ABSTRACT Introduction The world is currently fighting a COVID-19 pandemic, perhaps the most disruptive infectious disease outbreak since the 1918 Spanish influenza. Governments have taken drastic measures to curb the spread of SARS-CoV-2, and the development of safe and efficacious vaccine candidates is being accelerated. The possibility of vaccine-mediated disease enhancement with coronavirus vaccines has been flagged as a potential safety concern, and, despite the urgent need, should be thoroughly assessed as vaccines against SARS-CoV-2 are being tested. Area covered We review the in vivo evidence suggesting a theoretical risk of disease enhancement after vaccination with SARS-CoV and MERS-CoV vaccine candidates. We also identify knowledge gaps that need to be filled to maximize the chance of developing a safe vaccine and minimize the risk of encountering disease enhancement in vaccinated individuals after exposure to SARS-CoV-2. Expert opinion We compile and propose avenues to investigate the risk of vaccine-mediated disease enhancement both during pre-clinical and early clinical development. While the pressing need for a vaccine against COVID-19 (and future epidemic coronaviruses) cannot be ignored, we advocate to keep safety at the center of the debate. Protecting individuals with effective and safe vaccines should be a priority, even during extraordinary times like the COVID-19 pandemic.
【저자키워드】 COVID-19, SARS-CoV-2, coronavirus, vaccine safety, disease enhancement, 【초록키워드】 Coronaviruses, Vaccine, vaccination, SARS-CoV, Influenza, knowledge, COVID-19 pandemic, risk, MERS-CoV, Spread, Epidemic, vaccine candidate, coronavirus vaccine, infectious disease outbreak, in vivo, disease, Evidence, Safe, individual, measure, clinical development, vaccine candidates, vaccinated individual, while, theoretical risk, Spanish, expert, effective, tested, identify, accelerated, Area, drastic, Protecting, 【제목키워드】 disease,