Brief Summary
The goal of this study is to assess the safety and effectiveness of COVID vaccine booster doses in patients with cancer who have not developed an antibody after the U.S. Food and Drug Administration (FDA) Emergency Use Authorized COVID primary vaccination series.
Brief Title
Booster Dose Trial
Detailed Description
Cancer patients show increased morbidity with COVID-19 and need effective immunization strategies. Many healthcare regulatory agencies recommend administering 'booster' doses of COVID-19 vaccines beyond the standard two-dose series, for this group of patients. Therefore, studying the efficacy of these additional vaccine doses against SARS-CoV-2 and variants of concern is of utmost importance in this immunocompromised patient population.
The investigator team designed a prospective single arm clinical trial for consenting patients with cancer who had received two doses of mRNA, or one dose of AD26.CoV2.S vaccine, and were administered a third dose of mRNA vaccine. Patients who had no or low responses to three mRNA COVID vaccines were administered a fourth dose of mRNA vaccine. Efficacy was assessed by changes in anti-spike antibody, T-cell activity, and neutralization activity, at baseline and 4 weeks.
First Booster Dose ("3rd dose") study:
Following the informed consent process patients are enrolled into the study. After drawing baseline laboratory samples that include spike antibody, a sample for T-cell assay, and a biobank sample, patients will receive a third mRNA vaccine (initially BNT162b2 per protocol, later amended to allow for a third mRNA-1273 vaccine after the Food and Drug Administration \[FDA\] authorized 'booster' doses in the fall of 2021). Patients who had received Ad26.CoV2.S vaccine will receive a BNT162b2 booster vaccine. Follow-up visits are scheduled at \~4 weeks and 4-6 months following the booster dose and laboratory sample collections will be repeated.
Second Booster Dose ("4th dose") study:
For patients who did not seroconvert after three doses or had low antibody response (\<1000 AU/mL as determined by in-house Abbott assay), it was hypothesized that a 'mix and match' strategy with a 2nd booster dose ("4th dose") of COVID-19 vaccine would induce seroconversion and improve boosting of humoral antibody responses. To study this, a protocol was designed wherein patients who had received their 1st booster dose ("3rd dose") of mRNA vaccines and had undetectable anti-S antibody or had an anti-S antibody level of \<1000 AU/mL measured at least 14 days after third dose would be randomized to an mRNA vs. adenoviral booster ("4th") vaccine dose. Responses would be then assessed at 4 weeks after the 2nd booster dose ("4th dose") through measurement of anti-S antibody results. Complete blood counts (CBC), quantitative immunoglobulin levels (IgG, IgA, and IgM), lymphocyte subsets, T-cell responses, and neutralization activity at baseline and 4 weeks will be assessed for each of these patients. Following the implementation of this protocol, the Centers for Disease Control (CDC) published a statement that advised that the mRNA vaccines should be preferentially administered over the adenoviral vaccines given concern over rare side effects such as thrombocytopenia and thrombosis syndrome. Given this advisory, the protocol was amended to allow recruitment in a cohort that would receive a fourth dose of the BNT162b2 vaccine to comply with CDC guidelines.
The investigator team designed a prospective single arm clinical trial for consenting patients with cancer who had received two doses of mRNA, or one dose of AD26.CoV2.S vaccine, and were administered a third dose of mRNA vaccine. Patients who had no or low responses to three mRNA COVID vaccines were administered a fourth dose of mRNA vaccine. Efficacy was assessed by changes in anti-spike antibody, T-cell activity, and neutralization activity, at baseline and 4 weeks.
First Booster Dose ("3rd dose") study:
Following the informed consent process patients are enrolled into the study. After drawing baseline laboratory samples that include spike antibody, a sample for T-cell assay, and a biobank sample, patients will receive a third mRNA vaccine (initially BNT162b2 per protocol, later amended to allow for a third mRNA-1273 vaccine after the Food and Drug Administration \[FDA\] authorized 'booster' doses in the fall of 2021). Patients who had received Ad26.CoV2.S vaccine will receive a BNT162b2 booster vaccine. Follow-up visits are scheduled at \~4 weeks and 4-6 months following the booster dose and laboratory sample collections will be repeated.
Second Booster Dose ("4th dose") study:
For patients who did not seroconvert after three doses or had low antibody response (\<1000 AU/mL as determined by in-house Abbott assay), it was hypothesized that a 'mix and match' strategy with a 2nd booster dose ("4th dose") of COVID-19 vaccine would induce seroconversion and improve boosting of humoral antibody responses. To study this, a protocol was designed wherein patients who had received their 1st booster dose ("3rd dose") of mRNA vaccines and had undetectable anti-S antibody or had an anti-S antibody level of \<1000 AU/mL measured at least 14 days after third dose would be randomized to an mRNA vs. adenoviral booster ("4th") vaccine dose. Responses would be then assessed at 4 weeks after the 2nd booster dose ("4th dose") through measurement of anti-S antibody results. Complete blood counts (CBC), quantitative immunoglobulin levels (IgG, IgA, and IgM), lymphocyte subsets, T-cell responses, and neutralization activity at baseline and 4 weeks will be assessed for each of these patients. Following the implementation of this protocol, the Centers for Disease Control (CDC) published a statement that advised that the mRNA vaccines should be preferentially administered over the adenoviral vaccines given concern over rare side effects such as thrombocytopenia and thrombosis syndrome. Given this advisory, the protocol was amended to allow recruitment in a cohort that would receive a fourth dose of the BNT162b2 vaccine to comply with CDC guidelines.
Categories
Completion Date
Completion Date Type
Actual
Conditions
Cancer
Eligibility Criteria
Inclusion Criteria (Cohort 1):
* Above the age of 18
* Meet one of the sub-criteria below:
* Meet the CDC definition for immunocompromised status for cancer patients, i.e patients receiving active treatment for solid tumor or hematologic malignancy OR
* Be a recipient of stem cell transplant or CAR-T cell therapy in the last 2 years OR
* Have a negative SARS-CoV-2 spike IgG despite standard vaccination series, irrespective of active/inactive cancer status, on observation, or active therapy.
* Underwent an in-person encounter at a study facility during the study period
* Have received the second of the mRNA-based vaccines BNT162b2 and mRNA-1273 (Pfizer/BioNTech or Moderna, respectively) or one dose of the adenoviral Ad26CoV2.S (Johnson \& Johnson) vaccine at least 28 days before the booster dose.
Exclusion Criteria (Cohort 1):
* Patients who have had a serious adverse reaction to any prior COVID-19 vaccines resulting in emergency room visit or hospitalization, had events related to myocarditis, thrombosis and thrombocytopenia syndrome or anaphylaxis to any prior dose of the COVID-19 vaccines.
* Patients who have had a documented COVID-19 infection in the 90 days prior to starting the study
Inclusion Criteria (Cohort 2):
* Above the age of 18
* Have a diagnosis of prior or active malignancy, either hematological or solid tumor
* Have a negative or low-level SARS-CoV-2 spike IgG after 14 days of booster vaccination series irrespective of active/inactive cancer status, on observation, or active therapy.
* Have received an FDA-authorized booster dose of mRNA (BNT162b2 and mRNA-1273) vaccine at least 28 days before study enrollment.
Exclusion Criteria (Cohort 2):
* Patients who have had a serious adverse reaction to any prior COVID-19 vaccines resulting in emergency room visit or hospitalization, had events related to myocarditis, thrombosis and thrombocytopenia syndrome or anaphylaxis to any prior dose of the COVID-19 vaccines.
* Patients who have had a documented COVID-19 infection in the 90 days prior to study enrollment
* Above the age of 18
* Meet one of the sub-criteria below:
* Meet the CDC definition for immunocompromised status for cancer patients, i.e patients receiving active treatment for solid tumor or hematologic malignancy OR
* Be a recipient of stem cell transplant or CAR-T cell therapy in the last 2 years OR
* Have a negative SARS-CoV-2 spike IgG despite standard vaccination series, irrespective of active/inactive cancer status, on observation, or active therapy.
* Underwent an in-person encounter at a study facility during the study period
* Have received the second of the mRNA-based vaccines BNT162b2 and mRNA-1273 (Pfizer/BioNTech or Moderna, respectively) or one dose of the adenoviral Ad26CoV2.S (Johnson \& Johnson) vaccine at least 28 days before the booster dose.
Exclusion Criteria (Cohort 1):
* Patients who have had a serious adverse reaction to any prior COVID-19 vaccines resulting in emergency room visit or hospitalization, had events related to myocarditis, thrombosis and thrombocytopenia syndrome or anaphylaxis to any prior dose of the COVID-19 vaccines.
* Patients who have had a documented COVID-19 infection in the 90 days prior to starting the study
Inclusion Criteria (Cohort 2):
* Above the age of 18
* Have a diagnosis of prior or active malignancy, either hematological or solid tumor
* Have a negative or low-level SARS-CoV-2 spike IgG after 14 days of booster vaccination series irrespective of active/inactive cancer status, on observation, or active therapy.
* Have received an FDA-authorized booster dose of mRNA (BNT162b2 and mRNA-1273) vaccine at least 28 days before study enrollment.
Exclusion Criteria (Cohort 2):
* Patients who have had a serious adverse reaction to any prior COVID-19 vaccines resulting in emergency room visit or hospitalization, had events related to myocarditis, thrombosis and thrombocytopenia syndrome or anaphylaxis to any prior dose of the COVID-19 vaccines.
* Patients who have had a documented COVID-19 infection in the 90 days prior to study enrollment
Inclusion Criteria
Inclusion Criteria (Cohort 1):
* Above the age of 18
* Meet one of the sub-criteria below:
* Meet the CDC definition for immunocompromised status for cancer patients, i.e patients receiving active treatment for solid tumor or hematologic malignancy OR
* Be a recipient of stem cell transplant or CAR-T cell therapy in the last 2 years OR
* Have a negative SARS-CoV-2 spike IgG despite standard vaccination series, irrespective of active/inactive cancer status, on observation, or active therapy.
* Underwent an in-person encounter at a study facility during the study period
* Have received the second of the mRNA-based vaccines BNT162b2 and mRNA-1273 (Pfizer/BioNTech or Moderna, respectively) or one dose of the adenoviral Ad26CoV2.S (Johnson \& Johnson) vaccine at least 28 days before the booster dose.
Inclusion Criteria (Cohort 2):
* Above the age of 18
* Have a diagnosis of prior or active malignancy, either hematological or solid tumor
* Have a negative or low-level SARS-CoV-2 spike IgG after 14 days of booster vaccination series irrespective of active/inactive cancer status, on observation, or active therapy.
* Have received an FDA-authorized booster dose of mRNA (BNT162b2 and mRNA-1273) vaccine at least 28 days before study enrollment.
* Above the age of 18
* Meet one of the sub-criteria below:
* Meet the CDC definition for immunocompromised status for cancer patients, i.e patients receiving active treatment for solid tumor or hematologic malignancy OR
* Be a recipient of stem cell transplant or CAR-T cell therapy in the last 2 years OR
* Have a negative SARS-CoV-2 spike IgG despite standard vaccination series, irrespective of active/inactive cancer status, on observation, or active therapy.
* Underwent an in-person encounter at a study facility during the study period
* Have received the second of the mRNA-based vaccines BNT162b2 and mRNA-1273 (Pfizer/BioNTech or Moderna, respectively) or one dose of the adenoviral Ad26CoV2.S (Johnson \& Johnson) vaccine at least 28 days before the booster dose.
Inclusion Criteria (Cohort 2):
* Above the age of 18
* Have a diagnosis of prior or active malignancy, either hematological or solid tumor
* Have a negative or low-level SARS-CoV-2 spike IgG after 14 days of booster vaccination series irrespective of active/inactive cancer status, on observation, or active therapy.
* Have received an FDA-authorized booster dose of mRNA (BNT162b2 and mRNA-1273) vaccine at least 28 days before study enrollment.
Gender
All
Gender Based
false
Keywords
COVID-19
Booster
Healthy Volunteers
No
Last Update Post Date
Last Update Post Date Type
Actual
Last Update Submit Date
Minimum Age
18 Years
NCT Id
NCT05016622
Org Class
Other
Org Full Name
Montefiore Medical Center
Org Study Id
2021-13204
Overall Status
Terminated
Phases
Phase 2
Primary Completion Date
Primary Completion Date Type
Actual
Official Title
Safety and Efficacy of Booster Doses of COVID-19 Vaccine in Immunocompromised Patients With a Cancer Diagnosis
Primary Outcomes
Outcome Description
Rate will be determined as the percentage of patients demonstrating booster-induced seroconversion, as evidenced by anti-Spike antibody testing, who were seronegative after the primary series of FDA authorized COVID-19 vaccinations.
Outcome Measure
Rate of Seroconversion for SARS-CoV-2 Spike Antibody Among Patients Who Were Seronegative After Primary Series of COVID-19 Vaccinations
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Description
A patient was classified as a responder if they either (1) had positive anti-S antibody at 4 weeks if seronegative at baseline (following 1st booster dose) or (2) if they achieved a titer of \>1000 AU/mL at 4 weeks if they were sero-low at baseline (following 1st booster dose)
Outcome Measure
Percentage of Patients Who Were 'Responders' After 2nd Booster Dose
Outcome Time Frame
4 weeks after administration of 2nd booster dose
Secondary Ids
Secondary Id
2UG1CA189859-06
Secondary Id
IRV-BC0004-22
Secondary Id
3P30CA013330-49S3
Secondary Outcomes
Outcome Description
The number of patients with evaluable T-cell immune responses who demonstrated positive anti-S antibody (IgG) titers against SARS-CoV-2 after 1st booster dose of vaccine.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Positive Anti-Spike Antibody (IgG) Titer
Outcome Description
The median SARS-CoV-2 spike antibody (IgG) titer among the entire cohort at 4 weeks after administration of the 1st booster dose of vaccine was determined.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Spike Antibody Titer
Outcome Description
The median change in anti-S antibody titer for patients with Hematologic malignancies was determined.
Outcome Time Frame
Baseline to 4 weeks after administration of 1st booster dose
Outcome Measure
Change in Anti-Spike Antibody Titer for Patients With Hematologic Malignancies
Outcome Description
The median change in anti-S antibody titer for patients with Solid tumor malignancies was determined.
Outcome Time Frame
Baseline to 4 weeks after administration of 1st booster dose
Outcome Measure
Change in Anti-Spike Antibody Titer for Patients With Solid Tumor Malignancies
Outcome Description
Median change in Anti-S antibody titers was determined in patients who presented with Hematologic (either Lymphoid or Myeloid) malignancies.
Outcome Time Frame
Baseline to 4 weeks after administration of 1st booster dose
Outcome Measure
Change in Anti-Spike Antibody Titer Among Patients With Hematologic Malignancy by Type
Outcome Description
Percentage of Patients who were either seropositive or seronegative following administration of 1st booster dose as demonstrated by anti-S antibody testing.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Percentage of Patients Seropositive/Seronegative Following 1st Booster Dose
Outcome Description
The GenScript surrogate virus neutralization assay was used to analyze samples from seropositive patients to detect for the presence of neutralizing antibodies. The percentage of patients with neutralizing antibodies was determined.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Neutralizing Antibodies Detected Among Seropositive Patients
Outcome Description
Percentage of patients with a negative anti-S antibody following 1st booster dose who demonstrated a Positive T-cell response.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Positive T-cell Response Among Patients With a Negative Anti-S Antibody
Outcome Description
Percentage of patients who demonstrated a Positive T-cell response among those who demonstrated a negative T-cell response at baseline.
Outcome Time Frame
4 weeks after administration of 1st booster dose
Outcome Measure
Positive T-cell Response Among Patients With a Negative T-cell Response at Baseline
Outcome Description
In order to determine association of specific cancer-directed therapies with the booster effect, median change in anti-S antibody titers were assessed for patients on anti-CD20 antibody therapy within 6 months of administration of 1st booster dose.
Outcome Time Frame
Within 6 months prior to treatment to 4 weeks after administration of 1st booster dose
Outcome Measure
Anti-spike Antibody Titers for Patients on Anti-CD20 Antibody Therapy Within 6 Months of Treatment
Outcome Description
In order to determine association of specific cancer-directed therapies with the booster effect, median change in anti-S antibody titers were assessed for patients on anti-CD20 antibody therapy just prior to the study.
Outcome Time Frame
Baseline to 4 weeks after administration of 1st booster dose
Outcome Measure
Anti-spike Antibody Titers for Patients on Anti-CD20 Antibody Therapy
Outcome Description
In order to determine association of specific cancer-directed therapies with the booster effect, median change in anti-S antibody titers were assessed for patients not on anti-CD20 antibody therapy just prior to the study.
Outcome Time Frame
Baseline to 4 weeks after administration of 1st booster dose
Outcome Measure
Anti-spike Antibody Titers for Patients Not on Anti-CD20 Antibody Therapy
Outcome Description
In order to determine association of specific cancer-directed therapies with the booster effect, median change in anti-S antibody titers were assessed for patients not on anti-CD20 antibody therapy within 6 months of treatment
Outcome Time Frame
Within 6 months prior to treatment to 4 weeks after administration of 1st booster dose
Outcome Measure
Anti-spike Antibody Titers for Patients Not on Anti-CD20 Antibody Therapy Within 6 Months of Treatment
Outcome Description
Percentage of Patients who maintained a positive anti-S antibody (seropositive) following administration of 1st booster dose as demonstrated by anti-S antibody testing.
Outcome Time Frame
~4-6 months after administration of 1st booster dose
Outcome Measure
Percentage of Patients Who Remained Seropositive Following 1st Booster Dose
Outcome Description
The percentage of patients determined to be seronegative before 2nd booster dose
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Percentage of Seronegative Patients Before 2nd Booster Dose
Outcome Description
The percentage of patients with low serum antibodies before administration of the 2nd booster dose was determined by assay. Patients with anti-S antibody titers of \<1000 AU/mL were determined to have low serum antibodies.
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Percentage of Patients With Low (Anti-S Antibody) Serum Antibodies
Outcome Description
The percentage of patients who were classified as 'responders' after the 2nd Booster dose. A patient was classified as a responder if they: (1) had positive anti-S antibody at 4 weeks if seronegative after 1st booster dose or (2) if they achieved a titer of \>1000 AU/mL at 4 weeks if they were sero-low after 1st booster dose.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Anti-spike IgG Responders After the 2nd Booster Dose
Outcome Description
Rate was determined as the percentage of patients demonstrating booster-induced seroconversion to positive anti-S antibody who had remained seronegative following administration of Primary Vaccination series and 1st Booster dose of BNT162b2, mRNA-1273, or AdCoV2.S COVID vaccine.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Rate of Seroconversion for SARS-CoV-2 Spike Antibody Among Patients Who Remained Seronegative Following 1st Booster Dose
Outcome Description
The percentage of Patients with low anti-Spike antibody, determined to be IgG \<1000 AU/mL by assay, who responded following administration of 2nd booster dose. Responses in this context were determined to be those patients with assay results of IgG \> 1000 AU/mL.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Percentage of Patients With Low Anti-Spike Antibody Who Responded Following 2nd Booster Dose
Outcome Description
The median Anti-S antibody titer following administration of the primary vaccination series and 1st booster dose in Cohort B was determined.
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Anti-Spike Antibody Titer Following Administration of 1st Booster Dose
Outcome Description
The median Anti-S antibody titer following administration of the 2nd booster dose (Cohort B) was determined.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Anti-Spike Antibody Titer Following Administration of 2nd Booster Dose
Outcome Description
The number of Cohort B patients with evaluable T-cell immune responses who demonstrated positive anti-S antibody (IgG) titers against SARS-CoV-2 following 1st booster dose and prior to 2nd booster dose of vaccine.
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Positive Anti-Spike Antibody (IgG) Titer Prior to 2nd Booster Dose
Outcome Description
The percentage of Cohort B patients who demonstrated positive anti-S antibody (IgG) titers against SARS-CoV-2 following administration of 2nd booster dose of vaccine.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Positive Anti-Spike Antibody (IgG) Titer Following 2nd Booster Dose
Outcome Description
Neutralization activity against the WT variant was assessed using a neutralization activity assay. The percentage of patients with positive and negative T-cell results are reported.
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Neutralization Against Wildtype (WT) SARS-CoV-2 Variant Prior to 2nd Booster Dose
Outcome Description
Neutralization activity against the WT variant was assessed using a neutralization activity assay. The percentage of patients with positive and negative T-cell results are reported.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Neutralization Against Wildtype (WT) SARS-CoV-2 Variant Following 2nd Booster Dose
Outcome Description
Neutralization activity against the Omicron BA.1 variant was assessed using a neutralization activity assay. The percentage of patients with positive and negative T-cell results are reported.
Outcome Time Frame
Prior to administration of 2nd booster dose, a minimum of 14-28 days following 1st booster dose, a median of approximately 5 months
Outcome Measure
Neutralization Against Omicron BA.1 SARS-CoV-2 Variant Prior to 2nd Booster Dose
Outcome Description
Neutralization activity against the Omicron BA.1 variant was assessed using a neutralization activity assay. The percentage of patients with positive and negative T-cell results are reported.
Outcome Time Frame
~4 weeks after administration of 2nd booster dose, a minimum of 4-6 weeks following 1st booster dose, a median of approximately 6.0-6.5 months
Outcome Measure
Neutralization Against Omicron BA.1 SARS-CoV-2 Variant Following 2nd Booster Dose
Start Date
Start Date Type
Actual
Status Verified Date
First Post Date
First Post Date Type
Actual
First Submit Date
First Submit QC Date
Std Ages
Adult
Older Adult
Maximum Age Number (converted to Years and rounded down)
999
Minimum Age Number (converted to Years and rounded down)
18
Investigators
Investigator Type
Principal Investigator
Investigator Name
Balazs Halmos
Investigator Email
bahalmos@montefiore.org
Categories Mesh Debug
Cancer --- NEOPLASMS
COVID-19 --- COVID-19
COVID-19 --- PNEUMONIA, VIRAL
COVID-19 --- PNEUMONIA
Lung --- PNEUMONIA
COVID-19 --- RESPIRATORY TRACT INFECTIONS
Lung --- RESPIRATORY TRACT INFECTIONS
COVID-19 --- INFECTIONS
Infectious Disease --- INFECTIONS
COVID-19 --- VIRUS DISEASES
Hepatitis --- VIRUS DISEASES
Infectious Disease --- VIRUS DISEASES
COVID-19 --- CORONAVIRUS INFECTIONS
COVID-19 --- CORONAVIRIDAE INFECTIONS
COVID-19 --- NIDOVIRALES INFECTIONS
COVID-19 --- RNA VIRUS INFECTIONS
Infectious Disease --- RNA VIRUS INFECTIONS
Lung & Chest Cancers --- LUNG DISEASES
COVID-19 --- LUNG DISEASES
Lung --- LUNG DISEASES
Asthma and Other Respiratory Diseases --- RESPIRATORY TRACT DISEASES
Lung & Chest Cancers --- RESPIRATORY TRACT DISEASES
COVID-19 --- RESPIRATORY TRACT DISEASES
Lung --- RESPIRATORY TRACT DISEASES
MeSH Terms
NEOPLASMS
COVID-19
PNEUMONIA, VIRAL
PNEUMONIA
RESPIRATORY TRACT INFECTIONS
INFECTIONS
VIRUS DISEASES
CORONAVIRUS INFECTIONS
CORONAVIRIDAE INFECTIONS
NIDOVIRALES INFECTIONS
RNA VIRUS INFECTIONS
LUNG DISEASES
RESPIRATORY TRACT DISEASES
BNT162 VACCINE
MRNA VACCINES
NUCLEIC ACID-BASED VACCINES
VACCINES, SYNTHETIC
RECOMBINANT PROTEINS
PROTEINS
AMINO ACIDS, PEPTIDES, AND PROTEINS
VACCINES
BIOLOGICAL PRODUCTS
COMPLEX MIXTURES
COVID-19 VACCINES
VIRAL VACCINES
ANTIGENS
BIOLOGICAL FACTORS