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Intradermal Influenza Vaccine Study in Elders

Primary Purpose

Influenza

Status
Completed
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Fluzone Influenza Vaccine (2007-2008)
Sponsored by
PATH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Influenza focused on measuring influenza, prevention, intradermal, vaccine, delivery, elderly

Eligibility Criteria

65 Years - undefined (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Ambulatory, medically stable persons 65 years of age or older
  • Able to read and understand informed consent
  • Available during the trial period and for follow-up
  • Able to understand and comply with planned study procedures
  • Able to be contacted by telephone for follow-up of adverse events

Exclusion Criteria:

  • Known allergy to eggs or other components of vaccine (i.e., thimerosal)
  • History of Guillain-Barré Syndrome (GBS)
  • Has a confirmed or suspected immunodeficient or immunosuppressive condition (including congenital or acquired immunosuppressive therapy, and human immunodeficiency virus [HIV])
  • End-stage renal disease requiring hemodialysis
  • Active neoplastic disease or history of any hematologic malignancy (except localized skin or prostate cancer that is stable in the absence of therapy)
  • Acute or chronic condition that (in the opinion of the investigator) would render vaccination unsafe or would interfere with the evaluation of responses (including but not limited to the following: known chronic liver disease, significant renal disease, oxygen-dependent chronic lung disease, New York Heart Association Functional Class III or IV, unstable or progressive neurologic disorder, insulin controlled diabetes mellitus)
  • Use of experimental vaccines within the month prior to study entry, or expected use of experimental or licensed vaccines or blood/blood products during the duration of the study.
  • Receipt of immunoglobulin or other blood product within 3 months prior to enrollment
  • Receipt of other licensed vaccines within the preceding 4 weeks
  • History of a severe reaction following influenza vaccination
  • Current or planned participation in a research study of an investigational drug. Participation in research studies that involve use of licensed drugs, for either approved or investigational indications, will be permitted with the approval of the PI, as will participation in research studies that do not involve vaccines or medications.
  • Current use or previous chronic administration, defined as >14 days during the previous six months, of immunosuppressants or other immune-modifying drugs. (For oral or injected corticosteroids, the immune-modifying dose is defined as prednisone or its equivalent >10 mg/day or >800mcg per day of inhaled beclomethasone dipropionate or equivalent ). Topical steroids are allowed.
  • Use of cytotoxic therapy in the previous 2 years.
  • Plans to receive cytotoxic therapy during the study period.
  • Concurrent moderate to severe illness. Need to defer vaccination until recovery. (Vaccination is not contraindicated in subjects with mild illnesses or with low-grade fever).

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Active Comparator

    Experimental

    Arm Label

    0.3 mL Influenza Vaccine ID

    0.15 mL twice Influenza Vaccine ID

    0.5 mL Influenza Vaccine by IM

    0.3 mL Influenza Vaccine IM

    Arm Description

    60% dose - 0.3 mL delivered intradermally with needle and syringe

    60% dose - 0.15 mL delivered twice intradermally with needle and syringe

    100% dose - 0.5mL delivered intramuscularly with needle and syringe

    60% dose - 0.3 mL delivered intramuscularly with needle and syringe

    Outcomes

    Primary Outcome Measures

    Seroprotection Pre- and Post- Vaccination
    Seroprotection before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) Intramuscular (IM) or Reduced-Dose (9 mg) Intradermal (ID) Injections for A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)

    Secondary Outcome Measures

    Geometric Mean Titer (GMT) Pre- and Post- Vaccination
    GMT before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) IM or Reduced-Dose (9 mg) ID Injections. A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
    Assessment of Reactogenicity
    Maximum solicited systemic and local signs and symptoms during the week after initial vaccination, by Dose and Randomization Assignment

    Full Information

    First Posted
    July 12, 2007
    Last Updated
    June 8, 2012
    Sponsor
    PATH
    Collaborators
    VA Puget Sound Health Care System, Seattle Institute for Biomedical and Clinical Research
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00504231
    Brief Title
    Intradermal Influenza Vaccine Study in Elders
    Official Title
    Intradermal vs. Intramuscular Delivery of Influenza Vaccine in Immunocompetent Elders
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2011
    Overall Recruitment Status
    Completed
    Study Start Date
    September 2007 (undefined)
    Primary Completion Date
    January 2008 (Actual)
    Study Completion Date
    January 2008 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    PATH
    Collaborators
    VA Puget Sound Health Care System, Seattle Institute for Biomedical and Clinical Research

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This randomized trial compared the immunogenicity of 60% dose intradermal (ID) influenza vaccination to standard intramuscular (IM) vaccination of full-dose or 60% dose vaccine. Pre- and postvaccination measurements in the hemagglutination inhibition antibody (HAI) titer were compared. Participants who received reduced-dose vaccine were revaccinated with full-dose IM vaccine.
    Detailed Description
    This study was an open-label randomized trial consisting of community-dwelling adults 65 years and older living in Puget Sound area in Washington State. Subjects were enrolled and randomly assigned to receive licensed, 2007-2008 Northern Hemisphere TIV vaccine (Fluzone, lot U2440AA; Sanofi Pasteur) containing concentrations of hemagglutinin of each of A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), and B/Malaysia/2506/2004 (B): 15 ug/0.5 mL by the IM route, 9 ug/0.3 mL by the ID or IM route, or 4.5 ug/0.15 mL given twice by ID route to the nondominant arm. A block randomization scheme (1:1:1:1), stratified by sex, was used. For IM vaccination, 0.3 mL or 0.5 mL of vaccine was removed from a multidose (5 mL) vial through a 25-gauge, 1-inch detachable needle (Becton Dickinson) and was injected into the deltoid muscle at a 90 degree angle to the skin. For ID vaccination, 0.3 mL or 0.15 mL was drawn by a TB syringe through a 25-gauge, 5/8-inch needle (Terumo Medical). The needle was inserted at a 15 degree angle to the skin overlying the deltoid of the arm. The vaccine was slowly injected until all material was expelled and induration appeared. Subjects randomized to the 0.15-mL group received 2 side-by-side ID injections 3 cm apart. Participants returned at 4 weeks to determine postvaccination antibody titers. At this follow-up visit, those assigned to reduced dose IM or ID influenza vaccinations then received full-dose IM influenza vaccination. These participants returned in another 4 weeks to repeat HAI titers. A nonrandomized subset of subjects (based on availability and willingness to participate) returned at 14 days after initial vaccination for T cell assays in an exploratory substudy to examine cellular immune response.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Influenza
    Keywords
    influenza, prevention, intradermal, vaccine, delivery, elderly

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    257 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    0.3 mL Influenza Vaccine ID
    Arm Type
    Experimental
    Arm Description
    60% dose - 0.3 mL delivered intradermally with needle and syringe
    Arm Title
    0.15 mL twice Influenza Vaccine ID
    Arm Type
    Experimental
    Arm Description
    60% dose - 0.15 mL delivered twice intradermally with needle and syringe
    Arm Title
    0.5 mL Influenza Vaccine by IM
    Arm Type
    Active Comparator
    Arm Description
    100% dose - 0.5mL delivered intramuscularly with needle and syringe
    Arm Title
    0.3 mL Influenza Vaccine IM
    Arm Type
    Experimental
    Arm Description
    60% dose - 0.3 mL delivered intramuscularly with needle and syringe
    Intervention Type
    Biological
    Intervention Name(s)
    Fluzone Influenza Vaccine (2007-2008)
    Other Intervention Name(s)
    Fluzone
    Intervention Description
    Manufactured by Sanofi Pasteur
    Primary Outcome Measure Information:
    Title
    Seroprotection Pre- and Post- Vaccination
    Description
    Seroprotection before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) Intramuscular (IM) or Reduced-Dose (9 mg) Intradermal (ID) Injections for A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
    Time Frame
    1 month
    Secondary Outcome Measure Information:
    Title
    Geometric Mean Titer (GMT) Pre- and Post- Vaccination
    Description
    GMT before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) IM or Reduced-Dose (9 mg) ID Injections. A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
    Time Frame
    1 month
    Title
    Assessment of Reactogenicity
    Description
    Maximum solicited systemic and local signs and symptoms during the week after initial vaccination, by Dose and Randomization Assignment
    Time Frame
    1 week

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Ambulatory, medically stable persons 65 years of age or older Able to read and understand informed consent Available during the trial period and for follow-up Able to understand and comply with planned study procedures Able to be contacted by telephone for follow-up of adverse events Exclusion Criteria: Known allergy to eggs or other components of vaccine (i.e., thimerosal) History of Guillain-Barré Syndrome (GBS) Has a confirmed or suspected immunodeficient or immunosuppressive condition (including congenital or acquired immunosuppressive therapy, and human immunodeficiency virus [HIV]) End-stage renal disease requiring hemodialysis Active neoplastic disease or history of any hematologic malignancy (except localized skin or prostate cancer that is stable in the absence of therapy) Acute or chronic condition that (in the opinion of the investigator) would render vaccination unsafe or would interfere with the evaluation of responses (including but not limited to the following: known chronic liver disease, significant renal disease, oxygen-dependent chronic lung disease, New York Heart Association Functional Class III or IV, unstable or progressive neurologic disorder, insulin controlled diabetes mellitus) Use of experimental vaccines within the month prior to study entry, or expected use of experimental or licensed vaccines or blood/blood products during the duration of the study. Receipt of immunoglobulin or other blood product within 3 months prior to enrollment Receipt of other licensed vaccines within the preceding 4 weeks History of a severe reaction following influenza vaccination Current or planned participation in a research study of an investigational drug. Participation in research studies that involve use of licensed drugs, for either approved or investigational indications, will be permitted with the approval of the PI, as will participation in research studies that do not involve vaccines or medications. Current use or previous chronic administration, defined as >14 days during the previous six months, of immunosuppressants or other immune-modifying drugs. (For oral or injected corticosteroids, the immune-modifying dose is defined as prednisone or its equivalent >10 mg/day or >800mcg per day of inhaled beclomethasone dipropionate or equivalent ). Topical steroids are allowed. Use of cytotoxic therapy in the previous 2 years. Plans to receive cytotoxic therapy during the study period. Concurrent moderate to severe illness. Need to defer vaccination until recovery. (Vaccination is not contraindicated in subjects with mild illnesses or with low-grade fever).
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Ru-Chien Chi, MD
    Organizational Affiliation
    VAPSHCS
    Official's Role
    Principal Investigator
    First Name & Middle Initial & Last Name & Degree
    Kathy Neuzil, MD
    Organizational Affiliation
    PATH
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    20377407
    Citation
    Chi RC, Rock MT, Neuzil KM. Immunogenicity and safety of intradermal influenza vaccination in healthy older adults. Clin Infect Dis. 2010 May 15;50(10):1331-8. doi: 10.1086/652144.
    Results Reference
    derived

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    Intradermal Influenza Vaccine Study in Elders

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