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Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to scale up around the world, costing severe health and economic losses. The development of an effective COVID-19 vaccine is of utmost importance. Most vaccine designs can be classified into three camps: protein based (inactivated vaccines, protein subunit, VLP and T-cell based vaccines), gene based (DNA or RNA vaccines, replicating or non-replicating viral/bacterial vectored vaccines), and a combination of both protein-based and gene-based (live-attenuated virus vaccines). Up to now, 237 candidate vaccines against SARS-CoV-2 are in development worldwide, of which 63 have been approved for clinical trials and 27 are evaluated in phase 3 clinical trials. Six candidate vaccines have been authorized for emergency use or conditional licensed, based on their efficacy data in phase 3 trials. This review summarizes the strengths and weaknesses of the candidate COVID-19 vaccines from various platforms, compares, and discusses their protective efficacy, safety, and immunogenicity according to the published clinical trials results.
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Affiliation(s)
- Hu-Dachuan Jiang
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Jing-Xin Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Peng Zhang
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xiang Huo
- Food Safety and Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Feng-Cai Zhu
- School of Public Health, Southeast University, Nanjing 210009, China
- NHC Key Laboratory of Enteric Pathogenic Microbiology Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
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Detoc M, Launay O, Dualé C, Mutter C, Le Huec JC, Lenzi N, Lucht F, Gagneux-Brunon A, Botelho-Nevers E. Barriers and motivations for participation in preventive vaccine clinical trials: Experience of 5 clinical research sites. Vaccine 2019; 37:6633-6639. [PMID: 31543417 DOI: 10.1016/j.vaccine.2019.09.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/09/2023]
Abstract
Recruitment in preventive vaccine trials (PVT) is challenging due to common barriers to clinical research and lack of vaccine confidence. Identifying determinants of participation can help to improve recruitment. A prospective survey was conducted in 5 French clinical investigational sites. People asked to participate in a PVT were given a questionnaire whether they decided to participate or not in the trial. A total of 341 people answered the survey: 210 accepting and 131 declining to participate in a PVT. Acceptors were significantly younger (38.5 vs 54.9 years old), more likely to be involved in early phase trials, had a higher level of education (p < 0.005) and a significantly better general opinion concerning vaccines (92.3% versus 72.3%, p < 0.005) compared with those who declined. Factors associated with acceptance or refusal were evaluated in 224 people in the 4 sites where both groups were included. In a multivariate analysis, three factors: older age, having heard about PVT through multiple sources and financial incentives were significantly associated with refusal to participate in the PVT. A generally favourable opinion of vaccines was associated with acceptance. The main motivation for participation was altruism (93.2%) whereas fear of side effects was at the forefront of the barriers (36.6%). Information given by the physician was a key point for decision-making in 70.2% of those who accepted. In brief, vaccine hesitancy may decrease recruitment in PVTs; reinforcing altruism and quality of information given are key points in acceptance of participation in PVT.
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Affiliation(s)
- M Detoc
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - O Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; Inserm, CIC 1417, Assistance Publique-Hôpitaux de Paris, CIC Cochin Pasteur, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
| | - C Dualé
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; Centre de Pharmacologie Clinique (INSERM CIC1405), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - C Mutter
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France; CIC Inserm 1434, CHU de Strasbourg, Strasbourg, France
| | - J-C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Unité Rachis, Université Bordeaux Deterca Lab, 15 rue Boucher, 33000 Bordeaux, France
| | - N Lenzi
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - F Lucht
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - A Gagneux-Brunon
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - E Botelho-Nevers
- Clinical Trial Center, INSERM CIC 1408, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France; Groupe Immunité Muqueuse et Agents Pathogènes (GIMAP), EA3064 - Medical School of Saint-Etienne, University of Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.
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Callegaro A, Tibaldi F. Assessing correlates of protection in vaccine trials: statistical solutions in the context of high vaccine efficacy. BMC Med Res Methodol 2019; 19:47. [PMID: 30841856 PMCID: PMC6402125 DOI: 10.1186/s12874-019-0687-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background The use of correlates of protection (CoPs) in vaccination trials offers significant advantages as useful clinical endpoint substitutes. Vaccines with very high vaccine efficacy (VE) are documented in the literature (VE ≥95%). The rare events (number of infections) observed in the vaccinated groups of these trials posed challenges when applying conventionally-used statistical methods for CoP assessment. In this paper, we describe the nature of these challenges, and propose easy-to-implement and uniquely-tailored statistical solutions for the assessment of CoPs in the specific context of high VE. Methods The Prentice criteria and meta-analytic frameworks are standard statistical methods for assessing vaccine CoPs, but can be problematic in high VE cases due to the rare events data available. As a result, lack of fit and the problem of infinite estimates may arise, in the former and latter methods respectively. The use of flexible models within the Prentice framework, and penalized-likelihood methods to solve the issue of infinite estimates can improve the performance of both methods in high VE settings. Results We have 1) devised flexible non-linear models to counteract the Prentice framework lack of fit, providing sufficient statistical power to the method, and 2) proposed the use of penalised likelihood approaches to make the meta-analytic framework applicable on randomized subgroups, such as regions. The performance of the proposed methods for high VE cases was evaluated by running simulations. Conclusions As vaccines with high efficacy are documented in the literature, there is a need to identify effective statistical solutions to assess CoPs. Our proposed adaptations are straight-forward and improve the performance of conventional statistical methods for high VE data, leading to more reliable CoP assessments in the context of high VE settings.
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Chu K, Hu J, Meng F, Li J, Luo L, Xu J, Yuan Z, Li Z, Chen W, Jiao L, Chang Y, Wang B, Hu Y. Immunogenicity and safety of subunit plague vaccine: A randomized phase 2a clinical trial. Hum Vaccin Immunother 2016; 12:2334-40. [PMID: 27159397 DOI: 10.1080/21645515.2016.1175261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although the killed whole-cell and live attenuated plague vaccine have been licensed, they are rarely used today because of toxicities, limited evidence of efficacy against plague, poor immune persistence required booster immunization every year, and limited commercial availability. This study was a randomized phase 2a clinical trial aimed to evaluating the immunogenicity and safety of a novel subunit plague vaccine. METHODS 240 healthy adults aged 18-55 y were enrolled and randomly assigned at a ratio of 1:1 to receive 2 doses of 15 or 30 mcg vaccine at a 28-day interval between doses. Blood samples were collected at day 0, 28 and 56. Adverse events were collected during the first 28 d after each vaccination. Serious Adverse Event was observed throughout the study period. RESULTS 239 participants received the first dose at day 0 and 238 received the second dose at day 28. Antibodies to envelope antigen faction 1 (F1) and recombinant virulence antigen (rV) were increased at day 28, and boosted significantly at day 56. For anti-F1 antibodies, geometric mean titer (GMT) and geometric mean fold increase (GMFI) were significantly higher in 30 mcg group than in the 15 mcg group(each P1< 0.05 at day 28 and each P1< 0.001 at day 56), with similar seroconversion rate of antibodies between 15 and 30 mcg group at both of the 2 time points. For anti-rV antibodies, seroconversion rate at day 28 in 30 mcg group was higher than that in 15 mcg group. However, GMT and GMFI of anti-rV antibodies were increased to approximately the same levels in the 2 groups. Similar booster immune response was also noticed in both groups at day 56. The injections were well tolerated, with mainly mild or moderate local and systemic adverse reactions (lower than grad 3). The proportion of pain at injection site was higher in 30 mcg group. None of SAEs were reported during 56 d. CONCLUSION The plague vaccine comprised of F1 and rV antigens showed good safety and immunogenicity in adults aged 18-55 y old. The data show that the 30 mcg formulation is generally more immunogenic than the 15 mcg formulation, and represents the preferred formulation for further clinical development. It will be important to evaluate the long-term efficacy for appropriate formulations of the plague subunit vaccine.
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Affiliation(s)
- Kai Chu
- a Jiangsu Provincial Center for Diseases Control and Prevention , Nanjing , China
| | - Jialei Hu
- a Jiangsu Provincial Center for Diseases Control and Prevention , Nanjing , China
| | - Fanyue Meng
- a Jiangsu Provincial Center for Diseases Control and Prevention , Nanjing , China
| | - Jingxin Li
- a Jiangsu Provincial Center for Diseases Control and Prevention , Nanjing , China
| | - Li Luo
- b Department of Public Health , Southeast University , Nanjing , China
| | - Jianjun Xu
- c Yandu Center for Disease Control and Prevention , Yancheng , China
| | - Zhonghang Yuan
- c Yandu Center for Disease Control and Prevention , Yancheng , China
| | - Zhiyong Li
- c Yandu Center for Disease Control and Prevention , Yancheng , China
| | - Wangeng Chen
- c Yandu Center for Disease Control and Prevention , Yancheng , China
| | - Lei Jiao
- d Lanzhou Institute of Biological Products Co.,Ltd. , Lanzhou , China
| | - Yali Chang
- d Lanzhou Institute of Biological Products Co.,Ltd. , Lanzhou , China
| | - Bingxiang Wang
- d Lanzhou Institute of Biological Products Co.,Ltd. , Lanzhou , China
| | - Yuemei Hu
- a Jiangsu Provincial Center for Diseases Control and Prevention , Nanjing , China
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