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Mixing Pfizer, AstraZeneca Vaccines Provides Sturdy Covid Safety, Research Finds

Initial results from a UK vaccine study suggest that mixing different brands of vaccine can produce a protective immune response against Covid-19. In the study, volunteers produced high levels of antibodies and immune cells after receiving a dose of the Pfizer BioNTech vaccine and a dose of the AstraZeneca Oxford shot.

Giving the vaccines in any order will likely provide effective protection, said Dr. Matthew Snape, a vaccines expert at Oxford University, at a news conference Monday. “Any of these schedules I think could be argued and expected to be effective,” he said.

Dr. Snape and his colleagues began the study called Com-COV in February. In the first wave of the study, they gave 830 volunteers one of four vaccine combinations. Some received two doses from Pfizer or AstraZeneca, both of which have been shown to be effective against Covid-19. Others got a dose of AstraZeneca, followed by one from Pfizer, or vice versa.

With the first wave of volunteers, the researchers waited four weeks between doses. Studies have shown that the AstraZeneca vaccine offers greater protection when the second dose is delayed for up to 12 weeks. Therefore, the researchers are also conducting a separate 12-week study that should provide results over the next month.

The researchers found that volunteers reported more chills, headaches, and muscle aches than people who received two doses of the same vaccine. But the side effects were short-lived.

Dr. Snape and his colleagues then took blood samples to measure the immune response in the volunteers. They found that those who received two doses of Pfizer-BioNTech produced antibody levels about 10 times higher than those who received two doses of AstraZeneca. Volunteers who received Pfizer followed by AstraZeneca showed antibody levels about five times higher than those who received two doses of AstraZeneca. And volunteers who received AstraZeneca followed by Pfizer achieved antibody levels about as high as those who received two doses of Pfizer.

Dr. Snape said the differences would most likely decrease in the volunteers who received a second dose after 12 weeks when the AstraZeneca vaccine had more time to intensify its effects.

The study also found that using different vaccines produced higher levels of immune cells prepared to attack the coronavirus than when giving two doses of the same vaccine. Dr. Snape said it was not yet clear why mixing had this advantage. “It’s very fascinating, let’s say so much,” he said.

Dr. Snape and colleagues have started a similar study, adding Moderna and Novavax vaccines to their list of possibilities.

For now, he said, the best course of action remains to get two doses of the same vaccine. Large clinical studies have clearly shown that this strategy reduces the likelihood of developing Covid-19. “Your default should be what has been shown to work,” said Dr. Snape.

But there are many cases where that is not possible. Vaccine deliveries are sometimes delayed due to manufacturing issues, for example. Younger people in some countries have been advised not to receive a second dose of AstraZeneca due to concerns about the low risk of blood clots. In situations like this, it’s important to know if people can switch to another vaccine.

“This provides reassuring evidence that should work,” said Dr. Snape.

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The Coronavirus Is a Grasp of Mixing Its Genome, Worrying Scientists

In the past few weeks, scientists have been raising the alarm about new variants of the coronavirus that carry a handful of tiny mutations, some of which appear to make vaccines less effective.

But it’s not just these small genetic changes that are cause for concern. The novel coronavirus tends to mix up large chunks of its genome when making copies of itself. Unlike small mutations, which are like typos in sequence, a phenomenon called recombination is similar to a large copy-and-paste mistake, where the second half of a sentence is completely overwritten with a slightly different version.

A number of new studies suggest that recombination can allow the virus to transform itself in dangerous ways. In the long run, however, this biological machinery could provide a silver lining in helping researchers find drugs that will stop the virus.

“There’s no question that recombination is taking place,” said Nels Elde, an evolutionary geneticist at the University of Utah. “And in fact, it’s probably a little underrated and could even play a role in creating some of the new worrying variants.”

The coronavirus mutations that most people have heard of, like the one in the B.1.351 variant first discovered in South Africa, are changes in a single “letter” of the virus or RNA’s long genetic sequence. Because the virus has a robust system for proofreading its RNA code, these small mutations are relatively rare.

In contrast, recombination is widespread in coronaviruses.

Researchers at Vanderbilt University Medical Center, led by virologist Mark Denison, recently looked at how replication goes wrong in three coronaviruses, including SARS-CoV-2, which causes Covid. The team found all three viruses showed “extensive” recombination when replicated separately in the laboratory.

Scientists fear that recombination could combine different variants of the coronavirus into more dangerous versions in a person’s body. For example, variant B.1.1.7, first discovered in Great Britain, had more than a dozen mutations that appeared suddenly.

Dr. Elde said the recombination may have brought together mutations from different variants that may have arisen spontaneously within the same person over time or that co-infected someone at the same time. At the moment this idea is speculative: “It’s really hard to see these invisible scars from a recombination event.” And while it is possible to get infected with two variants at the same time, this is considered rare.

Katrina Lythgoe, an evolutionary epidemiologist at the Oxford Big Data Institute in the UK, is skeptical that co-infection is common. “But the new worrying variants have taught us that rare events can still have a big impact,” she added.

Recombination may also allow two different coronaviruses from the same taxonomic group to exchange some of their genes. To investigate this risk more closely, Dr. Elde and his colleagues tracked the genetic sequences of many different coronaviruses, including SARS-CoV-2 and some of its distant relatives that are known to infect pigs and cattle.

Using specially developed software, the scientists highlighted the places where the sequences of these viruses aligned and matched – and where they did not. The software suggested that in the last few centuries of virus evolution, many of the recombination events involved segments that made up the spike protein that helps the virus enter human cells. This is worrying, the scientists said, because it could be one way that one virus essentially infects another virus.

“Through this recombination, a virus that cannot infect humans could recombine with a virus like SARS-CoV-2 and take over the sequence for the tip and infect people,” said Stephen Goldstein, an evolutionary virologist who worked on the study.

Updated

Apr. 5, 2021, 8:13 p.m. ET

The results, which were posted online on Thursday but not yet published in a scientific journal, provided new evidence that related coronaviruses are quite promiscuous in terms of recombining with one another. There were also many sequences that appeared in the coronaviruses that seemed to come out of nowhere.

“In some cases, it almost looks like a sequence is coming from space, from coronaviruses that we don’t even know about,” said Dr. Elde. The recombination of coronaviruses across completely different groups has not been studied in detail, also because such experiments may have to be subject to a government review in the USA due to security risks.

Feng Gao, a virologist at Jinan University in Guangzhou, China, said that while the Utah researchers’ new software found unusual sequences in coronaviruses, it does not provide any iron evidence of recombination. It could just be that that’s how they evolved.

“Diversity, no matter how much, doesn’t mean recombination,” said Dr. Gao. “It could well be caused by tremendous diversification during virus development.”

Scientists have limited knowledge of whether new pandemic coronaviruses can arise through recombination, said Vincent Munster, a viral ecologist at the National Institute for Allergies and Infectious Diseases who has been studying coronaviruses for years.

Yet this evidence is growing. In a study published in July and officially published today, Dr. Munster and coworkers suggest that recombination is likely, as both SARS-CoV-2 and the virus behind the original SARS outbreak in 2003 resulted in a version of the spike protein that enables them to skillfully invade human cells. This spike protein binds to a specific entry point in human cells called ACE2. This paper calls for stronger coronavirus surveillance to see if there are others who are using ACE2 and therefore may pose similar threats to humans.

Some scientists are studying recombination machinery not only to ward off the next pandemic, but also to combat it.

For example, Dr. Vanderbilt’s Denison, in his recent study of the recombination of three coronaviruses, found that blocking an enzyme known as nsp14-ExoN in a mouse coronavirus caused a decrease in recombination events. This suggests that the enzyme is critical to the ability of coronaviruses to mix and match their RNA during replication.

Now, Dr. Denison and Sandra Weller, virologist at the University of Connecticut Medical School, asked whether this finding could treat people with Covid.

Certain antiviral drugs, like remdesivir, fight infection by acting as RNA bait that speeds up the viral replication process. But these drugs don’t work as well as some coronaviruses would have hoped. One theory is that the enzyme nsp14-ExoN removes the errors caused by these drugs and thus saves the virus.

Dr. Denison and Dr. Among other things, Weller are looking for drugs that block the activity of nsp14-ExoN and allow remdesivir and other antiviral agents to work more effectively. Dr. Weller compares this approach to cocktail therapies for HIV, which combine molecules that act on different aspects of virus replication. “We need combination therapy for coronavirus,” she said.

Dr. Weller notes that coronaviruses share nsp14-ExoN, so a drug that successfully suppresses it can work against more than just SARS-CoV-2. You and Dr. Denison are still in the early stages of drug discovery and are testing various molecules in cells.

Other scientists see potential in this approach not only to make drugs like remdesivir work better, but also to prevent the virus from correcting one of its replication errors.

“I think it’s a good idea,” said Dr. Goldstein, “because you would drive the virus into what is known as a ‘failure catastrophe’ – basically it would mutate so severely that it is fatal to the virus.”

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UK trial experiments with mixing Covid vaccines

Empty vials containing the Pfizer COVID-19 vaccine are seen at a drive-through vaccination facility operated by the Lake County Health Department in Groveland, Florida on January 28, 2021.

Paul Hennessy | NurPhoto | Getty Images

LONDON – A study is being launched in the UK to see if using different Covid-19 vaccines for first and second dose will help make nationwide immunization programs more flexible.

The study, led by Oxford University and conducted by the National Immunization Schedule Evaluation Consortium, will assess the feasibility of using a vaccine for the initial “prime” vaccination other than the subsequent “booster” vaccination.

It is hoped that the study will help policymakers understand whether mixing different Covid vaccines could be a viable way to increase the flexibility of vaccination programs, and whether it could even offer better protection.

“If we show that these vaccines can be used interchangeably on the same schedule, it will greatly increase the flexibility of vaccine delivery and could provide guidance on how protection against new strains of the virus can be enhanced,” said Matthew Snape, chief investigator of the process and associate Professor of Pediatrics and Vaccine at Oxford University said Thursday.

Officially known as the “COVID-19 Heterologous Prime Boost” study but dubbed the “Com-Cov” study, the study will recruit over 800 volunteers aged 50 and over in England to study the four different combinations of Prime and to evaluate booster vaccination.

A first dose of the Oxford AstraZeneca vaccine will be tested, followed by a booster with either the Pfizer BioNTech vaccine or another dose of the Oxford AstraZeneca vaccine. Research will also look at a first dose of the Pfizer BioNTech vaccine, followed by a booster with either the Oxford AstraZeneca vaccine or another dose of the Pfizer BioNTech vaccine. The British government has called the process a “world first”.

These are evaluated in two different dosing schedules: at an interval of four weeks to allow early intermediate reading of the data, and at an interval of 12 weeks. This latter dose interval is the current UK vaccination policy: delaying the second dose means that more people can get their first vaccines sooner with a shortage of vaccinations.

Although the policy has been viewed as controversial, some experts fear that it could make vaccines used in the UK less effective. So far only the candidates from the University of Oxford-AstraZeneca and Pfizer-BioNTech are used. The Moderna shot is due to be added to the vaccine basket later this spring.

However, Oxford University published a study on Wednesday that showed that a 12 week delay between the first and second dose of the AstraZeneca sting increased the vaccine’s effectiveness.

The researchers found that the shot was 76% effective at preventing symptomatic infection for three months after a single dose, and that the effectiveness rate increased to 82.4% if there was an interval of at least 12 weeks before the second dose. When the second dose was given less than six weeks after the first, the rate of effectiveness was 54.9%.

How the Com-Cov study will work

In the latest “Com-Cov” study, researchers will collect blood samples from volunteers from the study and monitor the effects of various dosage regimens on participants’ immune responses, as well as looking for additional side effects for the new vaccine combinations.

The study will last 13 months and was funded by the Vaccines Taskforce, established last April by the UK to coordinate efforts to research and manufacture a coronavirus vaccine, with £ 7 million of government funding (9, USD 5 million).

Professor Snape said the study was “tremendously exciting” before adding that “it will provide information that is critical to the launch of vaccines in the UK and globally”.

The richer countries are making every effort to vaccinate as many people as possible to limit the spread of infections and prevent hospitals from being overrun, which harms the economy.

Britain was hit hard by the pandemic, with cases spiking over the winter, aided by a more virulent variant of the virus that has emerged in south-east England and has now become a dominant strain in the country.

The UK currently has the fourth highest number of cases in the world with over 3.8 million confirmed infections. This comes from a record by Johns Hopkins University and recorded 109,547 deaths.

The UK government was quick to pre-order coronavirus vaccines from various manufacturers early last year and approve the vaccines currently in use. The vaccination program has been widely praised for its agility and range. The aim is to vaccinate 15 million people across the four top priority groups, including health and care workers, the elderly and the over 70s, and those who are considered to be extremely clinically at risk by mid-February.

The latest government data from Wednesday shows that just over 10 million people have received their first dose of vaccine and nearly 500,000 have received a second dose. The UK-made Oxford-AstraZeneca vaccine makes up the bulk of the UK vaccination program.

Professor Jonathan Van-Tam, deputy chief medical officer and senior responsible officer for the study, said the research may even show that alternating vaccines could increase the amount of antibodies needed to fight a possible Covid-19 infection.

“It’s even possible that the combination of vaccines may improve the immune response, resulting in even higher antibody levels that last longer. If this isn’t evaluated in a clinical trial, we just don’t know. This study will give us a better one Provide insight into how We can use vaccines to keep abreast of this dire disease, “he said.

The British vaccination minister Nadhim Zahawi told the BBC on Thursday that the country’s vaccination program will continue as usual for the time being: “At the moment we are not going to change anything,” Zahawi told the “Today” program.

“If you got a Pfizer BioNTech vaccine for your first dose, you got a Pfizer BioNTech vaccine for your second. If you had Oxford-AstraZeneca, you got Oxford-AstraZeneca for your second dose.”

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CDC modifications Covid vaccine steerage to OK mixing Pfizer and Moderna pictures

Syringe containers for the Covid-19 vaccines from Pfizer BioNtech and Moderna Inc. in Tucson, Arizona, USA, on Friday, January 15, 2021.

Cherry Orr | Bloomberg | Getty Images

The Centers for Disease Control and Prevention have tacitly changed their guidelines for Covid-19 vaccine shots, stating that it is now okay to mix Pfizer and Moderna shots in “exceptional situations” and that it is in Okay, wait up to six weeks to get the second shot. Two-dose immunization from both companies.

While Pfizer and Moderna’s vaccines, both of which use messenger RNA technology, were approved 21 and 28 days apart, the agency now says that under new guidelines, you can get both shots as long as they’re at least apart 28 days administered will be published on its website Thursday.

Although “every effort” should be made to ensure that a patient receives the same vaccine, in rare situations “any available mRNA COVID-19 vaccine can be administered with a minimum of 28 days between doses” – if supply Is limited or the patient does not know what vaccine they originally received, the CDC says in new guidelines.

The CDC says the two products are not interchangeable, admitting that they hadn’t yet investigated whether their new recommendations would alter the safety or effectiveness of either vaccine.

The agency said health care providers should give patients a vaccination card detailing when they received their first shot and what type of shot it was to ensure patients know which shot to receive the second time. The agency also recommends providers to record the patient’s vaccination information on their medical records and on the government vaccination information system.

Both companies need two doses to achieve maximum protection against the coronavirus. While both shots should be administered according to the guidelines originally recommended, the CDC said the second dose of both companies’ vaccine could be delayed for up to six weeks if necessary.

The updated guidelines come as some cities and counties across the country cancel vaccination appointments because they don’t have as many doses as they originally expected.

Wayne County, Michigan, for example, said last week it would be a priority to make sure people who got their first shot get their second shot on time. But the county said it had to cancel nearly 1,400 appointments for people to get their first shot.

“The intent is not to suggest people do something else, but rather to give clinicians flexibility in exceptional circumstances,” said Jason McDonald, a CDC spokesman, in an email to CNBC.

Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, was asked on Friday about the interval at which the two shots should be administered.

“The data we have is of a two-dose vaccine on the recommended schedule of 21 or 28 days,” she said at a virtual event hosted by Harvard TH Chan School of Public Health and National Public Radio . “At this point in time, we at CDC agree with what the FDA says, and the FDA has made it very clear that we should be using the approved regimen.”

“It’s firmly ingrained in science and the evidence available, and doing anything else would not follow science and possibly not allow us to really get the full potential of these vaccines,” she added. “For now, from the CDC’s point of view, we think it has to be two doses on the recommended schedule.”