ray Sheridan
  • Mina Maallah
  • Emma C Thomson
  • Shirley Todd
  • Chris Twelves
  • Robert C Read
  • Sue Charlton
  • Bassam Hallis
  • Mary Ramsay
  • Nick Andrews
  • Teresa Lambe
  • Jonathan S Nguyen-Van-Tam
  • Matthew D Snape
  • Xinxue Liu
  • Saul N Faust
  • Andrew Riordan
  • Andrew Ustianowski
  • Chris Rogers
  • Kashyap Katechia
  • Alison Cooper
  • Andrew Freedman
  • Rachel Hughes
  • Lynne Grundy
  • Lona Tudor Jones
  • Elizabeth Harrison
  • Emma Snashall
  • Lewis Mallon
  • Katharine Burton
  • Kim Storton
  • Malathi Munusamy
  • Bridget Tandy
  • Akamino Egbo
  • Stephen Cox
  • Nabeela Nazir Ahmed
  • Anil Shenoy
  • Rachel Bousfield
  • Donna Wixted
  • Helen Gutteridge
  • Becky Mansfield
  • Christopher Herbert
  • Jennifer Murira
  • James Calderwood
  • Dominique Barker
  • Jacqueline Brandon
  • Hayley Tulloch
  • Suzie Colquhoun
  • Helen Thorp
  • Helen Radford
  • Julie Evans
  • Helena Baker
  • Jeanette Thorpe
  • Sally Batham
  • Jessica Hailstone
  • Rachael Phillips
  • Dileep Kumar
  • Fran Westwell
  • Ann Sturdy
  • Lara Barcella
  • Najwa Soussi
  • Mushiya Mpelembue
  • Sreena Raj
  • Rajni Sharma
  • Tumena Corrah
  • Laurence John
  • Ashley Whittington
  • Siobhan Roche
  • Lynda Wagstaff
  • Adam Farrier
  • Karen Bisnauthsing
  • Movin Abeywickrama
  • Niamh Spence
  • Alice Packham
  • Teona Serafimova
  • Suahil Aslam
  • Caitlin McGreevy
  • Alessandro Borca
  • Pamela DeLosSantosDominguez
  • Emily Palmer
  • Samantha Broadhead
  • Sadaf Farooqi
  • Jo Piper
  • Rowena Weighell
  • Lorinda Pickup
  • Djamila Shamtally
  • Jason Domingo
  • Evgenia Kourampa
  • Colin Hale
  • Jennifer Gibney
  • Michael Stackpoole
  • Zalina Rashid-Gardner
  • Rebecca Lyon
  • Chloe McDonnell
  • Christine Cole
  • Anna Stewart
  • Gillian McMillan
  • Mary Savage
  • Helen Beckett
  • Chantelle Moorbey
  • Amisha Desai
  • Claire Brown
  • Kush Naker
  • Karishma Gokani
  • Charlotte Trinham
  • Charlette Sabine
  • Sophie Moore
  • Steve Hurdover
  • Edwin Justice
  • Megan Stone
  • Emma Plested
  • Carla Ferreira Da Silva
  • Rachel White
  • Hannah Robinson
  • Iain Turnbull
  • Gertraud Morshead
  • Rachael Drake-Brockman
  • Catherine Smith
  • Grace Li
  • Mwila Kasanyinga
  • Elizabeth A Clutterbuck
  • Sagida Bibi
  • Michael Singh
  • Trishna Champaneri
  • Margaret Irwin
  • Mohammed Khan
  • Alicia Kownacka
  • Martha Nabunjo
  • Carol Osuji
  • John Hladkiwskyj
  • Dominic Galvin
  • Gita Patel
  • Jacques Grierson
  • Samantha Males
  • Krishna Askoolam
  • Joshua Barry
  • Johanna Mouland
  • Beverley Longhurst
  • Maria Moon
  • Beth Giddins
  • Carlota Pereira Dias Alves
  • Leah Richmond
  • Christine Minnis
  • Sonia Baryschpolec
  • Scott Elliott
  • Lauren Fox
  • Victoria Graham
  • Natalie Baker
  • Kerry Godwin
  • Karen Buttigieg
  • Chanice Knight
  • Phillip Brown
  • Paminder Lall
  • Imam Shaik
  • Emily Chiplin
  • Emily Brunt
  • Stephanie Leung
  • Lauren Allen
  • Steve Thomas
  • Sara Fraser
  • Bea Choi
  • Jade Gouriet
  • Jonathan Perkins
  • Andrew Gowland
  • Jonathan Macdonald
  • John Paul Seenan
  • Igor Starinskij
  • Andrew Seaton
  • Erica Peters
  • Stephen Singh
  • Ben Gardside
  • Avril Bonnaud
  • Ceri Davies
  • Elizabeth Gordon
  • Samantha Keenan
  • Jane Hall
  • Suzanne Wilkins
  • Suzanne Tasker
  • Rob James
  • Ingrid Seath
  • Kelly Littlewood
  • Joseph Newman
  • Iryna Boubriak
  • Debbie Suggitt
  • Helen Haydock
  • Sara Bennett
  • Wiesia Woodyatt
  • Kerry Hughes
  • Judith Bell
  • Tricia Coughlan
  • Donald van Welsenes
  • Mohammed Kamal
  • Chris Cooper
  • Simon Tunstall
  • Nicholas Ronan
  • Rebecca Cutts
  • Tracey Dare
  • Yee Ting Nicole Yim
  • Sarah Whittley
  • Shama Hamal
  • Marivic Ricamara
  • Kirsty Adams
  • Holly Baker
  • Kimberley Driver
  • Nicola Turner
  • Todd Rawlins
  • Subarna Roy
  • Marta Merida-Morillas
  • Yukari Sakagami
  • Antonette Andrews
  • Lillian Goncalvescordeiro
  • Matthew Stokes
  • Wythehi Ambihapathy
  • Joanne Spencer
  • Nina Parungao
  • Lisa Berry
  • James Cullinane
  • Laura Presland
  • Amy Ross Russell
  • Sarah Warren
  • Jonathan Baker
  • Abigail Oliver
  • Amanda Buadi
  • Kim Lee
  • Louise Haskell
  • Rossana Romani
  • Ian Bentley
  • Tim Whitbred
  • Simon Fowler
  • John Gavin
  • Alan Magee
  • Tara Watson
  • Kari Nightingale
  • Phedra Marius
  • Eloise Summerton
  • Emily Locke
  • Thomas Honey
  • Aidan Lingwood
  • Anastasia de la Haye
  • Ryan Stephen Elliott
  • Karen Underwood
  • Mikayala King
  • Sharon Davies-Dear
  • Emily Horsfall
  • Olivia Chalwin
  • Holly Burton
  • Christopher J Edwards
  • Benjamin Welham
  • Kim Appleby
  • Emily Dineen
  • Sarah Garrahy
  • Fran Hall
  • Eleni Ladikou
  • Dee Mullan
  • Daniel Hansen
  • Marion Campbell
  • Filipa Dos Santos
  • Nicki Lakeman
  • Debbie Branney
  • Luke Vamplew
  • Alison Hogan
  • Jorden Frankham
  • Martin Wiselka
  • Denny Vail
  • Victoria Wenn
  • Valerie Renals
  • Kate Ellis
  • Jessica Lewis-Taylor
  • Haniah Habash-Bailey
  • Javier Magan
  • Anna Hardy
Summary Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19. Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 μg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 μg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (anti-spike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing. Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group). Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose. Funding UK Vaccine Task Force and National Institute for Health Research.
Original languageEnglish
Pages (from-to)1131-1141
Number of pages11
JournalLancet Infectious Diseases
Volume22
Issue number8
Early online date9 May 2022
DOIs
Publication statusPublished - 1 Aug 2022

Total downloads

No data available
View graph of relations