| Name of vaccine | Comirnaty (generic name BNT162b2) Paediatric Comirnaty (generic name Tozinameran) |
|---|---|
| Vaccine platform | Genetic vaccine (messenger RNA/mRNA) |
| Developer of vaccine | Pfizer/BioNTech |
| Registration | Provisional registration granted by the TGA on 16 February 2021 |
| For use | BNT162b2 registered for use in individuals aged ≥ 12 years Tozinameran registered for use in individuals ≥ 5 years |
| Primary course in immunocompetent individuals | Individuals aged ≥ 12 years should receive 2 doses of 30µ (3-6 weeks apart) Individuals aged 5-11 years should receive 2 doses of 10µ (3-8 weeks apart) |
| Primary course in immunocompromised individual | 3 dose primary schedule, with the third dose 2-6 months post dose 2 |
| Booster dose recommendations | Comirnaty (BNT162b2) approved for use as a booster in individuals aged ≥ 18 years |
| Manufacturer | Doses for Australia will be manufactured overseas |
| Storage requirements | Must be stored at ultra-cold temperatures of -90°C to -60°C. Unopened vials can be stored and transported at domestic freezer temperatures (-25°C to -15°C) for up to 2 weeks. Vials held at these temperatures can then be returned to ultra-cold temperatures for longer term storage ensuring that they remain within the manufacturer’s use by date. Unopened vials can be stored for up to one month (31 days) at temperatures of 2°C to 8°C. Once thawed, Comirnaty cannot be refrozen. |
| Preparation and injection | The vaccine must be thawed before preparation and should only be diluted with the recommended diluent. After reconstitution the vial must be used within six hours. |
Immunogenecity
Pre-clinical trials were conducted in non-human primates (rhesus macaques) and mice. Vaccinated primates, who were challenged with SARS-CoV-2 virus, had no virus detected in the lower respiratory tract and clearance of virus in the nose within three days. These results indicated the vaccine may reduce both infection and transmission.
The US Phase 1 trial included participants aged 18 – 85 years old and compared a placebo to one of two vaccine candidates (BNT162b1, which encoded the SARS-CoV-2 receptor-binding domain; or BNT162b2, which encodes the SARS-CoV-2 full-length spike protein). This trial supported the selection of BNT162b2 (full length spike protein) for advancement to Phase 2/3 trials.
Two doses of BNT162b2 were shown to elicit high SARS-CoV-2 neutralising antibody titres and robust spike protein-specific T-cell responses.
Safety profile
During clinical trials, symptoms following immunisation with Comirnaty were generally mild to moderate and generally short-term. They were less common and milder in older adults (>55 years), compared to younger adults (<55 years). Local reactions including pain (66-83%) and redness (5-7%) at the injection site were more common after the first dose compared to the second dose. Systemic reactions (including fatigue, headache, muscle ache and headache) were more common and severe following the second dose. The incidence of serious adverse events was low and similar in both the vaccine and placebo groups.
Vaccine efficacy
Phase 3 trial data showed 95% vaccine efficacy. Similar vaccine efficacy (generally 90 to 100%) was observed across all subgroups defined by age (>16 years), sex, race, ethnicity, baseline body-mass index, and the presence of co-existing conditions. Older adults, 65 years and over, also had the same vaccine efficacy as younger adults. An immune response was detected less than two weeks after the first dose, and a second dose three weeks later, boosted that response. The study was not designed to assess the efficacy of a single-dose regimen, however, in the interval between the first and second doses, the observed vaccine efficacy against COVID-19 was 52%, reaching full efficacy at least seven days after the second dose.
Paediatric clinical trials
2,260 adolescents (aged 12 to 15 years) were enrolled in a phase 3 trial in the United States (US). A good safety profile and strong immune response was observed with 100% efficacy 7 days after dose 2 of the vaccine. 18 cases of COVID-19 infection observed in the placebo group (n=1,129) versus zero cases in the vaccinated group (n=1,131).
2,268 children (aged 5 to 11 years) participated in a phase 2-3 clinical trial. Participants in the vaccine group were administered a 2 dose course of 10 micrograms of Comirnaty (Pfizer), 21 days apart. A similar safety profile to that seen in the ≥ 12 year old age group was observed in this younger cohort. A robust immune response was reported with a vaccine efficacy of 90.7% more than 7 days after the second dose. 3 cases of COVID-19 disease were observed in the vaccine group (n=5,157) and 16 cases among the placebo group (n=751).
For further information refer to MVEC: COVID-19 vaccination in children.
Post-licensure surveillance
Allergies
A true vaccine allergy (anaphylaxis) is a rare side effect occurring for all vaccines at a rate of approximately 1 case per million vaccine doses administered. Post-licensure surveillance of Comirnaty in the US has shown that it has a slightly higher rate of anaphylaxis with approximately 4.7 cases per million doses administered. Most cases (89%) occurred within 30 minutes of vaccination and 24% had a history of prior anaphylaxis.
Myocarditis/pericarditis
A small number of cases of myocarditis and pericarditis have been reported in individuals vaccinated with COVID-19 mRNA vaccines (eg. Comirnaty and Moderna). Reports have predominantly involved adolescents and young adults, more commonly males, after the second dose of vaccine. Symptom onset has typically been seen within 4 days of vaccination.
Resources
- Pfizer: Our progress in developing an investigational COVID-19 vaccine
- TGA: COVID-19 vaccine: Pfizer Australia – COMIRNATY BNT162b2 (mRNA)
- CDC: Pfizer/BioNTech COVID-19 vaccine
- NEJM: Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates
- NEJM: Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine
- TGA: Wider storage and transportation conditions for the Pfizer COVID-19 vaccine now approved
- TGA: TGA approves more flexible storage conditions for Pfizer-BioNTech COVID-19 vaccine
- ATAGI: Clinical guidance on use of COVID-19 vaccine in Australia in 2021
- JAMA Network: Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US
- BMJ: Covid-19: Pfizer reports 100% vaccine efficacy in children aged 12 to 15
- Pfizer: Clinical trials in children and adolescents
Authors: MVEC Education Team
Reviewed by: Rachael McGuire, (MVEC Education Nurse Coordinator) and Francesca Machingaifa (MVEC Education Nurse Coordinator)
Date: January 23, 2022
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.