Science & Technology

Combine-and-Match Strategy to Booster Vaccination Affords the Finest Safety Towards COVID-19


COVID Vaccine Comparison

According to a brand new research, administering a distinct kind of vaccination (heterologous) for the third or ‘booster’ dosage than the primary two doses leads to better vaccine efficiency than utilizing the identical (homologous) inactivated SARS-CoV-2 vaccine for all three doses.

A brand new research on Chile’s nationwide COVID-19 vaccination program, being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon, April 23-26), and published in the journal The Lancet Global Health on April 23, 2022, shows that giving a different type of vaccine (heterologous) for the third or ‘booster’ dose than was received for the first two doses, leads to better vaccine performance than using the same (homologous) inactivated SARS-CoV-2 vaccine for all three doses.

Dr. Rafael Araos of the Institute of Science and Innovation in Medicine, Clinica Alemana, Universidad del Desarrollo, Dr. Alejandro Jara and Dr. Eduardo A Undurraga of Pontificia Universidad Católica de Chile, and colleagues from the Chilean Ministry of Health contributed to the study.

The study assessed the effectiveness of CoronaVac (Sinovac Biotech), AZD1222 (Oxford-AstraZeneca), or BNT162b2 (Pfizer-BioNTech) vaccine boosters in individuals who had completed a primary two-dose immunization schedule with CoronaVac, an inactivated SARS-CoV-2 vaccine which accounts for about half the COVID-19 vaccine doses delivered globally, compared with no vaccination. The study looked at Chile’s national immunization program, where the two-dose Coronavac schedule was by far the most widely used.

Individuals administered vaccines from February 2, 2021, to the prespecified trial end date of November 10, 2021, were evaluated; the team excluded individuals with a probable or confirmed SARS-CoV-2 infection (RT-PCR or antigen test) on or before February 2, 2021, and individuals who had received at least one dose of any COVID-19 vaccine before February 2, 2021. They estimated the vaccine effectiveness of booster doses against laboratory-confirmed symptomatic COVID-19 (symptomatic COVID-19) cases and COVID-19 outcomes (hospitalization, admission to the intensive care unit [ICU], and dying).

A complete of 11,174,257 people had been eligible for this research, amongst whom 4,127,546 accomplished a major immunization schedule (two doses) with CoronaVac and acquired a booster dose through the research interval. 1 921 340 (46·5%) members acquired a heterologous AZD1222 booster, 2 019 260 (48·9%) acquired a heterologous BNT162b2 booster, and 186 946 (4·5%) acquired a homologous booster with CoronaVac.

The authors calculated an adjusted vaccine effectiveness (utilizing statistical modeling) in stopping symptomatic COVID-19 of 79% for a two-dose schedule plus CoronaVac booster, 97% for a BNT162b2 booster, and 93% for an AZD1222 booster. The adjusted vaccine effectiveness in opposition to COVID-19-related hospitalization, ICU admission, and dying was 86%, 92%, and 87% for a CoronaVac booster, 96%, 96%, and 97% for a Pfizer-BioNTech booster, and 98%, 99% and 98% for an Astra Zeneca booster.

The authors clarify that booster packages had been initiated in varied nations on account of rising proof of waning immunity from two dose schedules. Boosters are additionally necessary as a result of proof means that inactivated vaccines like Coronavac provide decrease safety than the brand new mRNA know-how vaccines from Pfizer -BioNTech and Moderna. Delta was the predominant circulating variant in Chile through the research interval.

They conclude: “Our results suggest that a third dose of Coronavac or using a different booster vaccine such as Pfizer-BioNTech or Astra Zeneca vaccines in those that had previously had two doses of Coronavac provides a high level of protection against COVID-19, including severe disease and death…However, receiving a different vaccine for the booster dose results in higher vaccine effectiveness than a third dose of Coronavac for all outcomes, providing additional support for a mix-and-match approach.”

The authors additional clarify that this is among the first research to look at the effectiveness of booster photographs for inactivated SARS-CoV-2 vaccines. A latest research in Brazil1 confirmed that homologous and heterologous booster vaccines (BNT162b2 and AZD1222) following a CoronoVac major vaccination schedule had been protected and immunogenic. Similarly, a section 1-2 research within the USA2 with mRNA-1273, Ad26.COV2.S, and BNT162b2 boosters discovered that heterologous boosters the place on common extra immunogenic than homologous boosters.

The UK’s Cov-Boost3 research (a section 2 trial) confirmed that varied vaccines are protected and immunogenic when given as boosters following a major two-dose schedule of AZD1222 and BNT162b2, with the very best antibody ranges achieved by mRNA boosters.

And prior research4 have examined the immunogenicity of a heterologous two-dose routine of ChAdOx1 adopted by an mRNA vaccine, and located mix-and-match methods had been extra immunogenic and provided extra safety in opposition to COVID-19 than two-dose homologous methods for that vaccine mixture.

In Chile, the federal government has now suggested that heterologous boosters ought to be used as the primary possibility; nevertheless, individuals can and have acquired a homologous booster in its place.


“Effectiveness of homologous and heterologous booster doses for an inactivated SARS-CoV-2 vaccine: a large-scale prospective cohort study” by Alejandro Jara, PhD; Eduardo A Undurraga, PhD; José R Zubizarreta, PhD; Cecilia González, MD; Alejandra Pizarro, MD; Johanna Acevedo, MS; Katherinne Leo, BSE; Fabio Paredes, MSc; Tomás Bralic, MS; Verónica Vergara, MS; Marcelo Mosso, BSE; Francisco Leon, MBA; Ignacio Parot, MA; Paulina Leighton, BSE; Pamela Suárez, BSE; Juan Carlos Rios, PhD; Heriberto García-Escorza, MS and Rafael Araos, MD, 23 April 2022, The Lancet Global Health.
DOI: 10.1016/S2214-109X(22)00112-7

“Heterologous versus homologous COVID-19 booster vaccination in previous recipients of two doses of CoronaVac COVID-19 vaccine in Brazil (RHH-001): a phase 4, non-inferiority, single blind, randomised study” by Sue Ann Costa Clemens, PhD; Lily Weckx, PhD; Ralf Clemens, PhD; Ana Verena Almeida Mendes, PhD; Alessandra Ramos Souza, PhD; Mariana B V Silveira, MD; Suzete Nascimento Farias da Guarda, PhD; Maristela Miyamoto de Nobrega, PhD; Maria Isabel de Moraes Pinto, PhD; Isabela G S Gonzalez, MD; Natalia Salvador, Nurse D; Marilia Miranda Franco, MD; Renata Navis de Avila Mendonça, MD; Isabelle Silva Queiroz Oliveira, MD; Bruno Solano de Freitas Souza, PhD; Mayara Fraga, Pharm D; Parvinder Aley, PhD; Sagida Bibi, PhD; Liberty Cantrell, MSc; Wanwisa Dejnirattisai, PhD; Xinxue Liu, PhD; Juthathip Mongkolsapaya, DPhil; Piyada Supasa, PhD; Gavin R Screaton, DPhil; Teresa Lambe, PhD and Merryn Voysey, DPhil, 21 January 2022, The Lancet.
DOI: 10.1016/S0140-6736(22)00094-0

“Homologous and Heterologous Covid-19 Booster Vaccinations” by Robert L. Atmar, M.D., Kirsten E. Lyke, M.D., Meagan E. Deming, M.D., Ph.D., Lisa A. Jackson, M.D., M.P.H., Angela R. Branche, M.D., Hana M. El Sahly, M.D., Christina A. Rostad, M.D., Judith M. Martin, M.D., Christine Johnston, M.D., M.P.H., Richard E. Rupp, M.D., Mark J. Mulligan, M.D., Rebecca C. Brady, M.D., Robert W. Frenck, Jr., M.D., Martín Bäcker, M.D., Angelica C. Kottkamp, M.D., Tara M. Babu, M.D., M.S.C.I., Kumaravel Rajakumar, M.D., Srilatha Edupuganti, M.D., M.P.H., David Dobrzynski, M.D., Rhea N. Coler, Ph.D., Christine M. Posavad, Ph.D., Janet I. Archer, M.Sc., Sonja Crandon, B.S.N., Seema U. Nayak, M.D., Daniel Szydlo, M.S., Jillian A. Zemanek, M.P.H., Clara P. Dominguez Islas, Ph.D, Elizabeth R. Brown, Sc.D., Mehul S. Suthar, Ph.D., M. Juliana McElrath, M.D., Ph.D., Adrian B. McDermott, Ph.D., Sarah E. O’Connell, M.S., David C. Montefiori, Ph.D., Amanda Eaton, M.B.A., Kathleen M. Neuzil, M.D., David S. Stephens, M.D., Paul C. Roberts, Ph.D. and John H. Beigel, M.D. for the DMID 21-0012 Study Group, 17 March 2022, The New England Journal of Medicine.
DOI: 10.1056/NEJMoa2116414

“Safety and immunogenicity of seven COVID-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST): a blinded, multicentre, randomised, controlled, phase 2 trial” by Alasdair P S Munro, MRCPCH; Leila Janani, PhD; Victoria Cornelius, PhD; Parvinder Okay Aley, PhD; Gavin Babbage, MPhil; Prof David Baxter, PhD; Marcin Bula, FRCP; Katrina Cathie, MD; Prof Krishna Chatterjee, FRCP; Kate Dodd, MSc; Yvanne Enever, BSc[Hons]; Karishma Gokani, MBBS; Anna L Goodman, DPhil; Christopher A Green, DPhil; Linda Harndahl, PhD; John Haughney, FRCGP; Alexander Hicks, PhD; Agatha A van der Klaauw, PhD; Jonathan Kwok, MB BChir; Prof Teresa Lambe, PhD; Prof Vincenzo Libri, MD; Prof Martin J Llewelyn, PhD; Alastair C McGregor, FRCPath; Angela M Minassian, DPhil; Patrick Moore, MRCGP; Mehmood Mughal, MBBS; Yama F Mujadidi, MSc; Jennifer Murira, BM; Orod Osanlou, FRCP; Rostam Osanlou, MBChB; Daniel R Owens, MRCPCH; Mihaela Pacurar, MBBS; Adrian Palfreeman, FRCP; Daniel Pan, MRCP; Tommy Rampling, DPhil; Karen Regan, BSc; Stephen Saich, BA; Jo Salkeld, BMBS; Prof Dinesh Saralaya, MD; Sunil Sharma, FRCPath; Ray Sheridan, MRCP; Ann Sturdy, MBBS; Prof Emma C Thomson, PhD; Shirley Todd, MSc; Prof Chris Twelves, MD; Prof Robert C Read, PhD; Sue Charlton, PhD; Bassam Hallis, PhD; Prof Mary Ramsay, FFPH; Prof Nick Andrews, PhD; Prof Jonathan S Nguyen-Van-Tam, DM; Prof Matthew D Snape, MD; Xinxue Liu, PhD and Prof Saul N Faust, PhD on behalf of theCOV-BOOST research group, 2 December 2021, The Lancet.
DOI: 10.1016/S0140-6736(21)02717-3

“Effectiveness of heterologous ChAdOx1 nCoV-19 and mRNA prime-boost vaccination against symptomatic Covid-19 infection in Sweden: A nationwide cohort study” by Peter Nordström, Marcel Ballin and Anna Nordström, 18 October 2021, The Lancet Regional Health – Europe.
DOI: 10.1016/j.lanepe.2021.100249

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