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Intradermal Trivalent Influenza Vaccine With Imiquimod

Primary Purpose

Chronic Illness

Status
Completed
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
influenza vaccine
Imiquimod
influenza vaccine
Aqueous cream
influenza vaccine
Aqueous cream
Sponsored by
The University of Hong Kong
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Chronic Illness focused on measuring intradermal, influenza, vaccination

Eligibility Criteria

21 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • All adult patients at the age of 21 or above with chronic illness and given written informed consent
  • Subjects must be available to complete the study and comply with study procedures. Willingness to allow for serum samples to be stored beyond the study period, for potential additional future testing to better characterize immune response.

Exclusion Criteria:

  • Clinically significant immune-related diseases or significant recent co-morbidities
  • Inability to comprehend and to follow all required study procedures
  • History or any illness that might interfere with the results of the study or pose additional risk to the subjects due to participation in the study
  • Have received 2011/2012 TIV
  • Have a recent history (documented, confirmed or suspected) of a flu-like disease within a week of vaccination.
  • Have a known allergy to eggs or other components of the Study Vaccines (including gelatin, formaldehyde, octoxinol, thimerosal, and chicken protein), or history of any anaphylaxis, serious vaccine reactions, to any excipients.
  • Have a positive urine or serum pregnancy test within 24 hours prior to vaccination, or women who are breastfeeding.
  • Female of childbearing potential, not using any acceptable contraceptive methods for at least 2 months prior to study entry or that do not plan to use acceptable birth control measures during the first 3 weeks after vaccination.
  • Have immunosuppression as a result of an underlying illness or treatment, or use of anticancer chemotherapy or radiation therapy (cytotoxic) within the preceding 36 months.
  • Have an active neoplastic disease or a history of any hematologic malignancy.
  • Have long-term use of glucocorticoids including oral, parenteral or high-dose inhaled steroids (>800 mcg/day of beclomethasone dipropionate or equivalent) within the preceding 6 months. (Nasal and topical steroids are allowed).
  • Have a history of receiving immunoglobulin or other blood product within the 3 months prior to vaccination in this study.
  • Have known active human immunodeficiency virus (HIV) infection, acute hepatitis B or C infection, autoimmune hepatitis and related cirrhosis
  • Received an experimental agent (vaccine, drug, biologic, device, blood product, or medication) within 1 month prior to vaccination in this study or expect to receive an experimental agent during this study. Unwilling to refuse participation in another clinical study through the end of this study.
  • History of progressive or severe neurological disorders
  • Have received any licensed vaccines within 4 weeks or inactivated licensed vaccines within 2 weeks prior to vaccination in this study or plan receipt of such vaccines within 21 days following the second vaccination (only exception being unadjuvanted seasonal influenza vaccines which are allowed until 1 week prior to and after 1 week study vaccinations).
  • Axillary temperature ≥ 38°C or oral temperature ≥ 38.5°C within 3 days of intended study vaccination
  • Surgery planned during the study period that in the Investigator's opinion would interfere with the study visits schedule
  • Have a history of alcohol or drug abuse in the last 5 years.
  • Have a history of Guillain-Barré Syndrome.
  • Have any condition that the investigator believes may interfere with successful completion of the study.

Sites / Locations

  • The University of Hong Kong, Queen Mary Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Experimental

Arm Label

IM vaccine and placebo cream

ID vaccine and placebo cream

ID vaccine and imiquimod cream

Arm Description

A single dose of intramuscular influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with aqueous cream

A single dose of intradermal influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with aqueous cream

A single dose intradermal influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with imiquimod cream applied to the skin before vaccination

Outcomes

Primary Outcome Measures

Seroconversion rate
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination on day 7

Secondary Outcome Measures

Geometric mean titer old increase in influenza antibody titer
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assays on day 21 compared to day 0
Seroprotection rate
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay on day 21
Adverse events (Immediate)
Patients who develop systemic or local adverse events within 30 minutes of vaccination
Geometric mean titer old increase in influenza antibody titer
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay on day 7 compared to day 0
Seroprotection rate
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay on day 7
Geometric mean titer old increase in influenza antibody titer
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay at year 1 compared to day 0
Seroprotection rate
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay at year 1
Seroconversion rate
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination at year 1
Adverse events (7 days)
Patients who develop systemic or local adverse events within 1 week of vaccination
Seroconversion rate
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination on day 21
Geometric mean titer old increase in influenza antibody titer
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay at year 1 compared to day 0
Seroprotection rate
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay at year 1
Seroconversion rate
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination at year 1
Effectiveness
hospitalization for pneumonia or influenza
Effectiveness
Nasopharyngeal sample positive for influenza A

Full Information

First Posted
January 9, 2012
Last Updated
December 8, 2013
Sponsor
The University of Hong Kong
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1. Study Identification

Unique Protocol Identification Number
NCT01508884
Brief Title
Intradermal Trivalent Influenza Vaccine With Imiquimod
Official Title
Efficacy and Effectiveness of Intradermal Trivalent Influenza Vaccine With Topical Imiquimod, a Double Blind Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
December 2013
Overall Recruitment Status
Completed
Study Start Date
January 2012 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
December 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The University of Hong Kong

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Despite the WHO International Health Regulations Emergency Committee declared an end to the 2009 H1N1 pandemic globally, the emergence of the novel 2009 H1N1 virus in March 2009 has affected more than 214 countries with at least 18000 deaths [1]. Patients with chronic underlying illness and extreme of ages are at risk of developing severe disease and complications [2-3]. Resistance to oseltamivir has also been reported [4]. Therefore, vaccination with the 2010/2011 trivalent influenza vaccine (TIV) with the 2009 H1N1-like virus incorporated will be the best protection against the influenza infection, especially among the at risk population. Recent study on dose sparing seasonal influenza vaccine delivered via a novel intradermal microneedle has demonstrated good immunogenic responses similar to full-dose intramuscular vaccination [6]. Poor immunogenicity of the H1N1 2009 component of the trivalent influenza has been reported [7]. Study has also suggested the combined intradermal vaccination with local stimulation of dermal antigen presenting cells by applying imiquimod cream (Aldara) to the injection site, which activate antigen presenting cells (APC) through the toll-like receptor 7 (TLR7) may produce better immunogenicity [8]. Imiquimod cream is currently registered for the treatment of warts and basal cell carcinoma. Scientific evidence has demonstrated that after treatment with imiquimod, the antigen is processed and presented to cells of the adaptive immune system leading to clearance of the virus and subsequent clearance of the lesions [9]. In addition to functional maturation, imiquimod induces migration of dendritic cells from the dermis to draining lymph nodes [10,11]. Subcutaneous administration of imiquimod as vaccine adjuvant simultaneously with the antigen of interest, has shown to induce enhanced responses towards the administered antigen [12]. We therefore performed a prospective, double blind, randomized controlled study to compare the safety and immunogenicity between intradermal 2011/2012 TIV immunization with pretreatment of imiquimod cream and conventional full dose intramuscular 2011/2012 TIV immunization with pretreatment of aqueous cream as control.
Detailed Description
References World Health Organization. Influenza A (H1N1) - update 95 [cited 2010 April 10]. Available from http://www.who.int/csr/don/2009_12_30/en/index.html Echevarria-Zuno S, Mejia-Arangure JM, Mar-Obeso AJ, et al. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis. Lancet 2009; 374: 2072-9. Louie JK, Acosta M, Winter K, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA 2009; 302: 1896-902. Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009; 361:1935-44. Chen H, Cheung CL, Tai H, et al. Oseltamivir-resistant influenza A pandemic (H1N1) 2009 virus, Hong Kong, China. Emerg Infect Dis 2009;15:1970-2. Van Damme P, Oosterhuis-Kafeja F, Van der Wielen M, et al. Safety and efficacy of a novel microneedle device for dose sparing intradermal influenza vaccination in healthy adults. Vaccine 2009;27:454-9 Myers CA, Faix DJ, Blair PJ. Possible reduced effectiveness of the 2009 H1N1 component of live, attenuated influenza vaccine. Clin Infect Dis. 2011;15;53:207-8.9. Roukens R, Vossen AC, Boland GJ, et al. Intradermal hepatitis B vaccination in non-responders after topical application of imiquimod (Aldara). Vaccine 2010;4288-4293. Tyring S, Conant M, Marini M, Van Der Meijden W, Washenik K. Imiquimod, an international update on therapeutic uses in dermatology. Int J Dermatol 2002;41(11):810-6. Burns Jr RP, Ferbel B, Tomai M, Miller R, Gaspari AA. The imidazoquinolines, imiquimod and R-848, induce functional, but not phenotypic, maturation of human epidermal Langerhans' cells. Clin Immunol 2000;94(1):13-23. Suzuki H, Wang B, Shivji GM, Toto P, Amerio P, Tomai MA, et al. Imiquimod, a topical immune response modifier, induces migration of Langerhans cells. J Invest Dermatol 2000;114(1):135-41. Thomsen LL, Topley P, Daly MG, Brett SJ, Tite JP. Imiquimod and resiquimod in a mouse model: adjuvants for DNA vaccination by particle-mediated immunotherapeutic delivery. Vaccine 2004;22(13-14):1799-809.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Illness
Keywords
intradermal, influenza, vaccination

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
93 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IM vaccine and placebo cream
Arm Type
Active Comparator
Arm Description
A single dose of intramuscular influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with aqueous cream
Arm Title
ID vaccine and placebo cream
Arm Type
Active Comparator
Arm Description
A single dose of intradermal influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with aqueous cream
Arm Title
ID vaccine and imiquimod cream
Arm Type
Experimental
Arm Description
A single dose intradermal influenza vaccine (15ug non-adjuvanted 2011/2012 TIV) with pre-treatment of the injected skin with imiquimod cream applied to the skin before vaccination
Intervention Type
Biological
Intervention Name(s)
influenza vaccine
Other Intervention Name(s)
Intanza 15
Intervention Description
single dose of intradermal 15 mcg non-adjuvanted 2011/2012 trivalent influenza vaccine
Intervention Type
Drug
Intervention Name(s)
Imiquimod
Other Intervention Name(s)
Aldara
Intervention Description
pretreatment with topical imiquimod cream to the injection site before vaccination
Intervention Type
Biological
Intervention Name(s)
influenza vaccine
Other Intervention Name(s)
Intanza 15
Intervention Description
single dose of intradermal 15mcg non-adjuvanted 2011/2012 trivalent influenza vaccine
Intervention Type
Drug
Intervention Name(s)
Aqueous cream
Intervention Description
pretreatment with topical aqueous cream to the injection site before vaccination
Intervention Type
Biological
Intervention Name(s)
influenza vaccine
Other Intervention Name(s)
Vaxigrip
Intervention Description
single dose of intramuscular 15mcg non-adjuvanted 2011/2012 trivalent influenza vaccine
Intervention Type
Drug
Intervention Name(s)
Aqueous cream
Intervention Description
pretreatment with topical aqueous cream to the injection site before vaccination
Primary Outcome Measure Information:
Title
Seroconversion rate
Description
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination on day 7
Time Frame
day 7
Secondary Outcome Measure Information:
Title
Geometric mean titer old increase in influenza antibody titer
Description
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assays on day 21 compared to day 0
Time Frame
day 21
Title
Seroprotection rate
Description
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay on day 21
Time Frame
day 21
Title
Adverse events (Immediate)
Description
Patients who develop systemic or local adverse events within 30 minutes of vaccination
Time Frame
30 minutes after vaccination
Title
Geometric mean titer old increase in influenza antibody titer
Description
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay on day 7 compared to day 0
Time Frame
day 7
Title
Seroprotection rate
Description
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay on day 7
Time Frame
day 7
Title
Geometric mean titer old increase in influenza antibody titer
Description
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay at year 1 compared to day 0
Time Frame
year 1
Title
Seroprotection rate
Description
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay at year 1
Time Frame
year 1
Title
Seroconversion rate
Description
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination at year 1
Time Frame
Year 1
Title
Adverse events (7 days)
Description
Patients who develop systemic or local adverse events within 1 week of vaccination
Time Frame
7 days after vaccination
Title
Seroconversion rate
Description
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination on day 21
Time Frame
Day 21
Title
Geometric mean titer old increase in influenza antibody titer
Description
The GMT fold increase in influenza antibody titer by hemagglutination inhibition or microneutralization antibody assay at year 1 compared to day 0
Time Frame
Day 14
Title
Seroprotection rate
Description
The percentage of subjects achieving an antibody titer achieving an influenza antibody titer of 1:40 or above by hemagglutination inhibition or microneutralization antibody assay at year 1
Time Frame
Day 14
Title
Seroconversion rate
Description
The percentage of subjects with an hemagglutination inhibition antibody titre <10 at baseline and a post-vaccination titre of ≥40 or a titre >10 at baseline and at least a four-fold increase in titre post-vaccination at year 1
Time Frame
Day 14
Title
Effectiveness
Description
hospitalization for pneumonia or influenza
Time Frame
1 year post vaccination
Title
Effectiveness
Description
Nasopharyngeal sample positive for influenza A
Time Frame
1 year post vaccination

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All adult patients at the age of 21 or above with chronic illness and given written informed consent Subjects must be available to complete the study and comply with study procedures. Willingness to allow for serum samples to be stored beyond the study period, for potential additional future testing to better characterize immune response. Exclusion Criteria: Clinically significant immune-related diseases or significant recent co-morbidities Inability to comprehend and to follow all required study procedures History or any illness that might interfere with the results of the study or pose additional risk to the subjects due to participation in the study Have received 2011/2012 TIV Have a recent history (documented, confirmed or suspected) of a flu-like disease within a week of vaccination. Have a known allergy to eggs or other components of the Study Vaccines (including gelatin, formaldehyde, octoxinol, thimerosal, and chicken protein), or history of any anaphylaxis, serious vaccine reactions, to any excipients. Have a positive urine or serum pregnancy test within 24 hours prior to vaccination, or women who are breastfeeding. Female of childbearing potential, not using any acceptable contraceptive methods for at least 2 months prior to study entry or that do not plan to use acceptable birth control measures during the first 3 weeks after vaccination. Have immunosuppression as a result of an underlying illness or treatment, or use of anticancer chemotherapy or radiation therapy (cytotoxic) within the preceding 36 months. Have an active neoplastic disease or a history of any hematologic malignancy. Have long-term use of glucocorticoids including oral, parenteral or high-dose inhaled steroids (>800 mcg/day of beclomethasone dipropionate or equivalent) within the preceding 6 months. (Nasal and topical steroids are allowed). Have a history of receiving immunoglobulin or other blood product within the 3 months prior to vaccination in this study. Have known active human immunodeficiency virus (HIV) infection, acute hepatitis B or C infection, autoimmune hepatitis and related cirrhosis Received an experimental agent (vaccine, drug, biologic, device, blood product, or medication) within 1 month prior to vaccination in this study or expect to receive an experimental agent during this study. Unwilling to refuse participation in another clinical study through the end of this study. History of progressive or severe neurological disorders Have received any licensed vaccines within 4 weeks or inactivated licensed vaccines within 2 weeks prior to vaccination in this study or plan receipt of such vaccines within 21 days following the second vaccination (only exception being unadjuvanted seasonal influenza vaccines which are allowed until 1 week prior to and after 1 week study vaccinations). Axillary temperature ≥ 38°C or oral temperature ≥ 38.5°C within 3 days of intended study vaccination Surgery planned during the study period that in the Investigator's opinion would interfere with the study visits schedule Have a history of alcohol or drug abuse in the last 5 years. Have a history of Guillain-Barré Syndrome. Have any condition that the investigator believes may interfere with successful completion of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ivan FN Hung, MD FRCP
Organizational Affiliation
The University of Hong Kong
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Hong Kong, Queen Mary Hospital
City
Hong Kong
Country
Hong Kong

12. IPD Sharing Statement

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Intradermal Trivalent Influenza Vaccine With Imiquimod

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