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Influenza A 2009 H1N1 Challenge Study in Healthy Adults

Primary Purpose

Influenza

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ca/04/2009/H1N1 Vero Grown Challenge Virus
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Influenza focused on measuring H1N1, Influenza, Human, Challenge Study, Healthy Volunteer

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesAccepts Healthy Volunteers

-INCLUSION CRITERIA:

  1. Greater than or equal to 18 and less than or equal to 50 years of age.
  2. Agrees to not use tobacco products during participation in this study.
  3. Willingness to remain in isolation for the duration of viral shedding (at a minimum 9 days) and to comply with all study requirements.
  4. A female participant is eligible for this study if she is not pregnant or breast feeding and 1 of the following:

    • Of non-childbearing potential (i.e., women who have had a hysterectomy or tubal ligation or are postmenopausal, as defined by no menses in greater than or equal to 1 year).
    • Of childbearing potential but agrees to practice effective contraception or abstinence for 4 weeks prior to and 8 weeks after administration of the influenza challenge virus. Acceptable methods of contraception include 1 or more of the following: 1) male partner who is sterile prior to the female participant s entry into the study and is the sole sexual partner for the female participant; 2) implants of levonorgestrel; 3) injectable progestogen; 4) an intrauterine device with a documented failure rate of < 1%; 5) oral contraceptives; and 6) double barrier methods including diaphragm or condom with a spermicide.
  5. Willing to have samples stored for future research.
  6. Prechallenge serum hemagglutination-inhibition titer against the challenge strain of 1:16 or less.
  7. HIV uninfected.

EXCLUSION CRITERIA:

  1. Presence of self-reported or medically documented significant medical condition including but not limited to:

    1. Chronic pulmonary disease (e.g., asthma, emphysema).
    2. Chronic cardiovascular disease (e.g., cardiomyopathy, congestive heart failure, cardiac surgery, ischemic heart disease, known anatomic defects).
    3. Chronic medical conditions requiring close medical follow-up or hospitalization during the past 5 years (e.g., diabetes mellitus, renal dysfunction, hemoglobinopathies).
    4. Immunosuppression or ongoing malignancy.
    5. Neurological and neurodevelopmental conditions (e.g., cerebral palsy, epilepsy, stroke, seizures).
    6. Postinfectious or postvaccine neurological sequelae.
  2. Have close or household (i.e., share the same apartment or house) high-risk contacts including but not limited to:

    1. Persons greater than or equal to 65 years of age.
    2. Children < 5 years of age.
    3. Residents of nursing homes.
    4. Persons of any age with significant chronic medical conditions such as:

      • Chronic pulmonary disease (e.g., asthma).
      • Chronic cardiovascular disease (e.g., cardiomyopathy, congestive heart failure, cardiac surgery, ischemic heart disease, known anatomic defects).
      • Contacts who required medical follow-up or hospitalization during the past 5 years because of chronic metabolic disease (e.g., diabetes mellitus, renal dysfunction, hemoglobinopathies).
      • Immunosuppression or cancer.
      • Neurological and neurodevelopmental conditions (e.g., cerebral palsy, epilepsy, stroke, seizures).
      • Children and teenagers who are receiving long-term aspirin therapy.
      • Women who are pregnant or who are trying to become pregnant.
  3. Individual with body mass index (BMI) less than or equal to 18.5 and greater than or equal to 40.
  4. Smokes more than 4 cigarettes or other tobacco products on weekly basis.
  5. Complete blood count (CBC) with differential outside of the NIH Department of Laboratory Medicine (DLM) normal reference range and deemed clinically significant by the PI.
  6. Chemistries in the acute care, mineral, and/or hepatic panels, and/or any of the following: lactate dehydrogenase, uric acid, creatine kinase, and total protein outside of the NIH DLM normal reference range and deemed clinically significant by the PI.
  7. Urinalysis outside of the NIH DLM normal reference range and deemed clinically significant by the PI.
  8. Clinically significant abnormality on electrocardiogram .
  9. Clinically significant abnormality as deemed by the PI on echocardiographic testing.
  10. Recent acute illness within 1 week of admission to the isolation facility.
  11. Known allergy to treatments for influenza (including but not limited to oseltamivir, nonsteroidals).
  12. Known allergy to 2 or more classes of antibiotics (e.g., penicillins, cephalosporins, fluoroquinolones, or glycopeptides).
  13. Receipt of blood or blood products (including immunoglobulins) within 3 months prior to enrollment.
  14. Receipt of any unlicensed drug within 3 months or 5.5 half lives (whichever is greater) prior to enrollment.
  15. Receipt of any unlicensed vaccine within 6 months prior to enrollment.
  16. Self-reported or known history of current alcoholism or drug abuse, or positive urine/serum test for drugs of abuse (i.e., amphetamines, cocaine, benzodiazepines, opiates, or metabolites, but not tetrahydrocannabinol(THC) or metabolites).
  17. Self-reported or known history of psychiatric or psychological issues deemed by the PI to be a contraindication to protocol participation
  18. Known close contact with anyone known to have influenza in the past 7 days.
  19. Any condition that, in the judgment of the Principal Investigator, is a contraindication to protocol participation or impairs the volunteer s ability to give informed consent.

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Challenge Virus

Arm Description

The Ca/04/2009/H1N1 Vero Grown Challenge Virus was administered intranasally to each participant using a nasal sprayer. A total volume of up to 1 mL of virus will be administered.

Outcomes

Primary Outcome Measures

Percent MMID
Percent of individuals experiencing mild to moderate influenza infection (MMID, defined as active shedding and symptoms of influenza A) in each dosing group.

Secondary Outcome Measures

Full Information

First Posted
July 18, 2012
Last Updated
April 5, 2016
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT01646138
Brief Title
Influenza A 2009 H1N1 Challenge Study in Healthy Adults
Official Title
Influenza A 2009 H1N1 Human Challenge Study in Healthy Adult Volunteers
Study Type
Interventional

2. Study Status

Record Verification Date
April 2016
Overall Recruitment Status
Completed
Study Start Date
February 2012 (undefined)
Primary Completion Date
December 2013 (Actual)
Study Completion Date
December 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Background: - A challenge study exposes a person to a disease and allows researchers to study the disease through the body's healing process. An influenza challenge study that looks at different amounts of the flu virus can provide more information on the smallest amount needed to cause an infection. Researchers want to give one dose of the Influenza A H1N1 virus to healthy volunteers to see how the body responds to the virus. Objectives: To find the smallest dose of Influenza A H1N1 virus that may cause a mild to moderate flu infection in a healthy adult. To study how the body s immune system responds to the virus. Eligibility: Healthy volunteers at least 18 years of age. Participants must be willing to remain in isolation for a minimum of 9 days. Design: Participants will be admitted to a hospital inpatient isolation unit. They will be screened with a physical exam and medical history. They will also have heart and lung function tests. Blood, urine, and nasal swab/wash samples will be collected. Participants will receive a single nasal spray of the flu virus. They will stay on the inpatient unit for at least 9 days. Participants will be monitored for the length of their stay. They will have frequent blood tests and other procedures as needed. Participants will be allowed to go home once they have had two negative tests for the virus. The tests will be given on two consecutive days....
Detailed Description
The high morbidity and mortality associated with both pandemic and seasonal influenza, and the anticipation of future influenza pandemics, puts influenza front and center in infectious disease research. Because the natural history and pathogenesis of human influenza has not been well characterized and cannot be adequately studied in animal models or with current in vitro techniques, important questions about influenza pathogenesis can only be approached through human challenge studies. Previous human challenge studies have addressed some aspects of the natural history of influenza by evaluating the timing of viral replication, shedding, clinical symptoms, and innate and adaptive immune responses. Although these studies have provided important information, in the United States, all but 1 were performed prior to 1990. Without exception, these studies had limitations due to the scope of the study and/or the scientific techniques available at that time. The primary objective of this study is to determine the dose of influenza A 2009 H1N1 human challenge virus that will induce a mild to moderate uncomplicated influenza infection in healthy volunteers. This protocol will examine some of the basic questions that remain unanswered regarding the pathogenesis of influenza in humans, namely, a detailed clinical and immunological characterization of uncomplicated influenza viral pathogenesis in healthy adult volunteers. Secondary objectives will evaluate clinical disease, length of viral shedding, and pathogenesis in those with influenza infection including identification of clinical markers of the disease. Notably, the exploratory objectives will seek to discover viral factors necessary for human infection/adaptation and to evaluate host immune response, viral replication, viral fitness, and the intrahost evolution. Collaboration between National Institute of Allergy and Infectious Diseases (NIAID) investigators and outside scientists will generate opportunities to further develop and expand areas of clinical influenza research based on the proposed challenge model.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Influenza
Keywords
H1N1, Influenza, Human, Challenge Study, Healthy Volunteer

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Challenge Virus
Arm Type
Experimental
Arm Description
The Ca/04/2009/H1N1 Vero Grown Challenge Virus was administered intranasally to each participant using a nasal sprayer. A total volume of up to 1 mL of virus will be administered.
Intervention Type
Biological
Intervention Name(s)
Ca/04/2009/H1N1 Vero Grown Challenge Virus
Intervention Description
The human challenge virus will be administered intranasally to each participant using a nasal sprayer. A total volume of up to 1 mL of virus will be administered.
Primary Outcome Measure Information:
Title
Percent MMID
Description
Percent of individuals experiencing mild to moderate influenza infection (MMID, defined as active shedding and symptoms of influenza A) in each dosing group.
Time Frame
67 days after influenza inoculation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
-INCLUSION CRITERIA: Greater than or equal to 18 and less than or equal to 50 years of age. Agrees to not use tobacco products during participation in this study. Willingness to remain in isolation for the duration of viral shedding (at a minimum 9 days) and to comply with all study requirements. A female participant is eligible for this study if she is not pregnant or breast feeding and 1 of the following: Of non-childbearing potential (i.e., women who have had a hysterectomy or tubal ligation or are postmenopausal, as defined by no menses in greater than or equal to 1 year). Of childbearing potential but agrees to practice effective contraception or abstinence for 4 weeks prior to and 8 weeks after administration of the influenza challenge virus. Acceptable methods of contraception include 1 or more of the following: 1) male partner who is sterile prior to the female participant s entry into the study and is the sole sexual partner for the female participant; 2) implants of levonorgestrel; 3) injectable progestogen; 4) an intrauterine device with a documented failure rate of < 1%; 5) oral contraceptives; and 6) double barrier methods including diaphragm or condom with a spermicide. Willing to have samples stored for future research. Prechallenge serum hemagglutination-inhibition titer against the challenge strain of 1:16 or less. HIV uninfected. EXCLUSION CRITERIA: Presence of self-reported or medically documented significant medical condition including but not limited to: Chronic pulmonary disease (e.g., asthma, emphysema). Chronic cardiovascular disease (e.g., cardiomyopathy, congestive heart failure, cardiac surgery, ischemic heart disease, known anatomic defects). Chronic medical conditions requiring close medical follow-up or hospitalization during the past 5 years (e.g., diabetes mellitus, renal dysfunction, hemoglobinopathies). Immunosuppression or ongoing malignancy. Neurological and neurodevelopmental conditions (e.g., cerebral palsy, epilepsy, stroke, seizures). Postinfectious or postvaccine neurological sequelae. Have close or household (i.e., share the same apartment or house) high-risk contacts including but not limited to: Persons greater than or equal to 65 years of age. Children < 5 years of age. Residents of nursing homes. Persons of any age with significant chronic medical conditions such as: Chronic pulmonary disease (e.g., asthma). Chronic cardiovascular disease (e.g., cardiomyopathy, congestive heart failure, cardiac surgery, ischemic heart disease, known anatomic defects). Contacts who required medical follow-up or hospitalization during the past 5 years because of chronic metabolic disease (e.g., diabetes mellitus, renal dysfunction, hemoglobinopathies). Immunosuppression or cancer. Neurological and neurodevelopmental conditions (e.g., cerebral palsy, epilepsy, stroke, seizures). Children and teenagers who are receiving long-term aspirin therapy. Women who are pregnant or who are trying to become pregnant. Individual with body mass index (BMI) less than or equal to 18.5 and greater than or equal to 40. Smokes more than 4 cigarettes or other tobacco products on weekly basis. Complete blood count (CBC) with differential outside of the NIH Department of Laboratory Medicine (DLM) normal reference range and deemed clinically significant by the PI. Chemistries in the acute care, mineral, and/or hepatic panels, and/or any of the following: lactate dehydrogenase, uric acid, creatine kinase, and total protein outside of the NIH DLM normal reference range and deemed clinically significant by the PI. Urinalysis outside of the NIH DLM normal reference range and deemed clinically significant by the PI. Clinically significant abnormality on electrocardiogram . Clinically significant abnormality as deemed by the PI on echocardiographic testing. Recent acute illness within 1 week of admission to the isolation facility. Known allergy to treatments for influenza (including but not limited to oseltamivir, nonsteroidals). Known allergy to 2 or more classes of antibiotics (e.g., penicillins, cephalosporins, fluoroquinolones, or glycopeptides). Receipt of blood or blood products (including immunoglobulins) within 3 months prior to enrollment. Receipt of any unlicensed drug within 3 months or 5.5 half lives (whichever is greater) prior to enrollment. Receipt of any unlicensed vaccine within 6 months prior to enrollment. Self-reported or known history of current alcoholism or drug abuse, or positive urine/serum test for drugs of abuse (i.e., amphetamines, cocaine, benzodiazepines, opiates, or metabolites, but not tetrahydrocannabinol(THC) or metabolites). Self-reported or known history of psychiatric or psychological issues deemed by the PI to be a contraindication to protocol participation Known close contact with anyone known to have influenza in the past 7 days. Any condition that, in the judgment of the Principal Investigator, is a contraindication to protocol participation or impairs the volunteer s ability to give informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matthew J Memoli, M.D.
Organizational Affiliation
National Institute of Allergy and Infectious Diseases (NIAID)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data will be shared through the NIH data repository BTRIS - Biomedical Translational Research Information System
Citations:
PubMed Identifier
9449698
Citation
Hayden FG, Fritz R, Lobo MC, Alvord W, Strober W, Straus SE. Local and systemic cytokine responses during experimental human influenza A virus infection. Relation to symptom formation and host defense. J Clin Invest. 1998 Feb 1;101(3):643-9. doi: 10.1172/JCI1355.
Results Reference
background
PubMed Identifier
9765409
Citation
Jameson J, Cruz J, Ennis FA. Human cytotoxic T-lymphocyte repertoire to influenza A viruses. J Virol. 1998 Nov;72(11):8682-9. doi: 10.1128/JVI.72.11.8682-8689.1998.
Results Reference
background
PubMed Identifier
18005742
Citation
McAuley JL, Hornung F, Boyd KL, Smith AM, McKeon R, Bennink J, Yewdell JW, McCullers JA. Expression of the 1918 influenza A virus PB1-F2 enhances the pathogenesis of viral and secondary bacterial pneumonia. Cell Host Microbe. 2007 Oct 11;2(4):240-9. doi: 10.1016/j.chom.2007.09.001.
Results Reference
background
PubMed Identifier
30953061
Citation
Memoli MJ, Han A, Walters KA, Czajkowski L, Reed S, Athota R, Angela Rosas L, Cervantes-Medina A, Park JK, Morens DM, Kash JC, Taubenberger JK. Influenza A Reinfection in Sequential Human Challenge: Implications for Protective Immunity and "Universal" Vaccine Development. Clin Infect Dis. 2020 Feb 14;70(5):748-753. doi: 10.1093/cid/ciz281.
Results Reference
derived
PubMed Identifier
25416753
Citation
Memoli MJ, Czajkowski L, Reed S, Athota R, Bristol T, Proudfoot K, Fargis S, Stein M, Dunfee RL, Shaw PA, Davey RT, Taubenberger JK. Validation of the wild-type influenza A human challenge model H1N1pdMIST: an A(H1N1)pdm09 dose-finding investigational new drug study. Clin Infect Dis. 2015 Mar 1;60(5):693-702. doi: 10.1093/cid/ciu924. Epub 2014 Nov 20.
Results Reference
derived
Links:
URL
http://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2012-I-0077.html
Description
NIH Clinical Center Detailed Web Page

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Influenza A 2009 H1N1 Challenge Study in Healthy Adults

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