Mixing and Matching COVID-19 Vaccination for Countries of COVID-19 Vaccine Shortage
Attapon Cheepsattayakorn1,2* Ruangrong Cheepsattayakorn3 Thanom Jewsuebpong1
1. Faculty of Medicine, Western University, Pathumtani Province, Thailand
2. 10th Zonal Tuberculosis and Chest Disease Center, Chiang Mai, Thailand
3. Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Corresponding Author: Attapon Cheepsattayakorn, 10th Zonal Tuberculosis and Chest Disease Center, 143 Sridornchai Road Changklan Muang Chiang Mai 50100 Thailand.
Copy Right: © 2021 Attapon Cheepsattayakorn, this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: October 04, 2021
Published date: November 01, 2021
Abstract
A comprehensive search was carried out in mainstream bibliographic databases or Medical Subject Headings, including ScienDirect, PubMed, Scopus, and ISI Web of Science. The search was applied to the articles that were published between January 2021 and September 2021. With strict literature search and screening processes, it yielded 8 articles from 106 articles of initial literature database. In June 2021, a preliminary study conducted by the University of Oxford scientists demonstrated that mixing the AstraZeneca and Pfizer vaccines produced a robust immune response against the SARS-CoV-2 (COVID-19) virus and induced higher antibodies than an only two-dose schedule of AstraZeneca vaccine and none of the groups demonstrated decreased neutralizing activity against the Alpha variant (UK variant), but the neutralization titer reduced by 2.5 to 6 times against the Beta variant (South African variant), Gamma variant (Brazilian variant), and Delta variant (Indian variant).
The Comparing COVID-19 Vaccine Schedule Combinations (Com-COV) study (463 cases of the 4-week interval group) revealed that immunization with AstraZeneca vaccine followed by Pfizer vaccine at the 4-week interval demonstrated a better immune response out of the two mixed dosing regimens. Com-COV study demonstrated in the earlier phase that around 30 % to 40 % of those who received mixed doses reported fevers after their second jab, compared to 10 % to 20 % of those who received the same vaccine for both doses. This result could be attributable to the shorter, 4-week interval between doses that was used during the Oxford study, whereas the safety data from a cohort with a 12-week dosing interval is still to appear.
In conclusion, it is better to give a different COVID-19 vaccine than not administer the second dose at all.
Keywords: COVID-19, mix-and-match, mix, match, vaccine, vaccination
Abbreviations:
Com-COV: COVID-19 Vaccine Schedule Combinations,
COVID-19: Coronavirus disease 2019,
HIV: Human immunodeficiency virus,
SARS-CoV-2: severe acute respiratory syndrome-coronavirus type 2,
UK: United Kingdom,
USA: United States of America
Objectives of The Study
The objective of this study is aimed to identify the feasibility of mixing and matching COVID-19 vaccination in the situation of shortage of COVID-19 vaccines.
Methods of the Study
Search Strategy and Inclusion Criteria
A comprehensive search was carried out in mainstream bibliographic databases or Medical Subject Headings, including ScienDirect, PubMed, Scopus, ISI Web of Science, and websites of the news. The search was applied to the articles that were published between January 2021 and September 2021. Our first involved performing searches of article abstract/keywords/title using strings of [(“ Mix-and-match covid-19 vaccination ” or “ Mixing and matching ”, “ Vaccination ” and “ COVID-19 ”]. After a first approach of search, published articles focusing on COVID-19 were retained and the information on vaccine type and COVID-19 was extracted for having a crude knowledge involving their themes. Another round of publication search was conducted for adding the missing published articles that were not identified by the first round.
All keywords combinations from one disease type and climatic variable to bind the population of cases under consideration. Search string for disease groups include [ “ SARS-CoV-2 ” or “ COVID-19 ” or “ Vaccination ” or “ Vaccines ” or “ Mixing and Matching ” or “ Mix-and-Match ” ]. The initial literature databases were further manually screened with the following rules : 1) non-human infectious disease-related articles were excluded; 2) articles that did not report mix-and-match vaccination related to COVID-19 were not considered, such as commentary articles, or editorial; 3) non-peer reviewed articles were not considered to be of a scholarly trustworthy validity; and 4) duplicated and non-English articles were removed. The articles were carefully selected to guarantee the literature quality, which is a trade-off for quantity.
With strict literature search and screening processes, it yielded 8 articles from 106 articles of initial literature database. Needed article information was extracted from each article by : 1) direct information including journal, title, authors, abstract, full text documents of candidate studies, publishing year; 2) spatial scale and place name of the study area; 3) study period; 4) research method used; 5) type of COVID-19 vaccine studied; 6) types of mix-and-match vaccination studied; and 7) the conclusions made about the impacts of mix-and-match COVID-19 vaccination types on patients’ COVID-19 outcomes.
Introduction
In low-income and middle income countries, Ebola vaccine (Johnson & Johnson) experience demonstrated that mix-and-match vaccination is feasible, safety, and long-lasting immunization, adopted in phase I and phase II trials and can overcome easily with active community participation and suitable national planning [1, 2]. In addition to Ebola, this concept has been previously implemented for influenza, malaria, and HIV [2]. The prime dose in the most of the current vaccination regimen is at a month interval followed by a second homologous booster dose [3]. Recent interest in COVID-19 mixing vaccination is aimed to simplify countries’ facing fluctuation of various vaccine supplies and immunization efforts and increase SARS-CoV-2 (COVID-19) protection by delivery of the similar or same antigens of the disease-causing agent via two different vaccine types and eliciting a strong and long-lasting immune response as compared to the single vaccine regimen, but has a lack of evidence and a potential risk of increased-mixing-vaccine-adverse side effects [3] that include increased headache, increased fever, increased malaise, increased joint pain, and increased AEFI, particularly in the elderly population [3].
Results
With strict literature search and screening processes, it yielded 8 articles from 106 articles of initial literature database. Needed article information was extracted from each article by : 1) direct information including journal, title, authors, abstract, full text documents of candidate studies, publishing year; 2) place name of the study area; 3) study period; 4) research method used; 5) type of mix-and-match COVID-19 vaccination studied; and 6) the conclusions made about the yields of mix-and-match COVID-19 vaccination on human protection of COVID-19.
Discussion
In June 2021, a preliminary study conducted by the University of Oxford scientists demonstrated that mixing the AstraZeneca and Pfizer vaccines produced a robust immune response against the SARS-CoV-2 (COVID-19) virus and induced higher antibodies than an only two-dose schedule of AstraZeneca vaccine and none of the groups demonstrated decreased neutralizing activity against the Alpha variant (UK variant), but the neutralization titer reduced by 2.5 to 6 times against the Beta variant (South African variant), Gamma variant (Brazilian variant), and Delta variant (Indian variant) [4]. The Comparing COVID-19 Vaccine Schedule Combinations (Com-COV) study (463 cases of the 4-week interval group) revealed that immunization with AstraZeneca vaccine followed by Pfizer vaccine at the 4-week interval demonstrated a better immune response out of the two mixed dosing regimens [4]. Com-COV study demonstrated in the earlier phase that around 30 % to 40 % of those who received mixed doses reported fevers after their second jab, compared to 10 % to 20 % of those who received the same vaccine for both doses. This result could be attributable to the shorter, 4-week interval between doses that was used during the Oxford study, whereas the safety data from a cohort with a 12-week dosing interval is still to appear [4]. The trials in Germany and Spain have also demonstrated that a mixed dosing regimen induced a better immune response than getting two doses of the AstraZeneca vaccine [4]. In South Korea, the study on 100 actually-receiving-mixed-doses cases out of 499 cases conducted by the Korea Disease Control and Prevention Agency on a mixed vaccination, with AstraZeneca vaccine as the first dose and Pfizer vaccine as the second dose revealed the increased neutralizing antibody levels of 6 times higher than those found after two doses of the AstraZeneca jab [4]. Initial phase of Com-COV study or Com-COV1 study has been concentrated on mixing the AstraZeneca and Pfizer jabs, whereas Com-COV2 study or phase 2 of the Com-COV study is assessing the immunogenicity and safety of combining the Moderna and Novavax vaccines with a first dose of either the Pfizer or AstraZeneca jab [4]. Globally, COVID-19-dose-mixing studies on assessing other vaccine combinations are also ongoing, including a Russian trial of an AstraZeneca-Sputnik V combinations and a Philippines-based study mixing Sinovac’ s CoronaVac jab with 6 other vaccines [4]. In India, COVID-19 mixing vaccination can assist in scaling up the vaccination drive to a large extent in this world’s-largest-COVID-19-vaccination-drive country [3].
As of June 6, 2021, China, UK, and USA have began the COVID-19-vaccine mixing trials, but have not yet officially approved them due to not being designed to assess actual COVID-19 protection and non-corresponding-COVID-19-real-life protection of the studies’ antibody and T-cell measurements, whereas only Canada, Denmark, France, Germany, Norway, and Sweden implemented mixing vaccination to their citizens with rarely reported ChAdOx1 nCoV-19 (AstraZeneca) thromboembolic complications [3, 5]. Whenever it is impossible to provide a second dose of COVID-19 vaccine, the Public Health of England guidelines recommend that it is better to give a different COVID-19 vaccine than not administer the second dose at all [3]. On July 12, 2021, the WHO’s chief scientist has suggested individuals against mixing and match in COVID-19 vaccines from different manufacturers [6]. Nevertheless, on July 13, 2021, Thailand defended mixing two different COVID-19 vaccines to fight against a surge in SARS-CoV-2 (COVID-19) infections since COVID-19 outbreak in April 2021 after the WHO’s top scientist warned that it was a “ dangerous trend ” not backed by evidence [5, 7]. Thailand’s health authorities will mix a first dose of the Chinese-produced “ Sinovac ” jab with a second dose of Astrazeneca vaccine to try and achieve a “ booster ” effect in 6 weeks instead of 12 weeks due to fast spreading disease (more than 353,700 reported- COVID-19-infected cases and 2,847 reported-COVID-19-related deaths in April 2021) [7]. Figure 1 [8], Table 1 [8] and 2 [3] demonstrate different platforms of COVID-19 vaccines and mechanisms of antigen presentation, advantages and disadvantages of various platforms of COVID-19 vaccines, and recently published clinical trials and ongoing clinical trials on mixing COVID-19 vaccination( as of July 11, 2021), respectively.
Conclusion
It is better to give a different COVID-19 vaccine than not administer the second dose at all.
Reference
Figure 1
Figure 2