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Phase III Trial to Evaluate Efficacy and Safety of a Tetravalent Dengue Vaccine

Primary Purpose

Dengue

Status
Active
Phase
Phase 3
Locations
Brazil
Study Type
Interventional
Intervention
Dengue 1,2,3,4 (attenuated) vaccine
Placebo
Sponsored by
Butantan Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Dengue

Eligibility Criteria

24 Months - 59 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Children who have completed 24 months of age, adolescents and adults who have not completed 60 years of age;
  2. Agree with periodic contacts, either/or by phone, electronic means, and home visits.
  3. Show voluntary intention to participate in the study, documented by the participant's or participant's legal representative's signature of the informed consent form.

Exclusion Criteria:

  1. For women: Pregnancy (confirmed by positive beta-hCG test) or breastfeeding;
  2. Evidence of active neurological, cardiac, pulmonary, hepatic or renal disease as per clinical history and/or physical examination;
  3. Compromised immune system diseases including: decompensated diabetes mellitus, cancer (except basal cell carcinoma), congenital or acquired immune deficiencies and not controlled autoimmune, as per clinical history and/or physical examination;
  4. Behavioral, cognitive or psychiatric disease that in the opinion of the principal investigator or his representative physician, affects the participant ability to understand and cooperate with all study protocol requirements;
  5. Abusive usage of alcohol or drugs in the past 12 months that has caused medical, professional or family problems, indicated by clinical history;
  6. History of severe allergic reactions or anaphylaxis to the vaccine or to components of the vaccine in study;
  7. History of asplenia;
  8. Use of any investigational product within 28 days before or after receiving this study vaccination;
  9. Has participated in another clinical trial six months prior to inclusion in the study or planning to participate in another clinical trial within 2 years following inclusion;
  10. Use of immunosuppressant drugs such as: antineoplastic chemotherapy, radiation therapy, immunosuppressants to induce tolerance to transplants, and corticosteroids use (except topical or nasal). For this protocol will be considered for exclusion use of corticosteroids 3 months prior to the inclusion in the study and 6 months prior to the inclusion for the other therapies mentioned, and planned use of any immunosuppressant therapy within 2 years following inclusion in the study. It will be considered immunosuppressive dose of corticosteroids the equivalent to a dose ≥20 mg of prednisone per day for adults and the equivalent of prednisone at 2 mg/kg/day for children for over 7 days;
  11. Have received blood products in the past three months, including transfusions or immunoglobulin, or scheduled administration of blood products or immunoglobulin for the following 2 years after vaccination;
  12. Fever or suspected fever within 72 hours prior to vaccination or axillary temperature greater than 37,8°C on the day of vaccination (inclusion might be postponed until participant has completed 72 hours of no fever);
  13. Have received live virus vaccine within 28 days or killed virus vaccine in the last 14 days prior to vaccination, or have a scheduled immunization during the first 28 days after receiving the investigational product;
  14. Any other condition that might put in risk the safety/rights of a potential participant or hurdle his/her compliance with this protocol in investigator's opinion or his representative physician.

Sites / Locations

  • Fundação de Medicina Tropical Doutor Heitor Vieira Dourado
  • Instituto Gonçalo Muniz - Fiocruz Bahia
  • Universidade Federal do Ceará
  • Universidade de Brasília
  • Universidade Federal de Minas Gerais
  • Hospital Universitário Júlio Müller da Universidade Federal de Mato Grosso
  • Universidade Federal de Mato Grosso do Sul
  • Centro de Pesquisas Aggeu Magalhães - Fiocruz Pernambuco
  • Hospital Escola da Universidade Federal de Pelotas (HEUFPel)
  • Universidade Federal de Roraima - UFRR
  • Centro de Pesquisas em Medicina Tropical de Rondônia (CEPEM)
  • Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul
  • Universidade Federal de Sergipe
  • Santa Casa de Misericórdia de São Paulo - CSEBF
  • Faculdade de Medicina de São José do Rio Preto - FAMERP
  • Instituto de Infectologia Evandro Chagas - Fiocruz
  • HCFMUSP

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dengue 1,2,3,4 (attenuated) vaccine

Placebo

Arm Description

Dengue 1,2,3,4 (attenuated) vaccine Single dose, SC

Placebo Single dose, SC

Outcomes

Primary Outcome Measures

Efficacy (incidence density of symptomatic dengue cases, virologically confirmed)
The primary efficacy outcome is incidence density of symptomatic dengue cases, virologically confirmed, after 28 days post-vaccination. Virological confirmation might be done by viral isolation, RT-PCR and/or detection of NS1.
Safety (adverse reactions)
The primary safety outcome is the frequency of local and systemic adverse reactions, solicited and non-solicited in the three age groups, within the first 21 days post-vaccination. Adverse reactions are defined as adverse events that have a reasonable causal relationship with vaccination.

Secondary Outcome Measures

Efficacy (incidence density of dengue cases confirmed virologically, regarding previous exposure to dengue viruses. )
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding previous exposure to dengue viruses. To demonstrate previous exposure or not to dengue viruses, validated serological methods such as: Elisa IgG Indirect, hemagglutination inhibition test or neutralizing antibodies (e.g., VRNT) or another validated test will be used. In case of doubtful results, more than one technique may be used to confirm the diagnosis.
Efficacy (incidence density of dengue cases confirmed virologically, regarding the viral serotype)
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding the viral serotype. Virological diagnosis of the viral serotype will be performed using the viral isolation technique or RT-PCR.
Efficacy (incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not)
Incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not, after 28 days of vaccination. Laboratory confirmation of these cases will occur through serological and/or virological tests.
Safety ( frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses )
The frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses during the 21-day period after vaccination.
Safety (frequency of unsolicited adverse reactions)
The frequency of unsolicited adverse reactions after 21 days of vaccination until the end of the study.
Immunogenicity (consistency of the immune response to different batches of the vaccine )
The geometric mean of neutralizing antibody titers for each serotype in the fourth week after vaccination in a subgroup of adult participants without previous exposure to dengue immunized with three consecutive batches of dengue vaccine 1,2,3,4 (attenuated).
Immunogenicity (non-inferiority between simplified formulation vs. conventional formulation)
The geometric mean of titers of neutralizing antibodies for each serotype at Week 4 postvaccination in a subgroup of adult participants without previous prior exposure to dengue and vaccinated with the conventional formulation and the simplified formulation of the dengue 1, 2, 3, 4 (attenuated) vaccine.

Full Information

First Posted
March 30, 2015
Last Updated
January 16, 2023
Sponsor
Butantan Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02406729
Brief Title
Phase III Trial to Evaluate Efficacy and Safety of a Tetravalent Dengue Vaccine
Official Title
Phase III, Double-Blind, Randomized, Placebo-Controlled Trial to Evaluate the Efficacy, Safety, and Immunogenicity of the Dengue 1, 2, 3, 4 (Attenuated) Vaccine From Instituto Butantan
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 22, 2016 (Actual)
Primary Completion Date
July 13, 2021 (Actual)
Study Completion Date
November 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Butantan Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a randomized, multicenter, double-blind, placebo-controlled Phase III study that will evaluate efficacy and safety of a live attenuated, tetravalent, lyophilized dengue vaccine produced by Butantan Institute. The study will be carried out in multiple sites in Brazil. The study will be community-based in select urban areas where there's dengue transmission. Study's intervention will be a single dose of the tetravalent dengue vaccine or placebo in a ratio 2:1. For efficacy analysis will be considered all dengue cases occurring after 28 days post-vaccination in the entire population of 16944 participants. For safety analysis participants will be divided in three age groups: 18 to 59 ys, 7-17 ys and 2 to 6 ys. In each of these age groups there will be a minimum of 4992 participants. The age groups of 18 to 59 ys and 7 to 17 ys will start first. Once safety data for the first 21 days after vaccination is analysed for 450 participants in 7-to17-ys age group, the following group, of 2 to 6 ys, will start. The study's hypothesis is that the vaccine under investigation and produced by Butantan Institute is safe and provides protection against dengue symptomatic disease of 80% or more with a lower bound of the 95% confidence interval of 25%. This way, the expected number of dengue cases virologically confirmed is 24 or more which will provide a response in terms of vaccine efficacy. All participants will be followed up for five years to verify dengue incidence, regardless severity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dengue

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
16935 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dengue 1,2,3,4 (attenuated) vaccine
Arm Type
Experimental
Arm Description
Dengue 1,2,3,4 (attenuated) vaccine Single dose, SC
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo Single dose, SC
Intervention Type
Biological
Intervention Name(s)
Dengue 1,2,3,4 (attenuated) vaccine
Other Intervention Name(s)
Butantan DV, TetraVax-DV-TV003
Intervention Description
Dose 1000 PFU per virus (1,2,3,4) Route:subcutaneous
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Route:subcutaneous
Primary Outcome Measure Information:
Title
Efficacy (incidence density of symptomatic dengue cases, virologically confirmed)
Description
The primary efficacy outcome is incidence density of symptomatic dengue cases, virologically confirmed, after 28 days post-vaccination. Virological confirmation might be done by viral isolation, RT-PCR and/or detection of NS1.
Time Frame
Five years post vaccination, all cases after 28 days post-vaccination
Title
Safety (adverse reactions)
Description
The primary safety outcome is the frequency of local and systemic adverse reactions, solicited and non-solicited in the three age groups, within the first 21 days post-vaccination. Adverse reactions are defined as adverse events that have a reasonable causal relationship with vaccination.
Time Frame
In the first 21 days post-vaccination
Secondary Outcome Measure Information:
Title
Efficacy (incidence density of dengue cases confirmed virologically, regarding previous exposure to dengue viruses. )
Description
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding previous exposure to dengue viruses. To demonstrate previous exposure or not to dengue viruses, validated serological methods such as: Elisa IgG Indirect, hemagglutination inhibition test or neutralizing antibodies (e.g., VRNT) or another validated test will be used. In case of doubtful results, more than one technique may be used to confirm the diagnosis.
Time Frame
at five years post vaccination, all cases after 28 days post-vaccination
Title
Efficacy (incidence density of dengue cases confirmed virologically, regarding the viral serotype)
Description
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding the viral serotype. Virological diagnosis of the viral serotype will be performed using the viral isolation technique or RT-PCR.
Time Frame
Five years post vaccination, all cases after 28 days post-vaccination
Title
Efficacy (incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not)
Description
Incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not, after 28 days of vaccination. Laboratory confirmation of these cases will occur through serological and/or virological tests.
Time Frame
Five years post vaccination, all cases after 28 days post-vaccination
Title
Safety ( frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses )
Description
The frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses during the 21-day period after vaccination.
Time Frame
In the first 21 days post-vaccination
Title
Safety (frequency of unsolicited adverse reactions)
Description
The frequency of unsolicited adverse reactions after 21 days of vaccination until the end of the study.
Time Frame
Five years post vaccination, all cases after the first 21 days post-vaccination
Title
Immunogenicity (consistency of the immune response to different batches of the vaccine )
Description
The geometric mean of neutralizing antibody titers for each serotype in the fourth week after vaccination in a subgroup of adult participants without previous exposure to dengue immunized with three consecutive batches of dengue vaccine 1,2,3,4 (attenuated).
Time Frame
4 weeks post vaccination
Title
Immunogenicity (non-inferiority between simplified formulation vs. conventional formulation)
Description
The geometric mean of titers of neutralizing antibodies for each serotype at Week 4 postvaccination in a subgroup of adult participants without previous prior exposure to dengue and vaccinated with the conventional formulation and the simplified formulation of the dengue 1, 2, 3, 4 (attenuated) vaccine.
Time Frame
4 weeks post vaccination

10. Eligibility

Sex
All
Minimum Age & Unit of Time
24 Months
Maximum Age & Unit of Time
59 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Children who have completed 24 months of age, adolescents and adults who have not completed 60 years of age; Agree with periodic contacts, either/or by phone, electronic means, and home visits. Show voluntary intention to participate in the study, documented by the participant's or participant's legal representative's signature of the informed consent form. Exclusion Criteria: For women: Pregnancy (confirmed by positive beta-hCG test) or breastfeeding; Evidence of active neurological, cardiac, pulmonary, hepatic or renal disease as per clinical history and/or physical examination; Compromised immune system diseases including: decompensated diabetes mellitus, cancer (except basal cell carcinoma), congenital or acquired immune deficiencies and not controlled autoimmune, as per clinical history and/or physical examination; Behavioral, cognitive or psychiatric disease that in the opinion of the principal investigator or his representative physician, affects the participant ability to understand and cooperate with all study protocol requirements; Abusive usage of alcohol or drugs in the past 12 months that has caused medical, professional or family problems, indicated by clinical history; History of severe allergic reactions or anaphylaxis to the vaccine or to components of the vaccine in study; History of asplenia; Use of any investigational product within 28 days before or after receiving this study vaccination; Has participated in another clinical trial six months prior to inclusion in the study or planning to participate in another clinical trial within 2 years following inclusion; Use of immunosuppressant drugs such as: antineoplastic chemotherapy, radiation therapy, immunosuppressants to induce tolerance to transplants, and corticosteroids use (except topical or nasal). For this protocol will be considered for exclusion use of corticosteroids 3 months prior to the inclusion in the study and 6 months prior to the inclusion for the other therapies mentioned, and planned use of any immunosuppressant therapy within 2 years following inclusion in the study. It will be considered immunosuppressive dose of corticosteroids the equivalent to a dose ≥20 mg of prednisone per day for adults and the equivalent of prednisone at 2 mg/kg/day for children for over 7 days; Have received blood products in the past three months, including transfusions or immunoglobulin, or scheduled administration of blood products or immunoglobulin for the following 2 years after vaccination; Fever or suspected fever within 72 hours prior to vaccination or axillary temperature greater than 37,8°C on the day of vaccination (inclusion might be postponed until participant has completed 72 hours of no fever); Have received live virus vaccine within 28 days or killed virus vaccine in the last 14 days prior to vaccination, or have a scheduled immunization during the first 28 days after receiving the investigational product; Any other condition that might put in risk the safety/rights of a potential participant or hurdle his/her compliance with this protocol in investigator's opinion or his representative physician.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Fernanda C Boulos, MD, PhD
Organizational Affiliation
Instituto Butantan
Official's Role
Study Director
Facility Information:
Facility Name
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado
City
Manaus
State/Province
Amazonas
ZIP/Postal Code
69040-000
Country
Brazil
Facility Name
Instituto Gonçalo Muniz - Fiocruz Bahia
City
Simões Filho
State/Province
BA
ZIP/Postal Code
43700-000
Country
Brazil
Facility Name
Universidade Federal do Ceará
City
Fortaleza
State/Province
CE
ZIP/Postal Code
60430-160
Country
Brazil
Facility Name
Universidade de Brasília
City
Brasilia
State/Province
DF
ZIP/Postal Code
71691-082
Country
Brazil
Facility Name
Universidade Federal de Minas Gerais
City
Belo Horizonte
State/Province
MG
ZIP/Postal Code
30750-140
Country
Brazil
Facility Name
Hospital Universitário Júlio Müller da Universidade Federal de Mato Grosso
City
Cuiabá
State/Province
Mount
ZIP/Postal Code
78048-610
Country
Brazil
Facility Name
Universidade Federal de Mato Grosso do Sul
City
Campo Grande
State/Province
MS
ZIP/Postal Code
79070-900
Country
Brazil
Facility Name
Centro de Pesquisas Aggeu Magalhães - Fiocruz Pernambuco
City
Recife
State/Province
Pernambuco
ZIP/Postal Code
50740-465
Country
Brazil
Facility Name
Hospital Escola da Universidade Federal de Pelotas (HEUFPel)
City
Pelotas
State/Province
Rio Grande Do Sul
ZIP/Postal Code
96020-360
Country
Brazil
Facility Name
Universidade Federal de Roraima - UFRR
City
Boa Vista
State/Province
Roraima
ZIP/Postal Code
69304-000
Country
Brazil
Facility Name
Centro de Pesquisas em Medicina Tropical de Rondônia (CEPEM)
City
Porto Velho
State/Province
RO
ZIP/Postal Code
78918-791
Country
Brazil
Facility Name
Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul
City
Porto Alegre
State/Province
RS
ZIP/Postal Code
90619-900
Country
Brazil
Facility Name
Universidade Federal de Sergipe
City
Laranjeiras
State/Province
SE
ZIP/Postal Code
49170-000
Country
Brazil
Facility Name
Santa Casa de Misericórdia de São Paulo - CSEBF
City
São Paulo
State/Province
SP
ZIP/Postal Code
01133-020
Country
Brazil
Facility Name
Faculdade de Medicina de São José do Rio Preto - FAMERP
City
São José Do Rio Preto
State/Province
São Paulo
ZIP/Postal Code
15090-000
Country
Brazil
Facility Name
Instituto de Infectologia Evandro Chagas - Fiocruz
City
Rio De Janeiro
ZIP/Postal Code
21710-232
Country
Brazil
Facility Name
HCFMUSP
City
São Paulo
ZIP/Postal Code
05403-000
Country
Brazil

12. IPD Sharing Statement

Citations:
PubMed Identifier
26458796
Citation
Precioso AR, Palacios R, Thome B, Mondini G, Braga P, Kalil J. Clinical evaluation strategies for a live attenuated tetravalent dengue vaccine. Vaccine. 2015 Dec 10;33(50):7121-5. doi: 10.1016/j.vaccine.2015.09.105. Epub 2015 Oct 14.
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Phase III Trial to Evaluate Efficacy and Safety of a Tetravalent Dengue Vaccine

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