The Platform Trial In COVID-19 Priming and BOOsting (PICOBOO): the immunogenicity, reactogenicity, and safety of different COVID-19 vaccinations administered as a second booster (fourth dose) in AZD1222 primed individuals aged 50-<70 years old
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(Published version)
Date
2024
Authors
McLeod, C.
Dymock,
Flanagan, K.L.
Plebanski, M.
Marshall, H.
Estcourt, M.J.
Tjiam, M.C.
Blyth, C.
Subbarao, K.
Mordant, F.L.
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Journal article
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Journal of Infection, 2024; 89(6):106286-1-106286-9
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C. McLeod, M. Dymock, K.L. Flanagan, M. Plebanski, H. Marshall h, M.J. Estcourt, M.C. Tjiam, C.C. Blyth, K. Subbarao, F.L. Mordant, S. Nicholson, S.N. Faust, U. Wadia, R.B. Thornton, Z. Ellis, A. Mckenzie, J.A. Marsh, T.L. Snelling, P. Richmond
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Abstract
Objectives: PICOBOO is a randomised, adaptive trial evaluating the immunogenicity, reactogenicity, and safety of COVID-19 booster strategies. We report data for second boosters among individuals 50- < 70 years old primed with AZD1222 (50- < 70y-AZD1222) until Day 84. Methods: Immunocompetent adults who received any first booster ≥ three months prior were eligible. Participants were randomly allocated to BNT162b2, mRNA-1273 or NVX-CoV2373 1:1:1. The concentrations of ancestral anti-spike immunoglobulin were summarised as the geometric mean concentrations (GMC). Reactogenicity and safety outcomes were captured. Additional analyses including neutralising antibodies were performed on a subset. ACTRN12622000238774. Results: Between Mar 2022 and Aug 2023, 743 participants were recruited and had D28 samples; 155 belonged to the 50- < 70y-AZD1222 stratum. The mean adjusted GMCs (95% credible intervals) were 20,690 (17 555−23 883), 23,867 (20 144−27 604) and 8654 (7267−9962) U/mL at D28 following boosting with BNT162b2, mRNA-1273 and NVX-CoV2372, respectively, and 10,976 (8826−13 196), 15,779 (12 512−19 070) and 6559 (5220−7937) U/mL by D84. IgG against Omicron BA.5 was 2.7–2.9 times lower than the ancestral strain. Limited neutralisation against Omicron subvariants was found following all vaccines. Severe reactogenicity events were < 4%. Conclusions: All vaccines were immunogenic with more rapid waning after mRNA vaccines. These data support boosting with vaccines with greater specificity for circulating Omicron subvariants.
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© 2024 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).