Low-dose intradermal mRNA-1273 boosting vaccine following BBiBP-CorV vaccination during the omicron pandemics

Abstract

Background: Long-term kinetics of the neutralizing antibody (NAb) response against Omicron using 1/10 intradermal (ID) mRNA vaccination as a booster following a complete series of inactivated vaccines, as well as its safety are still limited. Therefore, the objective of this study was to compare local and systemic reactions, NAb levels against Omicron BA.2 and BA.4/5 after four weeks of boosting, and durability of NAb against BA.2 and BA.4/5 after 12 and 24 weeks of mRNA-1273 vaccine boosting among the 1/10 ID, 1/5 ID, and full-dose IM groups in subjects who received a standard primary series of the BBIBP-CorV vaccine.

Methods: Two-week side effects and baseline, 4-week, 12-week and 24-week NAb levels against wild type, BA.2 and BA.4/5 Omicron among 3 groups were compared.

Results: There were 140 participants with 46, 47, and 47 subjects in 1/10 ID, 1/5 ID, and IM groups, respectively. The 1/10 ID-induced localized pain is less common than IM and 1/5 ID. Systemic reactions were lower than IM and comparable to 1/5 ID. BA.2 NAb was indifferent from the other 2 groups, except 2.5-fold lower than IM at 12 weeks. BA.2 NAb in 1/10 ID was higher than the cut-off level throughout the 24-week study period whereas BA.4/5 NAb at 24 weeks was below the NAb detection threshold and significantly lower than IM group.

Conclusion: The 1/10 ID mRNA-1273 boosting after BBIBP-CorV priming was safe and induced above-threshold NAb against BA.2 and BA.4/5 for at least 12 weeks.

Clinical trials registry: This study was registered to the Thai Clinical Trials Registry with study ID: TCTR20210822002.

Keywords: COVID-19; Intradermal vaccination; Neutralizing antibody; Reactogenicity; mRNA vaccine.