1. Epidemiology and Global Health
  2. Microbiology and Infectious Disease
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Single-dose BNT162b2 vaccine protects against asymptomatic SARS-CoV-2 infection

  1. Nick K Jones
  2. Lucy Rivett
  3. Shaun Seaman
  4. Richard J Samworth
  5. Ben Warne
  6. Chris Workman
  7. Mark Ferris
  8. Jo Wright
  9. Natalie Quinnell
  10. Ashley Shaw
  11. Cambridge COVID-19 Collaboration
  12. Ian G Goodfellow
  13. Paul J Lehner
  14. Rob Howes
  15. Giles Wright
  16. Nicholas J Matheson
  17. Michael P Weekes  Is a corresponding author
  1. Cambridge University Hospitals NHS Trust, United Kingdom
  2. University of Cambridge, United Kingdom
  3. Cambridge Biomedical Campus, United Kingdom
  4. AstraZeneca, Anne McLaren Building, United Kingdom
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Cite this article as: eLife 2021;10:e68808 doi: 10.7554/eLife.68808

Abstract

The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK’s first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates, and find a four-fold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease.

Data availability

All data generated or analysed during this study are included in the manuscript and supporting files. Source data files have been provided for Figure 1

Article and author information

Author details

  1. Nick K Jones

    Department of Infectious Diseases, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-4475-7761
  2. Lucy Rivett

    Department of Infectious Diseases, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-2781-9345
  3. Shaun Seaman

    Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  4. Richard J Samworth

    Statistical Laboratory, Centre for Mathematical Sciences, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  5. Ben Warne

    Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  6. Chris Workman

    Department of Infectious Diseases, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  7. Mark Ferris

    Department of Occupational Health and Wellbeing, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  8. Jo Wright

    Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  9. Natalie Quinnell

    Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  10. Ashley Shaw

    Medical Director, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  11. Cambridge COVID-19 Collaboration

    Department of Medicine, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  12. Ian G Goodfellow

    Department of Pathology, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-9483-510X
  13. Paul J Lehner

    Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-9383-1054
  14. Rob Howes

    Cambridge COVID-19 Testing Centre, AstraZeneca, Anne McLaren Building, Cambridge, United Kingdom
    Competing interests
    Rob Howes, Dr Howes was employed by AstraZeneca PLC during the period of study and preparation of this manuscript..
  15. Giles Wright

    Department of Occupational Health and Wellbeing, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
  16. Nicholas J Matheson

    Department of Medicine, University of Cambridge, Cambridge, United Kingdom
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-3318-1851
  17. Michael P Weekes

    Department of Medicine, University of Cambridge, Cambridge, United Kingdom
    For correspondence
    mpw1001@cam.ac.uk
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-3196-5545

Funding

Wellcome Trust (108070/Z/15/Z)

  • Michael P Weekes

Wellcome Trust (207498/Z/17/Z)

  • Ian G Goodfellow

Wellcome Trust (210688/Z/18/Z)

  • Paul J Lehner

Medical Research Council (MR/P008801/1)

  • Nicholas J Matheson

NHS Blood and Transplant (WPA15-02)

  • Nicholas J Matheson

EPSRC Centre for Doctoral Training in Medical Imaging (EP/P031447/1,EP/N031938/1)

  • Richard J Samworth

Medical Research Council (MC_UU_00002/10)

  • Shaun Seaman

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: This study was conducted as a service evaluation of the CUHNFT staff testing and vaccination services (CUHNFT clinical project ID ID3682). As a study of healthcare-associated infections, this investigation is exempt from requiring ethical approval under Section 251 of the NHS Act 2006 (see also the NHS Health Research Authority algorithm, available at http://www.hra-decisiontools.org.uk/research/, which concludes that no formal ethical approval is required).

Reviewing Editor

  1. Jos WM van der Meer, Radboud University Medical Centre, Netherlands

Publication history

  1. Received: March 26, 2021
  2. Accepted: April 7, 2021
  3. Accepted Manuscript published: April 8, 2021 (version 1)
  4. Version of Record published: April 23, 2021 (version 2)

Copyright

© 2021, Jones et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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Further reading

    1. Epidemiology and Global Health
    2. Medicine
    Lucy Rivett et al.
    Research Article Updated

    Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.

    1. Epidemiology and Global Health
    2. Medicine
    3. Microbiology and Infectious Disease
    Edited by Diane M Harper et al.
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