Dr Katrina Cathie and Dr Nisreen Alwan received their MBEs at ceremonies held at Windsor Castle. Dr Nisreen Alwan, Associate Professor in Public Health at the University of Southampton and Honorary Consultant at University Hospital Southampton, was presented with her medal for services to medicine and public health during the pandemic by Prince Charles. It comes after they were included in the Queen’s New Year’s Honours list for 2021 in January. Caring for children during the pandemic Dr Cathie works in general paediatrics, caring for children and families, supporting 24/7 cover on wards and covering outpatient clinics. She developed a specialist interest in children with secondary epilepsy, and now works as part of a multi-disciplinary team which has dramatically improved the service. In the first months of the COVID-19 crisis, she volunteered to be redeployed from research to cover clinical shifts in paediatric and short-stay units, as well as covering colleague sickness and organising new shifts and rotas for the paediatric team. COVID-19 vaccine research During the pandemic, Dr Cathie was quick to apply her knowledge and expertise from vaccine studies in children to help lead research into COVID-19 vaccines. Since the COVID-19 vaccine study was introduced at the University of Southampton (in collaboration with Oxford) she has shared oversight of it. She supports the large team involved from a medical perspective, working with research staff, nurses and fellows from around the region to recruit hundreds of participants to the trials. She helped to spearhead the vaccine project. Since November 2019, she has been the lead principal investigator locally for the Janssen COVID-19 vaccine trial. She is also a member of the paediatric steering group for the national RECOVERY trial, testing non-vaccine treatments for the virus, and part of recruiting children to this study. Dr Cathie said: “It was a wonderful occasion, and I couldn't have achieved it without the support of family, friends and colleagues.” COVID19 testing and long COVID Dr Nisreen Alwan’s persistent scientific and public advocacy has been instrumental in the recognition of Long COVID on a national and international level. Her frequent calls for further resources and investigations into the effects of long COVID have been a prevalent theme of her engagements on social media, mainstream media, webinars and journal articles. Throughout the pandemic, she has also highlighted the role of social factors like ethnicity, gender and deprivation in the pandemic’s impact on individuals and different groups, and the importance of addressing ethnic and socioeconomic inequalities. In Spring 2020, Dr Alwan co-led a proposal of COVID-19 universal weekly testing published in the Lancet which was the critical spark for the saliva testing pilot in Southampton. She was part of the core team developing a partnership between the University of Southampton, Southampton City Council and the NHS to deliver this pilot which has later developed into the Hampshire and Isle of Wight Saliva Testing Programme. Dr Alwan said: “I really enjoyed the day at Windsor Castle, which was made extra special by having my mother there with me. I am honoured to be recognised as a helper and I want to thank all the wonderful people I worked with along the way.” Image credits: Dr Cathie and Dr Alwan from @katrinacathie and @ClarenceHouse on Twitter.

Researchers in Southampton are part of a world-leading ‘challenge’ trial that infected young, healthy volunteers to give unique insights into COVID-19. The trial, which deliberately infected low-risk volunteers with SARS-COV-2, the virus which causes COVID-19, has provided important insights into the early stages of the disease. Southampton researchers Prof Robert Read, Prof Tom Wilkinson and Dr Stephen Harden are part of the team of researchers delivering the trial. It is led by Prof Christopher Chiu from the Institute of Infection at Imperial College London. Unique insights The researchers gave nose drops containing the virus to 36 healthy, unvaccinated volunteers aged 18-29 years at the Royal Free Hospital in London. None of the volunteers had previously been infected with COVID-19. The amount given was the same for all of them - the lowest possible measurable dose, equivalent to a single droplet from somebody's nose at the peak of their COVID-19 infection. Just over half of the participants became infected, showing that the virus is highly infectious in people who have no immunity, either through previous infection or vaccination. In those that were infected, the first symptoms and positive test results appeared within 42 hours, just under two days. This was much faster than the previous estimate of five days. Lateral flow tests were shown to be a good indicator of whether a patient was likely to be infectious. High levels of infectious virus were also detected in the nose, which the researchers say highlights the importance of wearing a mask correctly to cover both the nose and the mouth. The results have been published online but not yet formally reviewed by other scientists. Collaborative effort Prof Read is Director of the NIHR Southampton Biomedical Research Centre. Together with Prof Jonathan van Tam and Prof Peter Openshaw at Imperial College London, he initiated the first discussions that led to the creation of the research steering group. He helped develop the protocol and see it through an approval process by an ethics committee. This involved a series of discussions with the public in Southampton, together with behavioural science experts. As the study progressed, he chaired the trial steering committee and supported Prof Chiu. Prof Wilkinson, in his capacity as a respiratory consultant physician, was an advisor on lung imaging and lung function, while Dr Harden was radiologist adviser for the imaging tests used in the study. Prof Read, Professor of Infectious Diseases at the University of Southampton, said: “The data from the world’s first human challenge study with SARS-CoV-2 has shown that people can be safely infected with the virus for experimental purposes. “We have already learned a lot from the first 36 volunteers, including the minimum dose required to infect them, and the relative utility of diagnostic tests.”

Southampton researchers have identified genetic patterns that predict peoples’ likelihood of pancreatic cancer. This could ensure the early diagnosis and treatment that is vital for survival. Dr Zaed Hamady and Dr William Tapper of the NIHR Southampton Biomedical Research Centre and University of Southampton, have developed a computer model for pancreatic cancer risk. Combining common genetic variant, symptoms and lifestyle data has the potential to catch tumours earlier when treatment is most effective. Improving diagnosis and survival Pancreatic ductal adenocarcinoma (PDAC) has the lowest survival rates of any cancer. With no effective early diagnoses, it is usually detected when advanced and spreading around the body. Newly appeared diabetes is strongly linked to this cancer. Early traits can also include weight loss and changes to bowel habits. These inconsistent symptoms can make it challenging for people to swiftly detect the cancer. Advances in genetic testing and screening programmes have reduced deaths from breast cancer, however these techniques have not yet been well developed to identify people at high-risk of PDAC. Using genetic data to predict risk This study used data from the UK Biobank, a database of genetic and health information from half a million UK participants. The researchers analysed the genetic data of 1,042 people with PDAC and compared this against 10,420 healthy participants without cancer. They looked for small variations in genes previously linked to the disease. The team used these to test various computer models, giving people a pancreatic cancer risk score. The results have been published in the journal Gastroenterology Catching cancer earlier The best model they developed combined genetic data with information on a person’s symptoms, lifestyle and medical history. It worked most effectively when applied to people with diabetes, but was also found to be predictive to a lesser extent in people without diabetes. Dr Hamady, consultant hepato-pancreato-biliary surgeon at University Hospital Southampton NHS Foundation Trust, said: “This study could change the way we diagnose people with pancreatic ductal adenocarcinoma. It shows it is possible to develop a model which can predict who is most likely to develop the disease. “If used as a tool to aid diagnosis, this could greatly help to catch this cancer early, at a time when treatment is most effective. This would help save lives.”

A clinical evaluation of a simplified processing method for a rapid COVID-19 test has shown high accuracy in people with and without symptoms. Saliva and swab-based RT-LAMP tests are more scalable than standard COVID-19 PCR tests. Their faster results are possible because several changes of temperature are not needed. The tests are currently used in a widespread saliva testing programme across Hampshire and the Isle of Wight. A research team including Southampton scientists have published findings from their multi-site evaluation in the Journal of Molecular Diagnostics. Scalable alternative to PCR tests Loop-mediated isothermal amplification (LAMP) is a single-tube technique for the amplification of DNA. Reverse Transcription LAMP (RT-LAMP) combines LAMP with an extra step to allow the detection of genetic material known as RNA. This latest trial by NHS Trusts and universities tested samples from saliva and swabs. These were analysed both directly (Direct RT-LAMP) on the sample and after extraction of the viral RNA (RNA RT-LAMP). For RNA RT-LAMP on swabs, the overall diagnostic sensitivity was as high as RT-qPCR testing. This supports the use of such testing in mobile testing units, as recently seen for overseas visitors to high level meetings in the UK. Dr Veronica Fowler, a virologist who pioneered the optimisation and validation of the RT-LAMP technology for COVID-testing, said: “The application of using lower cost, rapid molecular tests, such as RT-LAMP to identify and control highly infectious viral diseases has been performed in the veterinary world for years. I am pleased through this huge collaborative effort that we have succeeded in transferring this concept and practice within the human infectious disease world for the benefit of saving people’s lives.” Accurate tests in cases without symptoms During the clinical trial, direct RT-LAMP was performed on 559 swabs and 86,760 saliva samples. RNA RT-LAMP was performed on 12,619 swabs and 12,521 saliva samples from asymptomatic and symptomatic people across healthcare and community settings. For Direct RT-LAMP, the overall diagnostic sensitivity was highest (85%) on saliva samples, with a specificity of 100% when compared to standard RT-qPCR testing. In tests on saliva samples containing a high viral load, the sensitivity of the test increased to 99%. This indicates that the test is highly effective in identifying infectious cases, including from people not displaying symptoms. The findings demonstrate that RT-LAMP can be applied to a variety of use-cases. These include regular testing of saliva from people without symptoms that could be missed using symptomatic testing alone. Prof Keith Godfrey, of the NIHR Southampton Biomedical Research Centre, who led the community-based aspects of the evaluation, said: “It is extremely helpful to have the ‘real world’ demonstration of how the RT-LAMP test can be implemented in different settings. It provides an important example of how these tests can make a valuable contribution to overall COVID-19 testing capability. “The saliva-based RT-LAMP test has proven easy to use, effective and highly acceptable to people of all ages for regular testing. Research in Southampton has shown that such testing can play a valuable role in controlling COVID-19 transmission in educational settings.”

The World Health Organisation (WHO) has used data from the COV-Boost trial in its advice on COVID-19 vaccine schedules. Comparing booster vaccines COV-Boost compared responses to seven COVID-19 vaccines when used as a third jab. A world first, its initial data informed the UK’s autumn 2021 booster roll-out. Now the full results are informing global vaccination efforts through WHO guidance. That guidance draws heavily on the December 2021 paper, published in The Lancet. The national trial looked at the safety, immune responses and side-effects of the seven vaccines. It ran at 18 sites across the country and was led from Southampton by Prof Saul Faust. It showed all were safe, and that six significantly boosted COVID-19 antibodies after two initial doses of AstraZeneca or Pfizer-BioNTech. 2,878 people aged 30 or over received one of the six boosters 10-12 weeks after their second dose. A control group received meningitis vaccine, to account for reactions not specific to the COVID-19 jabs. Global impact The document ‘Interim recommendations for heterologous COVID-19 vaccine schedules’, published on the WHO website, was developed based on advice from UK Government advisory group SAGE. COV-Boost results feature repeatedly, including as the basis for using lower doses of the Pfizer-BioNTech vaccine. Using lower doses could be key to making supplies go further. That's particularly important for lower- and middle-income countries. A sub-study of COV-Boost is now comparing different doses. The COV-Boost trial has also informed UK policy. It helped determine which vaccines were used in the booster programme. It also provided information on how safe it is to switch to a three-month gap between the second and third dose. The results were used to inform the public that antibody levels are high by day seven after the third dose. Prof Saul Faust, trial lead and Director of the NIHR Southampton Clinical Research Facility, said: “This shows the vital role of the UK’s vaccine research globally. Our results have not only underpinned UK booster strategy, but are helping the global effort.” “We hope that this guidance, and findings from our new sub study, will allow countries worldwide to optimise their approach and make supplies go further.”

Southampton researchers helped develop a new tool to diagnose a progressive form of the often ‘silent’ disease non-alcoholic fatty liver disease. Prof Christopher Byrne at the NIHR Southampton Biomedical Research Centre worked with colleagues in Italy and China to develop the ultrasound technique. It could be used for early diagnosis to prevent irreversible liver damage. ‘Silent’ liver disease Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It's usually seen in people who are overweight or obese, and is estimated to affect around 25% of the world’s population. It has four stages, where the liver becomes progressively more damaged. The first stage, steatosis, involves a largely harmless build-up of fat in the liver. Most people do not know they have it. However, if untreated it can progress to the next stage, non-alcoholic steatohepatitis (NASH), which is a more serious form of the disease where the liver becomes inflamed. NASH can then progress to the third stage, fibrosis, where persistent inflammation causes scar tissue around the liver and nearby blood vessels. The liver is still able to function normally. The final stage is cirrhosis. This is the most severe stage, occurring after years of inflammation. The liver shrinks and becomes scarred and lumpy. This damage is permanent and can lead to liver failure, where the liver stops working properly. Finding a better diagnostic tool Currently, NASH is usually diagnosed by a biopsy to remove a small piece of liver which is analysed in a laboratory. In this study, published in Liver International, the researchers looked to find a better diagnostic tool to diagnose NASH. Such a tool would enable people at risk to be diagnosed much more easily, allowing them to make changes to their lifestyle. Changes such as doing more exercise and eating a healthier diet could prevent their NAFLD from progressing to the later stages, when liver damage becomes permanent and irreversible. Such lifestyle changes may even be able to reverse some of the damage. People with NASH who lose more than 10 percent of their weight can remove some fat from the liver and improve their condition. Testing quantitative ultrasound The researchers investigated whether quantitative ultrasound, currently used to diagnose bone conditions such as osteoporosis, could be used for people with NASH. This technique measures the density of a body tissue - in this case liver tissue - by determining how rapidly high-frequency sound waves travel through it and are absorbed. They tested it on 259 Chinese people diagnosed with NAFLD using a biopsy. Using the two most useful predictive features from the quantitative ultrasound, they developed a scoring system. Then they trialled this scoring system to see if it was able to identify those with NASH, and found it was able to effectively select those with the condition. Prof Byrne, Professor of Endocrinology and Metabolism and Honorary Consultant Diabetologist & Metabolic Physician, said: “This research, while still in the early stages, shows it is possible to use quantitative ultrasound to diagnose NASH without the need for a biopsy or other invasive procedures. “Rates of NAFLD are extremely high worldwide. If used as a diagnostic tool, this could allow many more people to be diagnosed at an early stage, when lifestyle changes can still prevent and even reverse the damage to the liver.”

Southampton research has shown that absence of birth partner, impact of face masks on bonding, and infection risk were key concerns for parents of babies born before term during lockdown. Strict COVID-19 restrictions Strict measures to protect mothers and newborns were introduced as part of the UK lockdown over March to June 2020. All non-essential maternity care during pregnancy was paused, with in-person appointments switching to telephone or video consultations. Partners were no longer allowed to be present during birth. And for babies born before term or unwell, visits to neonatal care were limited to one parent at a time, wearing facemasks and PPE. Exploring parents’ experiences A team of Southampton researchers, led by Professor Anne-Sophie Darlington and Dr Luise Marino, set out to explore these challenges. Using an online survey, they gathered insights into parents’ experiences, information and support needs, and decision-making. Close working with the childbirth charity Bliss and Princess Anne Hospital’s neonatal teams was key to reaching parents of pre-term babies. 107 parents (103 mothers and four partners) completed the survey, which opened after the first lockdown. Around half of these families had their babies very early, before 33 weeks of pregnancy. Part of the larger SHARE study, looking at pandemic impacts on children and young adults with serious health conditions and their parents, the survey was designed to identify key themes. Assessing the impact The results, published in Acta Paediatrica, show many parents felt the restrictions had a significant psychological and emotional impact. A third felt restrictions affected their mental health. The researchers found 75% worried about the infection risk to their baby. However, this was far from their only concern. Over half of partners missed the birth, with only the health professionals helping deliver the baby with mothers at birth. 23% said they missed such close family support, many citing the partner’s missed experience. Mothers also worried that wearing a mask during the birth would mean their baby might not be able to recognise them, affecting their ability to bond with their baby. Prof Darlington, Professor of Child and Family Psychological Health, said: “These results show the impact lockdown restrictions have had on parents of premature babies across the UK.” “It is important that these experiences are considered in any future restrictions. These insights should inform pre-term care for families under this or any other future pandemic.”

Patients at highest risk of a quick return to emergency departments can be spotted and supported using machine learning, according to new research. The insight could be used to help reduce reattendance rates, easing pressure on emergency departments. Southampton researchers trained their machine learning model on thousands of visits to the emergency department at University Hospital Southampton. It is hoped the approach can now be tested on datasets from more NHS Trusts. It could then begin to support decision-making processes in emergency departments across the UK. Higher and lower risk reattendance The use of emergency departments has been growing steadily over the last decade. This has contributed to increased overcrowding and extended waiting times. The Southampton research aims to curb this trend by helping reduce the number of short-term reattendances. This is where a patient returns to an emergency department within 72 hours of being discharged. The initial results show that machine-learning models can be used to classify patients, with moderate performance, into low and high-risk groups. Scientists have published their findings in Scientific Reportsexternal link. Dr Francis Chmiel, lead author, says: “This model could serve as a check prior to a patient exiting from the emergency department or earlier in the process to identify possible care actions. The explanation can be extremely valuable by indicating why the patient is likely come back to the hospital, generating pathways to prevent that outcome. “Our hope is that models like this one can be used to reduce pressure on our NHS, to personalise and therefore enhance the care of our NHS patients. This will support the health of both our local population in Southampton, but nationally as well.” Learning through real-word data The new research combined expertise from the University of Southampton and its IT Innovation Centreexternal link with University Hospital Southampton and the NIHR Southampton Biomedical Research Centreexternal link. Computer scientists built a gradient boosting decision tree model. It was trained using 35,447 attendances by 28,945 patients in Southampton. This was then evaluated on a hold-out test set featuring 8,847 attendances by 7,237 patients. Dr Dan Burns, a Research Engineer at the IT Innovation Centre within the School of Electronics and Computer Science, says: “We extracted a number of variables such as the number of times a person had visited the emergency department in the last 30 days, lifestyle factors such as whether they live alone or have a history of smoking, and the number of conditions on their health record. We used these insights to form an algorithm that could predict whether a patient would be readmitted within 72 hours. “More importantly, in health, we are often seeking explanations behind why the algorithm produced a given prediction. We therefore also applied an explanation algorithm known as SHAP (Shapley Additive exPlanations) to generate a way of explaining which variables contributed most to a given decision by the algorithm for each individual prediction. These were grouped into explanation ‘scores’ that were clustered to be more communicable to clinicians.” Converting risks into a decision support tool Prior research has shown several factors are suggestive of short-term reattendance risk. These include living alone, depression, initial diagnosis and historical emergency department usage. In their exploratory analysis, the Southampton team found that higher reattendance rates were observed for incidents during the night. They also found that certain complaints, such as abdominal pain, had a higher reattendance rate than the hospital average. Knowledge of these risk factors is important to clinical staff, but more support could be available in the future optimise decision-making before discharge.

Healthy 18-55 year olds are being called on for a trial investigating immunity to whooping cough. Vaccine less effective against life-threatening disease Whooping cough, or pertussis, causes persistent coughing and breathing difficulties for up to three months. Whilst adults can have no symptoms, mild cold-like symptoms or sometimes a prolonged cough, the effects on babies under six months can be severe and even life-threatening. Caused by bacteria, it is highly infectious spreading through coughs and sneezes. It affects around 16 million people every year worldwide, particularly in developing countries. All UK babies are offered a vaccine, but this doesn’t offer lifelong protection. It is also less effective than when introduced 15 years ago. That’s contributed to a four-fold rise in UK cases, from 6,216 between 2005 and 2011 to 25,891 during 2012-2018. Nose drops to investigate immunity Prof Robert Read has pioneered the practice of giving people bacteria in their nose to prevent disease. He now aims to use that approach to investigate long-lasting immunity to whooping cough and help with the development of new vaccines. The PERISCOPE study will use nose drops to give participants a small, carefully refined dose of Bordetella pertussis bacteria - enough for the bacteria to settle in the nose and hopefully trigger an immune response, but not enough to make the person sick. The team will then look at participants’ immune responses against the bacteria, to see how well they protect people against future whooping cough infection. At the end of the study they will give the participants antibiotics to clear the bacteria. Taking part The study involves attending up to 12 visits over 4-6 months at the NIHR Southampton Clinical Research Facility and a course of antibiotics. Participants will be compensated up to £1000 for their time, travel and inconvenience. If you are interested in taking part, please contact the study team at UHS.recruitmentCRF@nhs.net or call 023 8120 3853.

A year-long study led by Southampton researchers has shown children with a weakened immune system are not more likely to become seriously ill with COVID-19. The ImmunoCOVID19 study, led by Dr Hans de Graaf, sent weekly COVID-19 questionnaires to ‘immunocompromised’ children or their parents between March 2020 and March 2021. The children all had a weakened immune system, either due to a health condition or the medication they were taking, such as chemotherapy drugs to treat cancer. The results, published in The Journal of Infection, found these children are not at greater risk of severe disease after catching COVID-19 compared to children in the general UK population. Reassuring results In total 1,527 families from 46 hospitals took part, completing a weekly online survey that included questions on COVID-19 symptoms and PCR test results. No COVID-19 cases were reported until September 2020. A total of 38 children had positive PCR test results between then and March 2021. Four of these children were hospitalised, but did not require intensive care, and none of the children died. Those who tested positive tended to be older, with symptoms of a fever, cough, and sore throat. This matched the national trend for children who are not immunocompromised. Signs of COVID-19 immunity In the last two months, the researchers also looked for the presence of antibodies to COVID-19 – a sign of developing immunity to the disease – in the blood of 452 unvaccinated children. People who are immunocompromised are less likely to have COVID-19 antibodies after infection, meaning their body’s immune system is unprepared the next time it encounters the virus. Of the 18 children who had a positive COVID-19 test result, half were found to have antibodies. They also detected antibodies in 7.4% of children with no record of having had COVID-19. Dr Hans de Graaf, consultant in paediatric rheumatology and clinical research fellow at University Hospital Southampton, said: “These results provide some much-needed reassurance for immunocompromised children and their parents, who we found experienced high levels of anxiety in relation to COVID-19. “I hope our study gives them the evidence they sought, and they can take comfort from our finding that they are at no higher risk than any other child in the UK.” This research was led by researchers at the NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, with contributions from researchers at the University of Nottingham and Wolfson Centre for Global Virus Research.

New research shows lower dose and shorter course antibiotic treatment of pneumonia in children is safe and works. The data offer new ways of preventing infections resistant to antibiotics. The CAP-IT trial looked at different doses of antibiotic amoxicillin and length of treatment in tackling pneumonia in children. It found little difference in outcomes between high and low doses, or between long and short courses. Southampton’s Prof Saul Faust, Prof Paul Little and Dr Katrina Cathie were co-authors of the findings published in the journal JAMA. Tackling rising antibiotic resistance Antibiotic resistance is a growing threat to health worldwide. It sees bacteria evolve defences against the antibiotics used to kill them. While less common in children’s infections in the UK, antibiotic resistant infections are difficult to treat, making even minor infections potentially life-threatening. Resistance occurs when bacteria are exposed to antibiotics frequently, or for long enough. That sees the toughest individuals survive and multiply. That’s why reducing unnecessary use of antibiotics is key to tackling its rise. The CAP-IT results show the scope for cutting antibiotic use, whilst keeping the same safety and benefits as full dose treatment. Optimising pneumonia treatment Pneumonia is common in young children. It sees the lungs’ air sacs (alveoli) become inflamed, often due to bacterial infection. Amoxicillin is the antibiotic most often used to tackle these infections. CAP-IT is one of the largest trials to try to optimise both dosing and length of treatment. 824 young children (average age 2.5 years) with pneumonia took part at 29 hospitals in the UK and Ireland. On leaving hospital took either a low or high dose of amoxicillin, for either three or seven days. The study team took nasal swabs to check for resistant bacteria then monitored the children for four weeks. Over that time they measured the number of infections needing further antibiotics. At the end of four weeks they took more nasal swabs. New infections, side effects or and levels of resistant bacteria were the same across the groups. Coughing persisted for slightly longer in those taking amoxicillin for three days rather than seven, but here was no difference in any symptoms between high and low dose groups. Prof Saul Faust, Professor of Paediatric Immunology and Infectious Diseases and Director of the NIHR Southampton Clinical Research Facility, said: “These results show we can reduce the amoxicillin dose for some specific groups of children without compromising the quality of the treatment. “That’s great for fighting antibiotic resistance in children’s pneumonia, but also opens the door to similar studies in other infections. That shift will help fight the rise in hard-to-treat antibiotic resistant bacterial infections.” The CAP-IT trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.

Volunteers from Southampton and the surrounding area are set to receive a third lower COVID-19 vaccine booster dose through the COV-BOOST study. The COV-BOOST: Young Adults Fractional Dosing Sub-study is being led by University Hospital Southampton NHS Foundation Trust. Why give lower doses to young people? Young adults have a stronger immune response to vaccines than older adults, and results from COVID-19 vaccine studies have suggested lower doses of the Pfizer or Moderna COVID-19 vaccines may give as good an immune response in young adults as higher doses. Lower doses may also be linked with fewer side effects or lower rates of already rare adverse events. Using lower doses could allow existing stocks of vaccines to be given to more people, which is important while the need for vaccines is greater than the number of doses available globally. Volunteers needed Participants will be randomly selected to receive one of the following doses: A single dose of Pfizer (currently used in the UK booster programme) One third of a single Pfizer dose (currently recommended for 5 - 11 years old in the UK) A half Moderna dose (the dosage used by the NHS as a 3rd dose booster) One quarter of a single Moderna dose The NIHR-supported study is looking for volunteers between 18 to 30 years old who have had two doses of the Pfizer or Moderna COVID-19 vaccines but have not received a booster. People who have tested positive for COVID-19 in the past can also take part in the study. Professor Saul Faust, Chief Investigator and Director of NIHR Southampton Clinical Research Facility, said: “The first phase of the COV-BOOST study looked at the safety, immune responses and side-effects of seven COVID-19 vaccines when used as a third booster jab. The findings have helped shape the UK booster programme and given important evidence towards global vaccination efforts. “In this next phase, we are looking for volunteers aged 18 to 30 to help us investigate the safety and side effect profile of giving lower doses of either the Pfizer or Moderna COVID-19 vaccines. “If we find that giving a lower dose of these vaccines to young adults gives as good an immune response as a higher dose, this could have positive implications for global vaccine supply and may result in a lower side effect profile in this age group. “Our vital COVID-19 vaccine research would not be possible without support from the public, who continue to step forward to take part in our studies. We need young adults from all backgrounds to take part in this new study and I would encourage anyone interested to visit the COV-BOOST to find out more and sign up.” The COV-BOOST study published its full initial results in the Lancet in December 2021, which found several COVID-19 vaccines were safe and boosted immunity and its early findings in September 2021 informed the UK’s booster programme. Taking part Anyone interested in finding out more or taking part in the study can visit the COV-BOOST website, where they can complete the study questionnaire to see if they are eligible. Participants are also being recruited through the NHS COVID-19 Vaccine Research Registry, with boosters given in January and into February. The study will take place at 15 hospitals across England, Wales and Scotland, and will include a total of over 900 participants. All participants will be monitored throughout the study for any potential side effects and will have bloods taken to measure their immune responses on the day of their first visit and then two weeks, one month, three months and eight months following vaccination. All the trial sites are working on ways of including people in research from a wide variety of backgrounds and individuals from ethnic minorities are encouraged to apply.