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Piggin M, Smith E, Mankone P, Ndegwa L, Gbesemete D, Pristerà P, Bahrami-Hessari M, Johnson H, Catchpole AP, Openshaw PJM, Chiu C, Read RC, Ward H, Barker C. The role of public involvement in the design of the first SARS-CoV-2 human challenge study during an evolving pandemic. Epidemics 2022; 41:100626. [PMID: 36088739 PMCID: PMC9434955 DOI: 10.1016/j.epidem.2022.100626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 02/08/2023] Open
Abstract
High quality health care research must involve patients and the public. This ensures research is important, relevant and acceptable to those it is designed to benefit. The world's first human challenge study with SARS-CoV-2 undertook detailed public involvement to inform study design despite the urgency to review and establish the study. The work was integral to the UK Research Ethics Committee review and approval of the study. Discussion with individuals from ethnic minorities within the UK population supported decision-making around the study exclusion criteria. Public review of study materials for consent processes led to the addition of new information, comparisons and visual aids to help volunteers consider the practicalities and risks involved in participating. A discussion exploring the acceptability of a human challenge study with SARS-CoV-2 taking place in the UK, given the current context of the pandemic, identified overall support for the study. Public concern for the wellbeing of trial participants, as a consequence of isolation, was identified. We outline our approach to public involvement and its impact on study design.
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Affiliation(s)
- Maria Piggin
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK.
| | - Emma Smith
- National Heart and Lung Institute, Imperial College London, London W2 1NY, UK
| | | | | | - Diane Gbesemete
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton General Hospital, Mailpoint 806, Level D, Southampton SO16 6YD, UK
| | - Philippa Pristerà
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | - Michael Bahrami-Hessari
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK
| | - Halle Johnson
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | | | - Peter J M Openshaw
- National Heart and Lung Institute, Imperial College London, London W2 1NY, UK
| | - Christopher Chiu
- Department of Infectious Diseases, Imperial College London, London W2 1NY, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; School of Clinical and Experimental Sciences, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton General Hospital, Mailpoint 806, Level D, Southampton SO16 6YD, UK
| | - Helen Ward
- NIHR Imperial Biomedical Research Centre, Patient Experience Research Centre, Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1NY, UK
| | - Caroline Barker
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, SO16 6YD, UK; NIHR Applied Research Collaboration Wessex, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Killingley B, Mann AJ, Kalinova M, Boyers A, Goonawardane N, Zhou J, Lindsell K, Hare SS, Brown J, Frise R, Smith E, Hopkins C, Noulin N, Löndt B, Wilkinson T, Harden S, McShane H, Baillet M, Gilbert A, Jacobs M, Charman C, Mande P, Nguyen-Van-Tam JS, Semple MG, Read RC, Ferguson NM, Openshaw PJ, Rapeport G, Barclay WS, Catchpole AP, Chiu C. Safety, tolerability and viral kinetics during SARS-CoV-2 human challenge in young adults. Nat Med 2022; 28:1031-1041. [PMID: 35361992 DOI: 10.1038/s41591-022-01780-9] [Citation(s) in RCA: 234] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/09/2022] [Indexed: 12/16/2022]
Abstract
Since its emergence in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused hundreds of millions of cases and continues to circulate globally. To establish a novel SARS-CoV-2 human challenge model that enables controlled investigation of pathogenesis, correlates of protection and efficacy testing of forthcoming interventions, 36 volunteers aged 18-29 years without evidence of previous infection or vaccination were inoculated with 10 TCID50 of a wild-type virus (SARS-CoV-2/human/GBR/484861/2020) intranasally in an open-label, non-randomized study (ClinicalTrials.gov identifier NCT04865237 ; funder, UK Vaccine Taskforce). After inoculation, participants were housed in a high-containment quarantine unit, with 24-hour close medical monitoring and full access to higher-level clinical care. The study's primary objective was to identify an inoculum dose that induced well-tolerated infection in more than 50% of participants, with secondary objectives to assess virus and symptom kinetics during infection. All pre-specified primary and secondary objectives were met. Two participants were excluded from the per-protocol analysis owing to seroconversion between screening and inoculation, identified post hoc. Eighteen (~53%) participants became infected, with viral load (VL) rising steeply and peaking at ~5 days after inoculation. Virus was first detected in the throat but rose to significantly higher levels in the nose, peaking at ~8.87 log10 copies per milliliter (median, 95% confidence interval (8.41, 9.53)). Viable virus was recoverable from the nose up to ~10 days after inoculation, on average. There were no serious adverse events. Mild-to-moderate symptoms were reported by 16 (89%) infected participants, beginning 2-4 days after inoculation, whereas two (11%) participants remained asymptomatic (no reportable symptoms). Anosmia or dysosmia developed more slowly in 15 (83%) participants. No quantitative correlation was noted between VL and symptoms, with high VLs present even in asymptomatic infection. All infected individuals developed serum spike-specific IgG and neutralizing antibodies. Results from lateral flow tests were strongly associated with viable virus, and modeling showed that twice-weekly rapid antigen tests could diagnose infection before 70-80% of viable virus had been generated. Thus, with detailed characterization and safety analysis of this first SARS-CoV-2 human challenge study in young adults, viral kinetics over the course of primary infection with SARS-CoV-2 were established, with implications for public health recommendations and strategies to affect SARS-CoV-2 transmission. Future studies will identify the immune factors associated with protection in those participants who did not develop infection or symptoms and define the effect of prior immunity and viral variation on clinical outcome.
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Affiliation(s)
- Ben Killingley
- Department of Infectious Diseases, University College London Hospital, London, UK
| | | | | | | | | | - Jie Zhou
- Department of Infectious Disease, Imperial College London, London, UK
| | - Kate Lindsell
- UK Vaccine Taskforce, Department for Business, Energy and Industrial Strategy, London, UK
| | - Samanjit S Hare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Jonathan Brown
- Department of Infectious Disease, Imperial College London, London, UK
| | - Rebecca Frise
- Department of Infectious Disease, Imperial College London, London, UK
| | - Emma Smith
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | | | - Tom Wilkinson
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, and NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Stephen Harden
- Department of Radiology, Southampton General Hospital, Southampton, UK
| | - Helen McShane
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Anthony Gilbert
- UK Vaccine Taskforce, Department for Business, Energy and Industrial Strategy, London, UK
| | - Michael Jacobs
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Christine Charman
- UK Vaccine Taskforce, Department for Business, Energy and Industrial Strategy, London, UK
| | - Priya Mande
- UK Vaccine Taskforce, Department for Business, Energy and Industrial Strategy, London, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Malcolm G Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool; Respiratory Department, Alder Hey Children's Hospital, Liverpool, UK
| | - Robert C Read
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, and NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Peter J Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Garth Rapeport
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK.
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