Safety and immunogenicity of fractional COVID-19 vaccine doses in Nigerian adults: A randomized non-inferiority trial.

Fractional dosing of vaccines is a viable strategy to extend COVID-19 vaccine supplies in resource-constrained settings. We did a triple-blinded, multi-site, randomized non-inferiority trial in Nigeria (PACTR202206754734018). Adults 18-65 years received full, half, or quarter primary doses of ChAdOx1 or Ad26.COV2.S, or full vs half doses of BNT162b2. Primary study outcome was seroconversion defined as ≥ 2.5-fold rise in anti-Spike IgG geometric-mean fold rise (GMFR) at day 28. A total of 1894 participants were enrolled between June 21, 2022, and January 25, 2023. 320 participants in the fractional dose group and 220 in the standard dose group completed follow-up and were included in the analysis. Seropositivity at baseline was high, at 68% (365/539). Seroconversion was comparable between standard and fractional doses (p = 0.822). For ChAdOx1, 31% achieved seroconversion at standard dose (16/52), 28% at half-dose (15/53), and 34% in quarter-dose (18/53). For Ad26.COV2.S, the proportions were 27% (28/105), 32% (22/68), and 30% (21/71) respectively. For BNT162b2, the proportions were 43% (27/63) and 39% (29/75) for standard- and half-dose. Serum neutralization showed ≥ twofold response across dosing. There were no serious adverse events. Fractional vaccine doses generated non-inferior immune responses compared to standard doses in the context of previous COVID-19.Protocol Registration: The protocol was registered with the Pan African Clinical Trials Registry (PACTR) PACTR202206754734018.