Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

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.

Development and optimization of porphyrin gas sensing LB films

A series of meso-substituted metal-free porphyrins has been developed which show high sensitivity to NO2 gas in the sub-5 ppm concentration range. By selecting different substituents, it has been possible to improve in a systematic manner the response time and sensitivity of the porphyrin LB film to NO2. Initially, a sulphonamino substituent yielded a fairly long response time of around 450 s but this was shortened considerably when this substituent was changed for a stearamido group. Further modifications resulted in achieving a porphyrin LB film which exhibited a t50 response time of only 11 s. By using an optically inert calixarene host material in which the porphyrin guest was incorporated, it was possible to obtain t50 values as low as 5 s.

Weight concerns in women smokers during pregnancy and postpartum

When women smokers become pregnant, they are asked to control weight gain and at the same time to relinquish an addictive drug with weight suppressing effects. For women with serious body image concerns or a history of unhealthful eating patterns, smoking cessation may be particularly problematic. To investigate the relationship of weight concerns with smoking and weight gain during pregnancy and postpartum weight loss strategies, we conducted a retrospective study of women who had given birth to their first child within the past 10 years and were smokers when they became pregnant. We observed that women smokers with high weight and body image concerns (HC) gained significantly more weight during pregnancy-in amounts that far exceeded maximum recommended weight gain-than did women with low concerns (LC). HC were more likely to adopt smoking as a weight-control strategy and to be receptive to multiple weight-control strategies. Although they lost significantly more weight in the first month postpartum than did LC, they had also gained significantly more during pregnancy; the net result was that weight loss as a percentage of weight gained did not differ significantly between groups. HC were significantly less likely to experience food cravings in the first trimester and marginally less likely to vomit than LC. We conclude that early identification of high-risk women, coordination of prenatal care with smoking cessation counseling, and development of effective relapse prevention strategies that specifically address weight issues both during and after pregnancy will be needed if efforts to reduce smoking during pregnancy and postpartum are to be optimized.

Systemic sclerosis: using high-resolution CT to detect lung disease in children

OBJECTIVE

The purpose of this study was to determine the prevalence of interstitial lung disease and the severity of disease in children with systemic sclerosis using high-resolution CT (HRCT).

SUBJECTS AND METHODS

Eleven children (mean age, 11 years) with scleroderma underwent HRCT, chest radiography, and pulmonary function testing. Eight of these 11 patients also underwent follow-up HRCT. HRCT studies were assessed by two observers for ground-glass attenuation, honeycombing, and other abnormalities. Profusion scores for ground-glass attenuation and honeycombing were determined by multiplying severity of disease by the percentage of lung involvement.

RESULTS

Chest radiographs predicted interstitial lung disease in only two patients, whereas HRCT showed interstitial lung disease in eight patients (p = .05). On HRCT, ground-glass attenuation was found in eight patients (73%), honeycombing in five patients (45%), linear opacities in six patients (55%), and subpleural micronodules in seven patients (64%). By the end of the study, 10 patients (91%) had evidence of interstitial lung disease on HRCT. Overall, profusion scores for these 10 patients showed four patients with mild, one with moderate, and five with severe disease. Also, HRCT revealed worsening disease in three of eight patients. We found no correlation between duration of scleroderma and severity of interstitial lung disease (p > .02). Seven patients with evidence of lung disease on HRCT had abnormal results on pulmonary function tests; patients with the highest scores for ground-glass attenuation had the most abnormal results on pulmonary function tests (p < .01).

CONCLUSION

HRCT shows significant pulmonary disease in children with systemic sclerosis, revealing abnormalities in 91% of our patients. Pulmonary disease should be suspected in children with scleroderma, even if the chest radiograph has normal findings.

Hemolytic transfusion reactions in a dog with an alloantibody to a common antigen

Alloantibodies to high-frequency red cell antigens, defined as inherited traits occurring in 92% to 99% or more of the general population, are recognized as a cause of hemolytic transfusion reactions in humans. Here we describe a dog (dog erythrocyte antigen [DEA] 1.2- and DEA 4-positive) sensitized by prior blood transfusion, for which a compatible blood donor could not be found; transfusion of DEA 1.1-negative blood resulted in hemolytic transfusion reactions. Patient serum from days 1 (before first transfusion) and 16 was available for further testing; using 4 dogs with different blood types as potential donors, the major crossmatches were compatible using serum from day 1. However the crossmatches were all incompatible with serum from day 16, indicating that the patient was sensitized to an antigen after the first transfusion. The presence of an alloantibody against DEA 1.1 was not ruled out in this patient, but the incompatibility reactions of patient serum with red cells from donors negative for DEA 1.1 indicated that an alloantibody against a red cell antigen other than DEA 1.1 or any other known DEA for which typing reagents were available (DEA 3, 5, and 7) was present. Subsequently, red cells from 1 of the patient's siblings (DEA 1.2-, 4-, and 7-positive) were found not to agglutinate when incubated with patient's serum from day 16, ruling out the presence of an anti-DEA 7 antibody, and suggesting that an alloantibody against a common red cell antigen missing in the patient and sibling was responsible for the blood incompatibility reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

A staff management system for maintaining improvements in continence with elderly nursing home residents

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.

Gluten antibodies in patients with multiple sclerosis

The level of gluten antibodies has been determined in plasma samples from 36 patients with MS using a haemagglutination technique. Only one of the 36 patients studied showed any evidence of gluten antibodies and the level of antibodies in this patient did not justify putting the patient on a gluten-free diet. This study has provided no evidence to support the use of a gluten-free diet as part of the management of MS.

Effect of intravenous infusion of calcium ions on the biosynthesis of the vitamin D-dependent calcium binding protein

Calcium ions were infused into the external jugular vein of 2 groups of rachitic chicks. One group had been injected with 5 micrograms cholecalciferol (vitamin D3), while the other group remained vitamin D-deficient. After approximately 72 h the chickens were killed and intestinal mucosa homogenates were prepared for the measurement of calcium-binding protein (CaBP). The results indicate that CaBP is not biosynthesised in response to raising the extracellular calcium ion concentration, and only appears if the chickens had received cholecalciferol.

The effect of various cholecalciferol-related substances on the biosynthesis of the cholecalciferol-dependent calcium-binding protein in the small intestine of the rachitic chick and its relation to rickets

Rachitic chicks were injected with different dose-levels of cholecalciferol and several cholecalciferol-related substances, i.e., dihydrotachysterol 3, ergocalciferol, 5,6-transcholecalciferol and 25-hydroxycholecalciferol. The response to treatment was assayed by the amount of cholecalciferol-dependent calcium-binding protein produced in the mucosa of the small intestine. The biological activity of these substances in the healing of rickets in the rat was also estimated except for ergocalciferol. The relative potencies in stimulating calcium-binding protein production were: 25-hydroxycholecalciferol > cholecalciferol > 5,6-trans-cholecalciferol > ergocalciferol > dihydrotachysterol 3.

The myoglobin of an echidna (Tachyglossus aculeatus aculeatus)

The skeletal myoglobin of the echidna was composed of 153 residues. Its primary amino acid sequence has been determined and compared with that of platypus. Nine differences were found. The number of differences from known marsupial and eutherian myoglobin is about twice as much.

The myoglobin of the Cape fox (Vulpes chama)

Tryptic, peptic and chymotryptic peptides from the myoglobin of the Cape fox (Vulpes chama) have been aligned with the sequence of the myoglobin of the domestic dog. No amino acid difference was found. Seven carnivore myoglobins now known are compared amongst themselves and it is noted that though the differences between them are found in many different parts of the myoglobin molecule, there seems to be a higher incidence along the loop formed by helix G, the interhelical region GH and the helix H.

The myoglobin of the killer whale (Orcinus orca)

Whereas the myoglobin of the dolphin surprisingly resembles that of the sperm whale more than that of the porpoise, the myoglobin of a killer whale does not show this feature. It differs from the myoglobins of the dolphin in 6, of the porpoise in 8, and of the sperm whale in 14 positions. The residues in which the cetaceans differ are localised in one particular area of the molecule.

The cure of ptosis by aponeurotic repair

Indications for the procedure of aponeurotic repair are nearly all of the ptoses that have 8 mm or more of elevation from downward to upward gaze. Such cases have a levator with an adequate striated part, an inadequate superior tarsal (Müller) muscle, and an aponeurosis that has involutional changes such as a dehiscence or disinsertion. Local anesthesia is advised. The incision is made 7 mm above the lash-line, through the skin and pretarsal muscle only. Blunt dissection upward is used until the preaponeurotic fat pad is uncovered. The upper part of the aponeurosis is picked up under the fat pad and sutured to the lower part of the aponeurosis with 5-0 chromic gut. Fifty-seven eyelids in thirty-four patients have been operated on, with excellent results and minimal trauma.