Cited by 2,419SARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research StudiesAnimal Virus Infections Studies

Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial

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Folegatti, Pedro M, Ewer, Katie J, Aley, Parvinder K, Angus, Brian, Becker, Stephan, Belij-Rammerstorfer, Sandra, Bellamy, Duncan, Bibi, Sagida +357 more·2020·The Lancet

Abstract

Background The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be curtailed by vaccination. We assessed the safety, reactogenicity, and immunogenicity of a viral vectored coronavirus vaccine that expresses the spike protein of SARS-CoV-2. Methods We did a phase 1/2, single-blind, randomised controlled trial in five trial sites in the UK of a chimpanzee adenovirus-vectored vaccine (ChAdOx1 nCoV-19) expressing the SARS-CoV-2 spike protein compared with a meningococcal conjugate vaccine (MenACWY) as control. Healthy adults aged 18–55 years with no history of laboratory confirmed SARS-CoV-2 infection or of COVID-19-like symptoms were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 at a dose of 5 × 10 10 viral particles or MenACWY as a single intramuscular injection. A protocol amendment in two of the five sites allowed prophylactic paracetamol to be administered before vaccination. Ten participants assigned to a non-randomised, unblinded ChAdOx1 nCoV-19 prime-boost group received a two-dose schedule, with the booster vaccine administered 28 days after the first dose. Humoral responses at baseline and following vaccination were assessed using a standardised total IgG ELISA against trimeric SARS-CoV-2 spike protein, a muliplexed immunoassay, three live SARS-CoV-2 neutralisation assays (a 50% plaque reduction neutralisation assay [PRNT 50 ]; a microneutralisation assay [MNA 50 , MNA 80 , and MNA 90 ]; and Marburg VN), and a pseudovirus neutralisation assay. Cellular responses were assessed using an ex-vivo interferon-γ enzyme-linked immunospot assay. The co-primary outcomes are to assess efficacy, as measured by cases of symptomatic virologically confirmed COVID-19, and safety, as measured by the occurrence of serious adverse events. Analyses were done by group allocation in participants who received the vaccine. Safety was assessed over 28 days after vaccination. Here, we report the preliminary findings on safety, reactogenicity, and cellular and humoral immune responses. The study is ongoing, and was registered at ISRCTN, 15281137, and ClinicalTrials.gov, NCT04324606. Findings Between April 23 and May 21, 2020, 1077 participants were enrolled and assigned to receive either ChAdOx1 nCoV-19 (n=543) or MenACWY (n=534), ten of whom were enrolled in the non-randomised ChAdOx1 nCoV-19 prime-boost group. Local and systemic reactions were more common in the ChAdOx1 nCoV-19 group and many were reduced by use of prophylactic paracetamol, including pain, feeling feverish, chills, muscle ache, headache, and malaise (all p<0·05). There were no serious adverse events related to ChAdOx1 nCoV-19. In the ChAdOx1 nCoV-19 group, spike-specific T-cell responses peaked on day 14 (median 856 spot-forming cells per million peripheral blood mononuclear cells, IQR 493–1802; n=43). Anti-spike IgG responses rose by day 28 (median 157 ELISA units [EU], 96–317; n=127), and were boosted following a second dose (639 EU, 360–792; n=10). Neutralising antibody responses against SARS-CoV-2 were detected in 32 (91%) of 35 participants after a single dose when measured in MNA 80 and in 35 (100%) participants when measured in PRNT 50 . After a booster dose, all participants had neutralising activity (nine of nine in MNA 80 at day 42 and ten of ten in Marburg VN on day 56). Neutralising antibody responses correlated strongly with antibody levels measured by ELISA ( R 2 =0·67 by Marburg VN; p<0·001). Interpretation ChAdOx1 nCoV-19 showed an acceptable safety profile, and homologous boosting increased antibody responses. These results, together with the induction of both humoral and cellular immune responses, support large-scale evaluation of this candidate vaccine in an ongoing phase 3 programme. Funding UK Research and Innovation, Coalition for Epidemic Preparedness Innovations, National Institute for Health Research (NIHR), NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and the German Center for Infection Research (DZIF), Partner site Gießen-Marburg-Langen.

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  1. [9]van Doremalen N ChAdOx1 nCoV-19 vaccination prevents SARS-CoV-2 pneumonia in rhesus macaques BioRxiv 2020 published online May 13. 10.1101/2020.05.13.093195 (preprint) 33469217 · DOI · Paper page
  2. [18]Wang X Guo X Xin Q Neutralizing antibodies responses to SARS-CoV-2 in COVID-19 inpatients and convalescent patients Clin Infect Dis 2020 published online June 4. 10.1093/cid/ciaa721ciaa721 PMC7314147 32497196 · DOI

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Folegatti, P. M., Ewer, K. J., Aley, P. K., Angus, B., Becker, S., Belij-Rammerstorfer, S., Bellamy, D., Bibi, S., Bittaye, M., Clutterbuck, E. A., Dold, C., Faust, S. N., Finn, A., Flaxman, A. L., Hallis, B., Heath, P., Jenkin, D., Lazarus, R., Makinson, R., Minassian, A. M., Pollock, K. M., Ramasamy, M., Robinson, H., Snape, M., Tarrant, R., Voysey, M., Green, C., Douglas, A. D., Hill, A. V. S., Lambe, T., Gilbert, S. C., Pollard, A. J., Aboagye, J., Adams, K., Ali, A., Allen, E., Allison, J. L., Anslow, R., Arbe-Barnes, E. H., Babbage, G., Baillie, K., Baker, M., Baker, N., Baker, P., Baleanu, I., Ballaminut, J., Barnes, E., Barrett, J., Bates, L., Batten, A., Beadon, K., Beckley, R., Berrie, E., Berry, L., Beveridge, A., Bewley, K. R., Bijker, E. M., Bingham, T., Blackwell, L., Blundell, C. L., Bolam, E., Boland, E., Borthwick, N., Bower, T., Boyd, A., Brenner, T., Bright, P. D., Brown-O'Sullivan, C., Brunt, E., Burbage, J., Burge, S., Buttigieg, K. R., Byard, N., Cabera Puig, I., Calvert, A., Camara, S., Cao, M., Cappuccini, F., Carr, M., Carroll, M. W., Carter, V., Cathie, K., Challis, R. J., Charlton, S., Chelysheva, I., Cho, J.-S., Cicconi, P., Cifuentes, L., Clark, H., Clark, E., Cole, T., Colin-Jones, R., Conlon, C. P., Cook, A., Coombes, N. S., Cooper, R., Cosgrove, C. A., Coy, K., Crocker, W. E. M., Cunningham, C. J., Damratoski, B. E., Dando, L., Datoo, M. S., Davies, H., De Graaf, H., Demissie, T., Di Maso, C., Dietrich, I., Dong, T., Donnellan, F. R., Douglas, N., Downing, C., Drake, J., Drake-Brockman, R., Drury, R. E., Dunachie, S. J., Edwards, N. J., Edwards, F. D. L., Edwards, C. J., Elias, S. C., Elmore, M. J., Emary, K. R. W., English, M. R., Fagerbrink, S., Felle, S., Feng, S., Field, S., Fixmer, C., Fletcher, C., Ford, K. J., Fowler, J., Fox, P., Francis, E., Frater, J., Furze, J., Fuskova, M., Galiza, E., Gbesemete, D., Gilbride, C., Godwin, K., Gorini, G., Goulston, L., Grabau, C., Gracie, L., Gray, Z., Guthrie, L. B., Hackett, M., Halwe, S., Hamilton, E., Hamlyn, J., Hanumunthadu, B., Harding, I., Harris, S. A., Harris, A., Harrison, D., Harrison, C., Hart, T. C., Haskell, L., Hawkins, S., Head, I., Henry, J. A., Hill, J., Hodgson, S. H. C., Hou, M. M., Howe, E., Howell, N., Hutlin, C., Ikram, S., Isitt, C., Iveson, P., Jackson, S., Jackson, F., James, S. W., Jenkins, M., Jones, E., Jones, K., Jones, C. E., Jones, B., Kailath, R., Karampatsas, K., Keen, J., Kelly, S., Kelly, D., Kerr, D., Kerridge, S., Khan, L., Khan, U., Killen, A., Kinch, J., King, T. B., King, L., King, J., Kingham-Page, L., Klenerman, P., Knapper, F., Knight, J. C., Knott, D., Koleva, S., Kupke, A., Larkworthy, C. W., Larwood, J. P. J., Laskey, A., Lawrie, A. M., Lee, A., Ngan Lee, K. Y., Lees, E. A., Legge, H., Lelliott, A., Lemm, N.-M., Lias, A. M., Linder, A., Lipworth, S., Liu, X., Liu, S., Lopez Ramon, R., Lwin, M., Mabesa, F., Madhavan, M., Mallett, G., Mansatta, K., Marcal, I., Marinou, S., Marlow, E., Marshall, J. L., Martin, J., McEwan, J., McInroy, L., Meddaugh, G., Mentzer, A. J., Mirtorabi, N., Moore, M., Moran, E., Morey, E., Morgan, V., Morris, S. J., Morrison, H., Morshead, G., Morter, R., Mujadidi, Y. F., Muller, J., Munera-Huertas, T., Munro, C., Munro, A., Murphy, S., Munster, V. J., Mweu, P., Noé, A., Nugent, F. L., Nuthall, E., O'Brien, K., O'Connor, D., Oguti, B., Oliver, J. L., Oliveira, C., O'Reilly, P. J., Osborn, M., Osborne, P., Owen, C., Owens, D., Owino, N., Pacurar, M., Parker, K., Parracho, H., Patrick-Smith, M., Payne, V., Pearce, J., Peng, Y., Peralta Alvarez, M. P., Perring, J., Pfafferott, K., Pipini, D., Plested, E., Pluess-Hall, H., Pollock, K., Poulton, I., Presland, L., Provstgaard-Morys, S., Pulido, D., Radia, K., Ramos Lopez, F., Rand, J., Ratcliffe, H., Rawlinson, T., Rhead, S., Riddell, A., Ritchie, A. J., Roberts, H., Robson, J., Roche, S., Rohde, C., Rollier, C. S., Romani, R., Rudiansyah, I., Saich, S., Sajjad, S., Salvador, S., Sanchez Riera, L., Sanders, H., Sanders, K., Sapaun, S., Sayce, C., Schofield, E., Screaton, G., Selby, B., Semple, C., Sharpe, H. R., Shaik, I., Shea, A., Shelton, H., Silk, S., Silva-Reyes, L., Skelly, D. T., Smee, H., Smith, C. C., Smith, D. J., Song, R., Spencer, A. J., Stafford, E., Steele, A., Stefanova, E., Stockdale, L., Szigeti, A., Tahiri-Alaoui, A., Tait, M., Talbot, H., Tanner, R., Taylor, I. J., Taylor, V., Te Water Naude, R., Thakur, N., Themistocleous, Y., Themistocleous, A., Thomas, M., Thomas, T. M., Thompson, A., Thomson-Hill, S., Tomlins, J., Tonks, S., Towner, J., Tran, N., Tree, J. A., Truby, A., Turkentine, K., Turner, C., Turner, N., Turner, S., Tuthill, T., Ulaszewska, M., Varughese, R., Van Doremalen, N., Veighey, K., Verheul, M. K., Vichos, I., Vitale, E., Walker, L., Watson, M. E. E., Welham, B., Wheat, J., White, C., White, R., Worth, A. T., Wright, D., Wright, S., Yao, X. L., & Yau, Y.
Affiliations
  • University of Oxford (GB)
  • Philipps University of Marburg (DE)
  • University Hospital Southampton NHS Foundation Trust (GB)
  • University of Bristol (GB)
  • Public Health England (GB)
  • St George's, University of London (GB)
  • University Hospitals Bristol and Weston NHS Foundation Trust (GB)
Corresponding author
Pollard, Andrew J
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-08
Volume
396
Issue
10249
Pages
467-478
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W3042833857
Cited by
2,419
References
22
Citations by year
2026: 39 · 2025: 96 · 2024: 145 · 2023: 254 · 2022: 578 · 2021: 955 · 2020: 347 · 2012: 1
FWCI
70.04
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion, cc-by-nc-nd)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc-nd)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
  • reponame:Expeditio Repositorio Institucional UJTL
Funders
  • Wellcome Trust (095541/A/11/Z, 109965/Z/15/Z)
  • UK Research and Innovation (MC_PC_19055)
  • Coalition for Epidemic Preparedness Innovations
  • National Institute for Health and Care Research (NIHR201409, CL-2018-13-007, CL-2016-13-008, CO-CIN-01, ACF-2018-13-005, NF-SI-0515-10005, COV19OxfordVaccine01, NF-SI-0617-10139, MC_PC_19055)
  • Academy of Medical Sciences (SGL023\1089)
  • University of Oxford
  • Pirbright Institute
  • Oxford University Hospitals NHS Foundation Trust
  • Oxford Health NHS Foundation Trust
  • Medical Research Council (MR/T001151/1)
  • Engineering and Physical Sciences Research Council (EP/R013756/1)
  • Biotechnology and Biological Sciences Research Council (BB/S007911/1)
  • National Institute of Allergy and Infectious Diseases (HHSN272201400008C))
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Virus Infections Studies
Keywords
ChAdOx1 nCoV-19 vaccine, SARS-CoV-2, COVID-19 vaccines, adenoviral vector, spike protein, vaccine safety, immunogenicity, humoral immune response, neutralizing antibodies, cell-mediated immunity, interferon-gamma, reactogenicity, booster vaccination
MeSH terms
Immunogenicity, Vaccine, Betacoronavirus, Acetaminophen, COVID-19, SARS-CoV-2, COVID-19 Vaccines, Adenoviruses, Simian, Adult, Antibodies, Viral, Female, Genetic Vectors, United Kingdom, Humans, Immunoglobulin G, Immunization, Secondary, Male, Pneumonia, Viral, T-Lymphocytes, Viral Vaccines, Single-Blind Method, Coronavirus Infections, Analgesics, Non-Narcotic, Antibodies, Neutralizing, Pandemics, Spike Glycoprotein, Coronavirus

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