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Influenza Vaccine Feasibility Study in Children With Persistent Asthma

Primary Purpose

Asthmatic

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
ccIIV4
IIV4
Sponsored by
Vanderbilt University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Asthmatic

Eligibility Criteria

5 Years - 11 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Children between 5-11 years of age, inclusive, at enrollment.
  • Participant must have a current diagnosis of persistent asthma.
  • Parent/legal guardian must provide written informed consent and subject must provide assent as appropriate for age prior to initiation of study procedures and according to local Institutional Review Board (IRB) requirement.
  • Parent/legal guardian and subject must be willing and able to comply with planned study procedures and be available for all study visits.
  • Children aged 5-8 years must have received at least 2 doses of seasonal trivalent or quadrivalent influenza vaccine prior to the current influenza season. Children 9-11 years must have received at least 1 dose of seasonal trivalent or quadrivalent influenza vaccine prior to the current influenza season.
  • Is in good health, other than their asthma, as determined by medical history and targeted physical examination based on medical history.
  • English or Spanish literate.
  • Intention of being available for entire study period and complete all relevant study procedures, including follow-up phone calls and collection of information.

Exclusion Criteria:

  • Acute illness and/or a reported oral temperature of ≥ 100.4°F within 72 hours prior to enrollment (this may result in a temporary delay of vaccination.
  • Use of antipyretic medication during the preceding 24 hours that might mask a fever (temporary deferral).
  • History of a severe allergic reaction (e.g., anaphylaxis) to any component of study influenza vaccines or a known allergy to eggs.
  • Receipt of any licensed vaccine within 14 days (for inactivated vaccines) or 28 days (for live vaccines) prior to vaccination or planned receipt of any licensed vaccine within 42 days after vaccination.
  • Receipt of current year's licensed influenza vaccine.
  • Received an investigational agent (licensed or unlicensed vaccine, drug, biologic, device, blood product, or medication) in the 28 days prior to enrollment or planned receipt before 42 days after vaccination.
  • Has immunosuppression as a result of an underlying illness or treatment, or use of anticancer chemotherapy or radiation therapy within the preceding 36 months.
  • Has taken ≥ 20mg/day of prednisone or its equivalent, for 14 days or more within the past 28 days.
  • Has know active neoplasm or a history of any hematologic malignancy.
  • Has had a previous exacerbation of their asthma symptoms requiring systemic steroids within the prior 28 days, or has had a life-threatening exacerbation of asthma in the past two years (e.g. hypoxic seizure, mechanical ventilation).
  • History of Guillian-Barre syndrome within 6 weeks of previous influenza vaccination.
  • Has any condition that, in the opinion of the investigator, would interfere with the evaluation of the responses or would place the participant at unacceptable risk of injury.
  • Has any diagnosis, current or past, of schizophrenia, bipolar disease, or other major psychiatric disorder.
  • Currently taking aspirin or aspirin-containing products.

Sites / Locations

  • Centers for Disease Control and Prevention
  • Duke Clinical Vaccine Unit
  • Cincinnati Children's Hospital Medical Center
  • Vanderbilt Vaccine Research Program

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

IIV4

cc IIV4

Arm Description

0.5 mL intramuscular injection

0.5 mL intramuscular injection

Outcomes

Primary Outcome Measures

Feasibility Benchmark: Number of Parents That Complete the Memory Aid 1.
Memory aid 1 is a diary completed by the subjects Parent. Daily symptoms, peak flow and requires the parent to record daily symptoms, peak flow, days, post-vaccination asthma clinical symptoms and symptom scores, adverse event, fever and concomitant medication administration data for 14 days (until day 15) after vaccination.
Feasibility Benchmark: Number of Parent Completing Collection of Adverse Event Data
Parent will collect the following data: need for new prescription or nonprescription medications for the control of asthma, an unscheduled healthcare provider visit or consultation within 42 days after vaccination, any other clinically significant event occurring at any point during the study period. Serious Adverse Events (SAEs) will also be monitored through 42 days after vaccination and will include events that result in death, were life threatening, result in subject hospitalization or prolongation of existing hospitalization, result in persistent or significant disability or incapacity. Additionally, important medical events that may not have resulted in death, were not life threatening, or did not require hospitalization might be considered SAEs when, according to appropriate medical judgment, they jeopardize the patient or subject and require medical or surgical intervention to prevent one of the outcomes listed above.
Feasibility Benchmark: Number of Parents That Perform and Document All Home Digital Peak Flow Measurements
Number of parents that perform and document all home digital peak flow measurements at least 11 days out of the 15-day monitoring period.
Feasibility Benchmark: Number of Parents That Perform and Document the Digital Peak Flow for Day 42
Parent will perform and document the digital peak flow for Day 42
Feasibility Benchmark: Number of Parents That Document Nighttime Awakenings
Number of parents that document nighttime awakenings for at least 11 of the 15-day monitoring period.
Feasibility Benchmark: Number of Parents That Respond to Day 4 Call and Provide Requested Data
Number of parents that respond to Day 4 ( -1 day or + 2 days) call and provide requested data
Feasibility Benchmark: Number of Parents That Respond to Day 8 Call and Provide Requested Data.
Number of parents that respond to Day 8 (plus 2 days) call and provide requested data.
Feasibility Benchmark: Number of Parents That Respond to Day 15 Call and Provide Requested Data
Number of parents that respond to Day 15 (minus 1 or plus 2 days) call and provide requested data
Feasibility Benchmark: Number of Parents That Respond to Day 29 Call and Provide Requested Data.
Number of Parents that respond to Day 29 ( Plus 2 Days) call and provide requested data.
Feasibility Benchmark: Number of Parents That Respond to Day 44 Call
Number of parents that respond to Day 44 ( Plus 3 Days) call and provide requested data.
Feasibility Benchmark: Number of Parents Completing a Satisfaction Survey
Parent of each participant will be asked to complete a at the end of the study

Secondary Outcome Measures

Severe Local Reactogenicity Events During the 14 Days Post-vaccination
Number of severe local reactogenicity events for 14 days after vaccination between recipients of ccIIV4 and IIV4.
Severe Systemic Reactogenicity Events During the 14 Days Post-vaccination
Number of solicited severe (not serious) systemic reactogenicity events for 14 days after vaccination between recipients of ccIIV4 and IIV4.
Unsolicited and Severe Adverse Events
The nature and frequency of the unsolicited and Severe adverse events will be described in children receiving ccIIV4 and IIV4 during the 42 days after vaccination.
Number of Asthma Exacerbations Requiring Steroids
For the purpose of this study, asthma exacerbation will be defined as: any acute episode of progressively worsening shortness of breath/dyspnea, cough, wheezing, chest tightness, and/or respiratory distress during the 42 days post-vaccination (until day 43) for which the patient receives a new prescription for systemic corticosteroids..
Number Participants With Asthma Exacerbations Requiring Medical Attention
For the purpose of this study, asthma exacerbation will be defined as: any acute episode of progressively worsening shortness of breath/dyspnea, cough, wheezing, chest tightness, and/or respiratory distress during the 42 days post-vaccination (until day 43) for which the patient seeks unscheduled medical attention (e.g., healthcare provider office or Emergency Department visit or hospitalization)

Full Information

First Posted
October 31, 2016
Last Updated
March 22, 2018
Sponsor
Vanderbilt University Medical Center
Collaborators
Centers for Disease Control and Prevention, Duke University, Children's Hospital Medical Center, Cincinnati
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1. Study Identification

Unique Protocol Identification Number
NCT02967393
Brief Title
Influenza Vaccine Feasibility Study in Children With Persistent Asthma
Official Title
Feasibility Study to Assess the Safety of Quadrivalent, Live Attenuated Influenza Vaccine (LAIV4) Versus Quadrivalent Inactivated Influenza Vaccine (IIV4) in Children Aged 5-11 Years With Persistent Asthma of Varied Severity (Cell Culture Quadrivalent IIV Used as Surrogate for LAIV4)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
October 10, 2016 (Actual)
Primary Completion Date
February 1, 2017 (Actual)
Study Completion Date
February 1, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Vanderbilt University Medical Center
Collaborators
Centers for Disease Control and Prevention, Duke University, Children's Hospital Medical Center, Cincinnati

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is designed to note whether a larger safety study using quadrivalent live attenuated influenza vaccine (LAIV4) versus quadrivalent inactivated influenza vaccine (IIV4)(FLUARIX®), would be feasible in children with persistent asthma. Half of the patients in this study will receive the FLUARIX® influenza vaccine, while the other half will receive a cell cultured quadrivalent inactivated influenza vaccine (ccIIV4)(Flucelvax®) being used as a surrogate for LAIV4.
Detailed Description
The association of an increased risk in wheezing following receipt of a live-attenuated influenza vaccine in children at least 2 years of age with a prior history of asthma or wheeze remains unclear. The Centers for Disease Control (CDC) and Prevention's Clinical Immunization Safety Assessment (CISA) planned to address a data safety gap regarding use of LAIV4 vaccine in children with asthma by conducting a 3-site randomized, non-inferiority prospective study. The main goal was to compare the safety of LAIV4 versus IIV4 in children 5-11 years with persistent asthma during the 2016-2017 influenza season. CDC and the CISA study sites developed a protocol and associated materials, and were poised to begin enrollment early during the 2016-2017 influenza season. However, after the June 22, 2016 Advisory Committee on Immunization Practices (ACIP) vote recommending against use of LAIV4 during the 2016-2017 influenza season, CDC and study investigators decided to defer implementing a study using LAIV4 during the 2016-2017 influenza season. Investigators will reconsider initiating this study during the 2017-2018 influenza season if ACIP votes to reinstate LAIV4 use or new data become available; ACIP makes recommendations annually. The planned LAIV4 study had unique features in its design that previously had not been implemented in vaccine safety studies, including: 1) enrolling a substantial proportion of children with moderate-severe asthma 2) using digital peak flow meters and 3) collecting clinical data through multiple, complementary, measures for 42 days after vaccination. To capitalize on progress made during development of the study protocol and associated documents and procedures, CISA is proposing to carry out a study at the three sites to assess the feasibility of recruiting, enrolling, retaining, and collecting clinical data on children 5-11 years with persistent asthma of varied levels of severity in an influenza vaccine safety study. Findings from this proposed feasibility study will facilitate improving the LAIV4 study in the future if it goes forward through the CISA Project or in another venue. In 2016-2017 season, FDA approved a new influenza vaccine for use in persons aged 4 years and older, Flucelvax® Quadrivalent (ccIIV4); ACIP incorporated this vaccine into its recommendations for the 2016-2017 influenza season. Therefore ccIIV4 will be used in place of LAIV4 for this feasibility study. There is no evidence that Flucelvax® increases the risk of wheezing in asthmatic children. The feasibility study also offers an opportunity to gain some additional descriptive safety data for this new vaccine in asthmatic children.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Other
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IIV4
Arm Type
Active Comparator
Arm Description
0.5 mL intramuscular injection
Arm Title
cc IIV4
Arm Type
Active Comparator
Arm Description
0.5 mL intramuscular injection
Intervention Type
Drug
Intervention Name(s)
ccIIV4
Other Intervention Name(s)
Flucelvax
Intervention Type
Drug
Intervention Name(s)
IIV4
Other Intervention Name(s)
Fluarix
Primary Outcome Measure Information:
Title
Feasibility Benchmark: Number of Parents That Complete the Memory Aid 1.
Description
Memory aid 1 is a diary completed by the subjects Parent. Daily symptoms, peak flow and requires the parent to record daily symptoms, peak flow, days, post-vaccination asthma clinical symptoms and symptom scores, adverse event, fever and concomitant medication administration data for 14 days (until day 15) after vaccination.
Time Frame
15 days
Title
Feasibility Benchmark: Number of Parent Completing Collection of Adverse Event Data
Description
Parent will collect the following data: need for new prescription or nonprescription medications for the control of asthma, an unscheduled healthcare provider visit or consultation within 42 days after vaccination, any other clinically significant event occurring at any point during the study period. Serious Adverse Events (SAEs) will also be monitored through 42 days after vaccination and will include events that result in death, were life threatening, result in subject hospitalization or prolongation of existing hospitalization, result in persistent or significant disability or incapacity. Additionally, important medical events that may not have resulted in death, were not life threatening, or did not require hospitalization might be considered SAEs when, according to appropriate medical judgment, they jeopardize the patient or subject and require medical or surgical intervention to prevent one of the outcomes listed above.
Time Frame
Day 16 to 43
Title
Feasibility Benchmark: Number of Parents That Perform and Document All Home Digital Peak Flow Measurements
Description
Number of parents that perform and document all home digital peak flow measurements at least 11 days out of the 15-day monitoring period.
Time Frame
15 days
Title
Feasibility Benchmark: Number of Parents That Perform and Document the Digital Peak Flow for Day 42
Description
Parent will perform and document the digital peak flow for Day 42
Time Frame
Day 42
Title
Feasibility Benchmark: Number of Parents That Document Nighttime Awakenings
Description
Number of parents that document nighttime awakenings for at least 11 of the 15-day monitoring period.
Time Frame
15 days
Title
Feasibility Benchmark: Number of Parents That Respond to Day 4 Call and Provide Requested Data
Description
Number of parents that respond to Day 4 ( -1 day or + 2 days) call and provide requested data
Time Frame
Day 3 to 6
Title
Feasibility Benchmark: Number of Parents That Respond to Day 8 Call and Provide Requested Data.
Description
Number of parents that respond to Day 8 (plus 2 days) call and provide requested data.
Time Frame
Day 8-10
Title
Feasibility Benchmark: Number of Parents That Respond to Day 15 Call and Provide Requested Data
Description
Number of parents that respond to Day 15 (minus 1 or plus 2 days) call and provide requested data
Time Frame
Day 14 to 17
Title
Feasibility Benchmark: Number of Parents That Respond to Day 29 Call and Provide Requested Data.
Description
Number of Parents that respond to Day 29 ( Plus 2 Days) call and provide requested data.
Time Frame
Day 29-31
Title
Feasibility Benchmark: Number of Parents That Respond to Day 44 Call
Description
Number of parents that respond to Day 44 ( Plus 3 Days) call and provide requested data.
Time Frame
Day 44-47
Title
Feasibility Benchmark: Number of Parents Completing a Satisfaction Survey
Description
Parent of each participant will be asked to complete a at the end of the study
Time Frame
42 days
Secondary Outcome Measure Information:
Title
Severe Local Reactogenicity Events During the 14 Days Post-vaccination
Description
Number of severe local reactogenicity events for 14 days after vaccination between recipients of ccIIV4 and IIV4.
Time Frame
14 days
Title
Severe Systemic Reactogenicity Events During the 14 Days Post-vaccination
Description
Number of solicited severe (not serious) systemic reactogenicity events for 14 days after vaccination between recipients of ccIIV4 and IIV4.
Time Frame
14 days
Title
Unsolicited and Severe Adverse Events
Description
The nature and frequency of the unsolicited and Severe adverse events will be described in children receiving ccIIV4 and IIV4 during the 42 days after vaccination.
Time Frame
42 days
Title
Number of Asthma Exacerbations Requiring Steroids
Description
For the purpose of this study, asthma exacerbation will be defined as: any acute episode of progressively worsening shortness of breath/dyspnea, cough, wheezing, chest tightness, and/or respiratory distress during the 42 days post-vaccination (until day 43) for which the patient receives a new prescription for systemic corticosteroids..
Time Frame
42 days
Title
Number Participants With Asthma Exacerbations Requiring Medical Attention
Description
For the purpose of this study, asthma exacerbation will be defined as: any acute episode of progressively worsening shortness of breath/dyspnea, cough, wheezing, chest tightness, and/or respiratory distress during the 42 days post-vaccination (until day 43) for which the patient seeks unscheduled medical attention (e.g., healthcare provider office or Emergency Department visit or hospitalization)
Time Frame
42 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
11 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Children between 5-11 years of age, inclusive, at enrollment. Participant must have a current diagnosis of persistent asthma. Parent/legal guardian must provide written informed consent and subject must provide assent as appropriate for age prior to initiation of study procedures and according to local Institutional Review Board (IRB) requirement. Parent/legal guardian and subject must be willing and able to comply with planned study procedures and be available for all study visits. Children aged 5-8 years must have received at least 2 doses of seasonal trivalent or quadrivalent influenza vaccine prior to the current influenza season. Children 9-11 years must have received at least 1 dose of seasonal trivalent or quadrivalent influenza vaccine prior to the current influenza season. Is in good health, other than their asthma, as determined by medical history and targeted physical examination based on medical history. English or Spanish literate. Intention of being available for entire study period and complete all relevant study procedures, including follow-up phone calls and collection of information. Exclusion Criteria: Acute illness and/or a reported oral temperature of ≥ 100.4°F within 72 hours prior to enrollment (this may result in a temporary delay of vaccination. Use of antipyretic medication during the preceding 24 hours that might mask a fever (temporary deferral). History of a severe allergic reaction (e.g., anaphylaxis) to any component of study influenza vaccines or a known allergy to eggs. Receipt of any licensed vaccine within 14 days (for inactivated vaccines) or 28 days (for live vaccines) prior to vaccination or planned receipt of any licensed vaccine within 42 days after vaccination. Receipt of current year's licensed influenza vaccine. Received an investigational agent (licensed or unlicensed vaccine, drug, biologic, device, blood product, or medication) in the 28 days prior to enrollment or planned receipt before 42 days after vaccination. Has immunosuppression as a result of an underlying illness or treatment, or use of anticancer chemotherapy or radiation therapy within the preceding 36 months. Has taken ≥ 20mg/day of prednisone or its equivalent, for 14 days or more within the past 28 days. Has know active neoplasm or a history of any hematologic malignancy. Has had a previous exacerbation of their asthma symptoms requiring systemic steroids within the prior 28 days, or has had a life-threatening exacerbation of asthma in the past two years (e.g. hypoxic seizure, mechanical ventilation). History of Guillian-Barre syndrome within 6 weeks of previous influenza vaccination. Has any condition that, in the opinion of the investigator, would interfere with the evaluation of the responses or would place the participant at unacceptable risk of injury. Has any diagnosis, current or past, of schizophrenia, bipolar disease, or other major psychiatric disorder. Currently taking aspirin or aspirin-containing products.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kathryn M Edwards, MD
Organizational Affiliation
Vanderbilt Vaccine Research Program
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centers for Disease Control and Prevention
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30329
Country
United States
Facility Name
Duke Clinical Vaccine Unit
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
Vanderbilt Vaccine Research Program
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Influenza Vaccine Feasibility Study in Children With Persistent Asthma

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