COVID-19, Prevention

by Editorial Board last updated 2021-01-22 16:21:26.518747-05:00
Vaccine

Available Vaccines

Vaccine Pfizer-BioNTech COVID-19 Vaccine (Comirnaty, mRNA BNT162b2) Moderna COVID-19 Vaccine (mRNA-1273) COVID-19 Vaccine AstraZeneca
(AZD1222 or
ChAdOx1, Covishield (India)).
CoronaVac SinoVac Biotech Co. BBIBP-CorV.
Sinopharm/Beijing
Institute of Biological Products
Sputnik V (Gam-COVID-Vac)
Gamaleya Research
Institute
Authorized for Use in US, Canada, EU, UK, WHO EUL, 20 others  US, Canada, EU and others UK, India, Mexico and others China, Brazil, Chile, Turkey, Indonesia China, UAE, several
other Middle Eastern
Countries
Russia, Belarus, UAE, Argentina
and others
Type Lipid nanoparticle (LNP) encapsulated mRNA  Lipid nanoparticle (LNP) encapsulated mRNA Nonreplicating live adenovirus Inactivated Inactivated Nonreplicating live
adenovirus
Overall Efficacy vs. symptomatic disease 95.0% 94.1% 62.0%  50-78% (non peerreviewed)  73.9% (Chinese
government press
release only)
 91.4% (Phase 3 press
release data)
Efficacy Age >65 94.7% 86.4% Insufficient data  No data  No data  No data
Efficacy vs. severe disease or death 100% (preliminary) 100% (preliminary) 100% (preliminary)  No data  No data  100% (press release data)
Efficacy vs. infectiosness of vaccinee Unknown  Unknown Unknown  No data  No data  No data
Duration of efficacy after final dose Unknown  Unknown Unknown  No data  No data  No data
Dosing Age ≥ 16 yrs: 0.3 mL IM; 2 doses 21 days apart (up to 42 days acceptable). No further boosters currently recommended  Age ≥ 18 yrs: 0.5 mL IM; 2 doses 28 days apart (up to 42 days acceptable). No further boosters currently recommended Age ≥ 18 yrs: 0.5 mL IM; 2 doses
4-12 wks apart (UK)
 Age ≥ 18 yrs: 2
doses 14 or 28 days
apart
 Age ≥ 18 yrs: 2 doses
14 or 21 days apart
 Age ≥ 18 yrs: 2 doses 21
days apart. Dose 1 is
Ad26, Dose 2 Ad5
Storage -70C (-94F) or 2-8C (36-46F) for up to 5 days -20C (-4F) for up to 6 mos 2-8C (36-46F) for up to so days 2-8C (36-46F)  2-8C (36-46F) 2-8C (36-46F)  2-8C (36-46F)
Contraindications Anaphylaxis or immediate allergic reaction (within 4 hours of administration) to a previous dose of an mRNA vaccine or
vaccine constituent including polyethylene glycol (PEG) or polysorbate.
Defer vaccination for 90 days after receipt of
monoclonal or plasma therapy.
Same as Pfizer mRNA Anaphylactic reaction to a
vaccine constituent
 No data  No data  No data
Precautions Immediate allergic reaction (within 4 hours of administration) to any other vaccine or injectable therapy not related to a component of mRNA-COVID-19 vaccines
or polysorbate
Same as Pfizer mRNA Postpone vaccination in persons
with acute severe febrile illness.
No data  No data  No data
Not contraindications Allergies: food (including egg and gelatin), pet, insect, venom, environmental, latex, oral
medications (including the oral
equivalents of injectable medications); any other history of anaphylaxis not related to vaccine or injectables; or a family history of anaphylaxis
Same as mRNA    No data  No data  No data
Adverse effects Injection site pain, fatigue, headache, muscle pain, chills, joint pain, fever, injection site swelling / redness, nausea,
malaise, lymphadenopathy. May be milder in Age >65
Injection site pain, fatigue, headache,
muscle pain, chills, joint pain, fever,
injection site swelling / redness, nausea, malaise, lymphadenopathy. May be milder in Age >65
Injection-site pain, fatigue,
headache, fever, and weakness
 No data  No data  No data
Pregnancy Use. No reproductive or development concerns (preliminary); risk of disease
effect > known vaccine risk; endorsed for use by ACOG
Same as Pfizer mRNA Unknown  No data  No data  No data
Immunocompromised or HIV Use, but potential for reduced immune response and unknown safety and efficacy
profiles exist in this group.
  Insufficient data  No data  No data  No data
References

FDA Provider Fact Sheet / EUA Prescribing Information

N Engl J Med 2020; 383:2603

FDA Provider Fact Sheet / EUA Prescribing Information

N Engl J Med DOI: 10.1056/NEJMoa2035389

       
Interchangeability with other COVID vaccines No data; use same vaccine for all doses. If dose of 1 brand is unavailable, any available mRNA vaccine may be administered for dose 2 at a minimum interval of 28 days and constitutes a complete series No data; use same vaccine for all doses. If dose of 1 brand is unavailable, any available mRNA vaccine may be administered for dose 2 at a minimum interval of 28 days and constitutes a complete series No data, use same vaccine for all
doses
 No data  No data  No data

Background / General Considerations

  • Current vaccine scorecard:  291 candidates, 70 in clinical trials, 20 in Phase III.  Table lists those in current use in at least 1 country. All vaccines express similar antigenic components related to the original SARS CoV-2 strain isolated in China
  • Current vaccine preference order:
    • Vaccines of choice: mRNA vaccines (Pfizer/BioNTech / Moderna)
    • Alternate vaccines: AstraZeneca
    • Vaccines with unknown efficacy: Sinovac, Sinopharm, Gamaleya

Comments

  • RNA vaccines have the greatest ability for rapid, large-scale manufacturing (scale-up) and greater flexibility for antigen replacement with little lead time. 
  • Viral vector vaccines have a high level of protein expression, stability, and strong immune responses; adenovirus vectored vaccines are cheap and rapid to produce at scale.
  • Recombinant protein technology is widely used for many existing diseases;  lots of experience and safety record and much existing production capacity but with longer production times.
  • Novel mRNA vaccines additional considerations
    • Antibody testing is not recommended to assess for immunity following mRNA COVID-19 vaccination or to assess the need for vaccination in an unvaccinated person.
    • Persons with recent (time period now undefined) documented acute symptomatic or asymptomatic SARS-CoV-2 infection should be vaccinated but may choose to temporarily delay vaccination (conserves doses for others), if desired. Risk of reinfection likely increases with time following initial infection.  In acute illness, including for those who develop SARS-CoV-2 infection after the first vaccine dose but before receipt of the second dose, vaccination should be deferred until criteria for discontinuing isolation have been met
    • Currently available vaccines are not recommended for outbreak management or for postexposure prophylaxis (vaccination to prevent the development of SARS-CoV-2 infection in a person with an exposure).
    • The majority of persons are protected by 12 days after the first dose but this single-dose immunity may well be very transient without a second dose; this could not be assessed one way or the other because all trial subjects eventually received a second dose.
    • If Dose 2 is administered no more than 4 days before the minimum (21 or 28 day) interval it is considered valid; however, a dose inadvertently administered > 4 days before the minimum interval does not need to be repeated.
    • Should be given at least 14 days apart from any other vaccine, but shorter intervals may be used where the benefits of the other vaccine outweigh the potential unknown risks and neither vaccine needs to be repeated.
    • Do not have a risk of modifying the vaccine recipient’s genetic makeup as mRNA does not enter cell nucleus where host DNA is located
  • Further detail:  https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/