Abstract
Background: Currently, booster dose is needed after 2 doses of non-live COVID-19 vaccine. With limited resources and shortage of COVID-19 vaccines, intradermal(ID) administration might be a potential dosesparing strategy. Objective: To determine immunologic response and reactogenicity of ID ChAdOx1 nCoV-19 vaccine (AZD1222,Oxford/AstraZeneca) as a booster dose after completion of 2-dose CoronaVac(SV) in healthy adult.Methods: This is a prospective cohort study of adult aged 18-59 years who received 2-dose SV at 14-35 days apart for more than 2 months. Participants received ID AZD1222 at fractional low dose (1x1010 viral particles,0.1 ml). Antibody responses were evaluated by surrogate virus neutralization test(sVNT) against delta variant and wild type, and anti-spike-receptor-binding-domain immunoglobulin G(anti-S-RBD IgG) at prior, day14, 28, 90, and 180 post booster. Solicited reactogenicity was collected for 7 days post-booster. Primary endpoint was the differences of sVNT against delta strain > 80%inhibition at day14 and 90 compared with the parallel cohort study of 0.5-ml intramuscular(IM) route.Results: From August2021, 100 adults with median age of 46 years (IQR 41-52) participated. Prior to booster, geometric mean (GM) of sVNT against delta strain was 22.4% inhibition (95 %CI 18.7-26.9) and of anti-S-RBD IgG was 109.3 BAU/ml (95.4-125.1). Post ID booster, GMs of sVNT against delta strain were 95.5% inhibition (95%CI 94.2-96.8) at day14, 73.1% inhibition (66.7-80.2) at day 90, and 22.7% inhibition (14.9-34.6) at day180. The differences of proportion of participants achieving sVNT against delta strain > 80%inhibition in ID recipients versus IM were + 4.2% (95 %CI -2.0to10.5) at day14, and -37.3% (-54.2to-20.3) at day 90. Anti-S-RBD IgG GMs were 2037.1 BAU/ml (95%CI 1770.9-2343.2) at day 14 and 744.6 BAU/ml (650.1-852.9) at day 90,respectively. Geometric mean ratios (GMRs) of anti-S-RBD IgG were 0.99 (0.83-1.20) at day 14, and 0.82 (0.66-1.02) at day 90. Only 18% reported feverish, compared with 37% of IM (p = 0.003). Common reactogenicity was erythema at injection site (53%) while 7% reported blister.Conclusion: Low-dose ID AZD1222 booster enhanced lower neutralizing antibodies at 3 months compared with IM route. Less systemic reactogenicity occurred, but higher local reactogenicity.(c) 2022 Elsevier Ltd. All rights reserved.
