The requester asked for specific vaccination uptake numbers for children on the Isle of Man up to April 6, 2022, but the authority provided a general medical chapter on SARS-CoV-2 instead of the requested statistics.
Key Facts
The request was made to Manx Care regarding COVID-19 vaccination data for children.
The outcome was classified as 'Some information sent but not all held'.
The response document provided is a medical chapter dated February 28, 2022, describing the virus and its variants.
The response does not contain the specific vaccination numbers or percentages requested for the 5-11 age group.
The document mentions the Alpha, Delta, and Omicron variants of SARS-CoV-2.
Data Disclosed
2022-05-03
2022-05-30
06/04/22
28 February 2022
5-11 year olds
2019
2020
2021
5-6 days
20%
17 days
2 and 3
5.7
50-70%
Original Request
On the 06/04/22 the Manx Care Vaccination team sent a letter to parents of 5-11 year olds which stated "we have already seen a good uptake in the vaccinations offered to children, but we would like to increase this further"
I would like to know what age range Manx Care classifies as children regarding vaccination?
I am trying to find out what the "good uptake" numbers were before 06/04/22
Please supply, (if possible in individual yearly age groups) the numbers of vaccinated children (and as a percentage of total children if possible) that there were, on the Isle of Man up to 06/04/22.
Data Tables (8)
Category
Population
Size
SARS-CoV-2
antibody
prevalence%
(95% CI)1
Confirmed
COVID-19
deaths2
Infection fatality
ratio %
(95% CI)2
Estimated
number of
infections
(95% CI)
Total
56,286,961
6.0 (5.7, 6.8)
30180
0.9 (0.9, 0.9)
3,362,037
(3,216,816;
3,507,258)
Sex
- 2-voC-SRAS
91-DIVOC
Male
27,827,831
6.5 (5.8, 6.6)
18575
1.1 (1.0, 1.2)
1,729,675
(1,614,585;
1,844,766)
Female
28,459,130
5.8 (5.4, 6.1)
11600
0.7 (0.7, 0.8)
1,633,785
1,539,821;
1,727,749)
Age (years)
15-44
21,335,397
7.2 (6.7,7.7)
524
0.0 (0.0, 0.0)
1,535,884
(1,436,941;
(1,634,826)
45-64
14,405,759
6.2 (5.8, 6.6)
4657
0.5 (0.5, 0.5)
895,238
(837,231;
953,244)
65-74
5,576,066
3.2 (2.7, 3.7)
5663
3.1 (2.6, 3.6)
181,044
(153,426;
208,661)
75+
4,777,650
3.3 (2.5, 4.1)
19330
11.6 (9.2, 14.1)
166,077
(131,059;
200,646)
Priority group
Risk group
1
Residents in a care home for older adults
Staff working in care homes for older adults
2
All those 80 years of age and over
Frontline health and social care workers
3
All those 75 years of age and over
4
All those 70 years of age and over
Individuals aged 16 to 69 in a high risk group1
5
All those 65 years of age and over
6
Adults aged 16 to 65 years in an at-risk group (Table 3)
7
All those 60 years of age and over
8
All those 55 years of age and over
9
All those 50 years of age and over
Clinical risk groups
Chronic respiratory
disease
Individuals with a severe lung condition, including those with poorly
controlled asthma1 and chronic obstructive pulmonary disease (COPD)
including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis,
interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia
(BPD).
Chronic heart
disease and vascular
disease
Congenital heart disease, hypertension with cardiac complications, chronic heart
failure, individuals requiring regular medication and/or follow-up for ischaemic
heart disease. This includes individuals with atrial fibrillation, peripheral vascular
disease or a history of venous thromboembolism.
Chronic kidney
disease
Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic
syndrome, kidney transplantation.
Chronic liver disease
Cirrhosis, biliary atresia, chronic hepatitis.
Chronic
neurological disease
Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function
may be compromised due to neurological or neuromuscular disease (e.g. polio
syndrome sufferers). This group also includes individuals with cerebral palsy,
severe or profound and multiple learning disabilities (PMLD), Down’s syndrome,
multiple sclerosis, epilepsy, dementia, Parkinson’s disease, motor neurone
disease and related or similar conditions; or hereditary and degenerative disease
of the nervous system or muscles; or severe neurological disability.
Diabetes mellitus
and other endocrine
disorders
Any diabetes, including diet-controlled diabetes, current gestational diabetes,
and Addison's disease.
Immunosuppression
Immunosuppression due to disease or treatment, including patients undergoing
chemotherapy leading to immunosuppression, patients undergoing radical
radiotherapy, solid organ transplant recipients, bone marrow or stem cell
transplant recipients, HIV infection at all stages, multiple myeloma or genetic
disorders affecting the immune system (e.g. IRAK-4, NEMO, complement
disorder, SCID).
Individuals who are receiving immunosuppressive or immunomodulating
biological therapy including, but not limited to, anti-TNF, alemtuzumab,
ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP
inhibitors, and individuals treated with steroid sparing agents such as
cyclophosphamide and mycophenolate mofetil.
Individuals treated with or likely to be treated with systemic steroids for more
than a month at a dose equivalent to prednisolone at 20mg or more per day
for adults.
Anyone with a history of haematological malignancy, including leukaemia,
lymphoma, and myeloma.
Those who require long term immunosuppressive treatment for conditions
including, but not limited to, systemic lupus erythematosus, rheumatoid
arthritis, inflammatory bowel disease, scleroderma and psoriasis.
Some immunosuppressed patients may have a suboptimal immunological
response to the vaccine (see Immunosuppression and HIV).
Asplenia or
dysfunction of the
spleen
This also includes conditions that may lead to splenic dysfunction, such as
homozygous sickle cell disease, thalassemia major and coeliac syndrome.
Morbid obesity
Adults with a Body Mass Index (BMI) ≥40 kg/m².
Severe mental
illness
Individuals with schizophrenia or bipolar disorder, or any mental illness that
causes severe functional impairment.
Younger adults in
long-stay nursing
and residential care
settings
Many younger adults in residential care settings will be eligible for vaccination
because they fall into one of the clinical risk groups above (for example learning
disabilities). Given the likely high risk of exposure in these settings, where a high
proportion of the population would be considered eligible, vaccination of the
whole resident population is recommended.
Younger residents in care homes for the elderly will be at high risk of exposure,
and although they may be at lower risk of mortality than older residents should
not be excluded from vaccination programmes (see priority 1 above).
Pregnancy
All stages (first, second and third trimesters)
Other risk groups
Household contacts
of people with
immunosuppression
Individuals who expect to share living accommodation on most days (and
therefore for whom continuing close contact is unavoidable) with individuals
who are immunosuppressed (defined as immunosuppressed in tables 3 or 4).
Carers
Those who are eligible for a carer’s allowance, or those who are the sole or
primary carer of an elderly or disabled person who is at increased risk of COVID-
19 mortality and therefore clinically vulnerable.1
Chronic respiratory
disease
Including those with poorly controlled asthma1 that requires continuous or
repeated use of systemic steroids or with previous exacerbations requiring hospital
admission, cystic fibrosis, ciliary dyskinesias and bronchopulmonary dysplasia
Chronic heart
conditions
Haemodynamically significant congenital and acquired heart disease, or less
severe heart disease with other co-morbidity. This includes:
• single ventricle patients or those palliated with a Fontan (Total Cavopulmonary
Connection) circulation
• those with chronic cyanosis (oxygen saturations <85% persistently)
• patients with cardiomyopathy requiring medication
• patients with congenital heart disease on medication to improve heart
function
• patients with pulmonary hypertension (high blood pressure in the lungs)
requiring medication
Chronic conditions of
the kidney, liver or
digestive system
Including those associated with congenital malformations of the organs,
metabolic disorders and neoplasms, and conditions such as severe gastro-
oesophageal reflux that may predispose to respiratory infection
Chronic neurological
disease
This includes those with
• neuro-disability and/or neuromuscular disease that may occur as a result of
conditions such as cerebral palsy, autism, epilepsy and muscular dystrophy
• hereditary and degenerative disease of the nervous system or muscles, other
conditions associated with hypoventilation
• severe or profound and multiple learning disabilities (PMLD), Down’s
syndrome, those on the learning disability register
• neoplasm of the brain
Endocrine disorders
Including diabetes mellitus, Addison’s and hypopituitary syndrome
Immunosuppression
Immunosuppression due to disease or treatment, including:
• those undergoing chemotherapy or radiotherapy, solid organ transplant
recipients, bone marrow or stem cell transplant recipients
• genetic disorders affecting the immune system (e.g. deficiencies of IRAK-4 or
NEMO, complement disorder, SCID)
• those with haematological malignancy, including leukaemia and lymphoma
• those receiving immunosuppressive or immunomodulating biological therapy
• those treated with or likely to be treated with high or moderate dose
corticosteroids
• those receiving any dose of non-biological oral immune modulating drugs e.g.
methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
• those with auto-immune diseases who may require long term
immunosuppressive treatments
Children who are about to receive planned immunosuppressive therapy should
be considered for vaccination prior to commencing therapy.
Asplenia or dysfunction
of the spleen
Including hereditary spherocytosis, homozygous sickle cell disease and
thalassemia major
Serious genetic
abnormalities that affect
a number of systems
Including mitochondrial disease and chromosomal abnormalities
Pregnancy
All stages (first, second and third trimesters)
Other risk groups
Household contacts
of people with
immunosuppression
Individuals who expect to share living accommodation on most days (and
therefore for whom continuing close contact is unavoidable) with
individuals who are immunosuppressed (defined as immunosuppressed in
tables 3 or 4).
Proceed with vaccination
(no special precautions)
Special precautions
Vaccination
contra-indicated
SCITSIRETCARAHC
TNEITAP
● previous allergic reaction
(including anaphylaxis) to
a food, insect sting and
most medicines (where
trigger has been identified)
● previous non-systemic
reaction to a vaccine
● hypersensitivity to non-
steroidal anti-inflammatory
drugs e.g. aspirin,
ibuprofen
● mastocytosis
● prior non-anaphylaxis allergic
reaction to COVID-19 vaccine
● history of immediate
anaphylaxis to multiple,
different drug classes, with
the trigger unidentified (this
may indicate PEG allergy)
● history of anaphylaxis to a
vaccine, injected antibody
preparation or a medicine
likely to contain PEG (e.g.
depot steroid injection,
laxative)
● history of idiopathic
anaphylaxis
● prior anaphylaxis reaction
to COVID-19 vaccine
● prior systemic allergic
reaction to a component
of the vaccine
(for known PEG allergy
see text above)
SNOITCA
● proceed with vaccination
in any setting
● some individuals may be
reassured by being
observed for 15 minutes
(may not be required if
previously tolerated the
same vaccine)
● some patients (e.g. those
with mastocytosis) may
benefit from pretreatment
with anti-histamine to
reduce allergic symptoms
● consider possibility of PEG
allergy and seek allergy advice
if needed
● a person has previously
tolerated a dose of the same
vaccine, it is safe to
administer in any setting.
Otherwise
- consider giving vaccine and
observe for 30 minutes
● refer to allergist or other
appropriate specialist
● consider administration
of the implicated mRNA
vaccine under medical
supervision in hospital,
or, where reaction was to
AstraZeneca vaccine give
alternative vaccine in any
setting
● consider observation for
30 minutes
Age
Feb.22
Mar.22
1 - 6 Apr.22
5 - 11 years
56
0
0
Full Response Text
1
Chapter 14a -
COVID-19 -
SARS-Cov-2
Chapter 14a - COVID-19 - SARS-CoV-2
28 February 2022
14a
COVID-19 - SARS-CoV-2
NOTIFIABLE
The virus
COVID-19 disease first emerged as a presentation of severe respiratory infection in Wuhan,
China in late 2019 (WHO, 2020). By January 2020, lower respiratory samples taken from
affected patients were sequenced and demonstrated a novel coronavirus (SARS-CoV-2) (Huang
et al, 2020). The first two cases in the UK were seen in late January (Lillie et al, 2020). In March
2020, the World Health Organization (WHO) declared a SARS-CoV-2 pandemic (WHO Director-
General, 2020).
SARS-CoV-2 is a member of the family of Coronaviridae and genus Betacoronavirus (Zhu
et al, 2020). Phylogenetic analysis of SARS-CoV-2 has shown that it is genetically distinct
from the SARS coronavirus (Dhama, et al, 2020), but appears to share strong sequence
similarity to bat coronaviruses in China (Lam et al, 2020).
As with other coronaviruses, SARS-CoV-2 is an RNA virus which encodes four major
structural proteins, spike (S), membrane (M), envelope (E) and a helical nucleocapsid (N)
(Dhama et al, 2020) The S glycoprotein is considered the main antigenic target and
consists of an S1 and S2 subunit (Kaur et al, 2020). The S1 subunit has two functional
domains: the N terminal domain (NTD) and receptor binding domain (RBD) which contains
the receptor binding motif (RBM) (Kaur et al, 2020). The RBM binds to angiotensin
converting enzyme 2 (ACE2) on host cells and is endocytosed with subsequent release of
the viral genome into the cytoplasm (Amanat et al, 2020).
SARS-CoV-2 is primarily transmitted by person to person spread through respiratory
aerosols, direct human contact and fomites (Kaur et al, 2020). Estimates of the basic
reproduction number [R] were initially between 2 and 3 although a recent estimate was as
high as 5.7 (Sanche et al, 2020). This high transmissibility indicates that stringent control
measures, such as active surveillance, physical distancing, early quarantine and contact
tracing, are needed in order to control viral spread. Perinatal transmission has been
reported although the exact transmission route has not been elucidated (ECDCa, 2020).
After the initial exposure, patients typically develop symptoms within 5-6 days
(incubation period) although about 20% of patients remain asymptomatic throughout
infection (Cevik et al, 2020). Polymerase chain reaction (PCR) tests can detect viral SARS-
CoV-2 RNA in the upper respiratory tract for a mean of 17 days, although transmission is
maximal in the first week of illness. Symptomatic and pre-symptomatic transmission (1-2
days before symptom onset), is thought to play a greater role in the spread of SARS-
CoV-2 than asymptomatic transmission.
During late 2020 and 2021, a range of SAR-CoV-2 variants have emerged, some of
which have been associated with increased transmission. These more transmissible
variants have become established globally and replaced the original Wuhan strain, being
associated with successive waves of infections in many countries. The first widely
2
Chapter 14a -
COVID-19 -
SARS-Cov-2
Chapter 14a - COVID-19 - SARS-CoV-2
28 February 2022
distributed variant, designated Alpha, first emerged in Kent in late 2020 and led to a
second wave in the UK in early 2021. Emergence of the Delta variant, first seen in India,
has now been associated with further waves of infection in many countries. Information
on variants under investigation is posted each week at: https://www.gov.uk/government/
publications/investigation-of-sars-cov-2-variants-technical-briefings
A recent increased incidence in South Africa, associated with a new variant Omicron, has
raised particular concern due to a large number of mutations, including many in the
spike protein. These mutations appear to be associated with a higher rate of reinfection,
suggesting a degree of immune escape.
Many countries, including the UK, are now experiencing increases in the incidence of
Omicron. Preliminary UK data confirms observations from other countries that the
severity of infection due to Omicron is low, with an estimated reduction in risk of
hospitalisation of 50-70% (https://www.gov.uk/government/publications/investigation-of-
sars-cov-2-variants-technical-briefings).
The disease
In adults, the clinical picture varies widely. A significant proportion of individuals are likely
to have mild symptoms and may be asymptomatic at the time of diagnosis.
Symptoms are commonly reported as a new onset of cough and fever (Grant et al, 2020),
but may include headache, loss of smell, nasal obstruction, lethargy, myalgia (aching
muscles), rhinorrhea (runny nose), taste dysfunction, sore throat, diarrhoea, vomiting and
confusion; fever may not be reported in all symptomatic individuals. Patients may also be
asymptomatic (He et al, 2020).
Progression of disease, multiple organ failure and death will occur in some individuals
(Pachetti et al, 2020).
Currently available data suggest that increasing age and male gender are significant risk
factors for severe infection. However, there are also groups of patients with underlying
comorbidities, where infection may result in increased risk of serious disease (Docherty
et al, 2020). In a large review of primary care records pseudonymously linked with SARS-
CoV-2 status, comorbidities including diabetes, cancer and poorly controlled asthma were
associated with increased risk of death (Williamson et al, 2020).
Infection fatality ratios (IFR) for COVID-19 in the UK, derived from combining mortality data
with infection rates in seroprevalence studies, show a marked increase in IFR in the oldest
age groups (Table 1) (Ward et al, 2020).
In Europe and the UK, deaths attributed to SARS-CoV-2 have been reported
disproportionately from residential care homes (ECDCb, 2020, Graham et al, 2020). Other
notable risk groups include healthcare workers (Nguyen et al, 2020) who may acquire
infection both in the hospital or within the community setting (Bielicki et al, 2020). Current
evidence suggests that deprivation and being from black and asian minority ethnic groups
results in a higher risk for death from SARS-CoV-2 infection (Williamson et al, 2020),
although the factors that contribute to this are not yet clear.
3
Chapter 14a -
COVID-19 -
SARS-Cov-2
Chapter 14a - COVID-19 - SARS-CoV-2
28 February 2022
Table 1: UK Infection fatality ratio and estimated total numbers of deaths (February to July 2020)
Category
Population
Size
SARS-CoV-2
antibody
prevalence%
(95% CI)1
Confirmed
COVID-19
deaths2
Infection fatality
ratio %
(95% CI)2
Estimated
number of
infections
(95% CI)
Total
56,286,961
6.0 (5.7, 6.8)
30180
0.9 (0.9, 0.9)
3,362,037
(3,216,816;
3,507,258)
Sex
Male
27,827,831
6.5 (5.8, 6.6)
18575
1.1 (1.0, 1.2)
1,729,675
(1,614,585;
1,844,766)
Female
28,459,130
5.8 (5.4, 6.1)
11600
0.7 (0.7, 0.8)
1,633,785
1,539,821;
1,727,749)
Age (years)
15-44
21,335,397
7.2 (6.7,7.7)
524
0.0 (0.0, 0.0)
1,535,884
(1,436,941;
(1,634,826)
45-64
14,405,759
6.2 (5.8, 6.6)
4657
0.5 (0.5, 0.5)
895,238
(837,231;
953,244)
65-74
5,576,066
3.2 (2.7, 3.7)
5663
3.1 (2.6, 3.6)
181,044
(153,426;
208,661)
75+
4,777,650
3.3 (2.5, 4.1)
19330
11.6 (9.2, 14.1)
166,077
(131,059;
200,646)
1 All estimates of prevalence adjusted for imperfect test sensitivity and specificity (see text for details).
Responses have been re-weighted to account for differential sampling (geographic) and for variation in
response rate (age, gender, ethnicity and deprivation) in final column to be representative of the England
population (18+).
2 Infection fatality ratios were calculated excluding care home residents. Confirmed COVID-19 death counts
were obtained from https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-
England-week-ending-17-jul-2020.html. Deaths in care homes by age on 12 June 2020 were obtained
from www.ons.gov.uk. Total deaths in care home residents up to 17 July 2020 were obtained from
www.ons.gov.uk. The age stratified estimates of COVID-19 deaths were then estimated using the total
deaths from 17 July and the age distribution from 12 June. We assumed that age distribution of deaths
did not change between 12 June and 17 July 2020.
4
Chapter 14a -
COVID-19 -
SARS-Cov-2
Chapter 14a - COVID-19 - SARS-CoV-2
28 February 2022
Children
In general children appear to exhibit mild disease. Although cough and fever are the main
symptoms in children (Ladhani et al, 2020), a UK study tracking children of healthcare
workers has shown that of those who were seropositive, gastrointestinal symptoms were also
commonplace (Waterfield et al, 2020). Initial evidence suggested that children had a lower
susceptibility to SARS-CoV-2 infection, and they were unlikely to be key drivers of
transmission at a population level (Viner et al, 2020). However, a prospective study found
higher secondary attack rates where the household index case was a child (Lopez Bernal
et al, 2020).
Following the large scale vaccination of adults in the UK, recent rates of reported cases in
children have exceeded those in adults.
A spectrum of multi system inflammatory disease similar to Kawasaki disease (KD) was was
initially identified in children admitted during the SARS-CoV-2 pandemic, temporally
associated with severe acute respiratory syndrome attributed to SARS-CoV-2 (Paediatric
multisystem inflammatory syndrome temporally associated with SARS-CoV-2 infection
(PIMS-TS)) (Whittaker et al, 2020). This severe presentation in children is extremely rare, but
appears to encompass a wide range of features, including fever, gastrointestinal symptoms,
rash, myocardial injury and shock (Swann et al, 2020).
Pregnant women and neonates
The risks to pregnant women and neonates following COVID-19 infection have worsened
over the course of the pandemic: the maternal mortality ratio as a result of COVID-19 has
significantly increased from 1.4 per 100,000 live births in the Wildtype SARS-CoV-2
dominant period to 5.4 per 100,000 live births in the Delta dominant period. (Knight et al,
2021). During the Delta dominant period, six neonatal deaths were recorded. No neonatal
deaths were reported in previous waves. The proportion of pregnant women hospitalised
with symptomatic COVID-19 that experienced moderate to severe infection increased from
Wildtype to subsequent Alpha and Delta dominant periods, and the proportion admitted
to intensive care units also increased (Vousden et al, 2021a, https://www.icnarc.org/Our-
Audit/Audits/Cmp/Reports). Pregnant and recently pregnant women with COVID-19 are
more likely to be admitted to an intensive care unit, have invasive ventilation or
extracorporeal membrane oxygenation in comparison to non-pregnant women of
reproductive age (Allotey et al, 2021).
UK studies have suggested a high rate of stillbirth in infected women (Allotey et al, 2020,
Gurol-Urganci et al, 2021), and this appears to have increased during the Delta period
(Vousden et al, 2021a). Vertical transmission appears rare (Gale et al, 2021). However, the
risk of preterm birth is increased two to threefold for women with symptomatic COVID-19
(Vousden et al, 2021a,b)), usually as a result of a medical recommendation to deliver early
to improve maternal oxygenation.1
Pregnant women are more likely to have severe COVID-19 infection if they are overweight
or obese, are of black and asian minority ethnic background, have co-morbidities such as
diabetes, hypertension and asthma, or are 35 years old or older (Vousden et al, 2021a,
Allotey et al, 2020).
1 NICE Guideline 25, 2019 https://www.nice.org.uk/guidance/ng25
5
Chapter 14a -
COVID-19 -
SARS-Cov-2
Chapter 14a - COVID-19 - SARS-CoV-2
28 February 2022
COVID-19 vaccines
The recognition of the pandemic has accelerated the development and testing of several
vaccines using platforms investigated during previous emergencies such as the SARS
pandemic (Amanat et al, 2020) and Ebola in West Africa. Candidate vaccines include
nucleic acid vaccines, inactivated virus vaccines, live attenuated vaccines, protein or peptide
subunit vaccines, and viral-vectored vaccines.
Most vaccine candidates focus on immunisation with the spike (S) protein, which is the
main target for neutralising antibodies. Neutralising antibodies that block viral entry into
host cells through preventing the interaction between the spike protein Receptor Binding
Motif (RBM) and the host cell Angiotensin-converting enzyme 2 (ACE2) are expected to be
protective (Addetia et al, 2020, Thompson et al, 2020).
In the UK four vaccines targeting the S protein have been authorised for supply; two use an
mRNA platform (Pfizer BioNTech COVID-19 BNT162b2 vaccine (tozinameran)/Comirnaty® and
Moderna mRNA-1273 COVID-19 vaccine/Spikevax®) and two use an adenovirus vector
(AstraZeneca COVID-19 ChAdOx1-S vaccine/Vaxzevria® and COVID-19 vaccine Janssen
Ad26.COV2-S [recombinant]). One other vaccine is now approved for use in the UK,
Nuvaxovid® is the COVID-19 vaccine developed by Novavax. This vaccine uses a
recombinant S protein (grown in baculovirus infected insect cells) as an antigen with the
Matrix-M adjuvant. The latter adjuvant includes two saponins derived from tree bark.
COVID-19 Vaccine Janssen and Nuvaxovid® are currently approved for primary
immunisation in those aged 18 and older. As there are relatively limited indications for
these vaccines in the current programme, they are not currently being supplied routinely in
the UK.
The Pfizer BioNTech and Moderna COVID-19 vaccines are nucleoside-modified messenger
RNA (mRNA) vaccines. mRNA vaccines use the pathogen’s genetic code as the vaccine; this
then exploits the host cells to translate the code and then make the target spike protein. The
protein then acts as an intracellular antigen to stimulate the immune response (Amanat et al,
2020). mRNA is then normally degraded within a few days. Both the Moderna mRNA-1273
and the Pfizer BioNTech COVID-19 BNT162b2 vaccines have been generated entirely in vitro
and are formulated in lipid nanoparticles which are taken up by the host cells (Vogel et al,
2020, Jackson et al, 2020). The Pfizer vaccine was tested in healthy adults between the ages
of 18-55 and 65-85 years in phase 1 studies and the BNT162b2 vaccine product at a 30
microgram dose was chosen by Pfizer as the lead candidate in phase 2/3 trials (Walsh et al,
2020). The Moderna mRNA-1273 vaccine was tested at three dose levels in those aged
18-55 years and the 100 microgram dose chosen for phase 3 study (Jackson et al, 2020).
AstraZeneca COVID-19 vaccine uses a replication deficient chimpanzee adenovirus (ChAd) as
a vector to deliver the full-length SARS-CoV2 spike protein genetic sequence into the host cell
(Van Doremalen et al, 2020). The adenovirus vector is grown in a human cell-line (HEK293)
(see chapter 1). ChAd is a non-enveloped v
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