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Maternal Immunization To Prevent Infant Otitis Media

Primary Purpose

Otitis Media

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PNCRM9
Placebo comparator
Sponsored by
National Institute on Deafness and Other Communication Disorders (NIDCD)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Otitis Media focused on measuring Maternal immunization, Pneumococcal conjugate vaccine, Otitis media

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

Maternal inclusion criteria:

  • Pregnant, at least 18 yrs of age and healthy based on medical history.
  • Plans to continue HealthPartners insurance coverage until infant is 13 mos old; mother and child will receive care in staff model clinic participating in the study, and obstetric care will be provided by a HP obstetrician/CNM with delivery at affiliated hospital.
  • Plans to reside in Twin Cities metro area until infant is 13 mos old.
  • Has a residence phone and a back-up phone contact.
  • Provides informed consent.

Infant inclusion criteria:

  • Infants born to enrolled women.

Exclusion Criteria:

Maternal exclusion criteria:

  • Known hypersensitivity to any of the vaccine components or to latex.
  • Prior vaccination with any S. pneumoniae vaccine.
  • Recent (w/in 2 mos) vaccination with diphtheria or tetanus-diphtheria toxoid vaccines. Administration of influenza, or any other vaccine, or RhoGAM in the 2 wks prior to administration of the study product.
  • Known history of life-threatening pneumococcal infection.
  • Known impairment of immunologic function or history of immunodeficiency.
  • Previous child with a major congenital anomaly or fetal malformation.
  • Known to be carrying more than one fetus.
  • Any medical condition or history that, in the opinion of the investigator, may interfere with the evaluation of the study objectives.
  • History of preterm birth or fetal death.
  • Known history of chronic hypertension, severe pre-eclampsia in a previous pregnancy, current pre-eclampsia or any type of diabetes mellitus.
  • Known anatomical defects of the cervix or uterus.
  • Known history of teratogenic drug use or illegal substance abuse during current pregnancy, not including tobacco or alcohol use.
  • Women who have tested positive (based on medical record information) for HIV or hepatitis B infection.
  • Any contraindication specified in the vaccine manufacturer's CIB.
  • History of febrile illness (temp 100.0 degrees F or over) during the 72 hrs prior to vaccine administration.
  • History of significant mental illness (e.g. schizophrenia, psychoses, major depression).

Infant exclusion criteria:

  • Hypersensitivity to any component of the vaccine, including diphtheria toxoid.
  • Thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection.
  • Latex sensitivity.
  • Known impaired immune responsiveness, whether due to the use of immunosuppressive therapy (including irradiation, corticosteroids, antimetabolites, alkylating agents, and cytotoxic agents), a genetic defect, HIV infection, or other causes that may reduce antibody response to active immunization.
  • Vaccination may be delayed because of a current or recent febrile illness depending largely on the severity of the symptoms and their etiology. Although a severe or even a moderate febrile illness is sufficient reason to postpone vaccinations, minor illnesses, such as a mild upper respiratory infection with or without low-grade fever, are not generally contraindications.

Sites / Locations

  • HealthPartners Research Foundation
  • University of Minnesota

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Group 1

Group 2

Arm Description

Group 1 (experimental)

Group 2 (placebo comparator)

Outcomes

Primary Outcome Measures

Determine if offspring of women immunized with PNCRM9 or control during the third trimester have equivalent anticapsular polysaccharide (PS) IgG antibody responses to PNCRM7 measured 1 mo after the 3rd injection given at 6 mos of age.

Secondary Outcome Measures

Determine if offspring of these women have equivalent antibody responses to PNCRM7 at 13 mos. Sera are analyzed for anti-PS IgG, opsonic activity, IgG1 & IgG2 subclasses (14,6B,19F,23F), & antibodies against Hib-PRP & diphtheria toxoid.

Full Information

First Posted
February 14, 2008
Last Updated
February 14, 2008
Sponsor
National Institute on Deafness and Other Communication Disorders (NIDCD)
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1. Study Identification

Unique Protocol Identification Number
NCT00617682
Brief Title
Maternal Immunization To Prevent Infant Otitis Media
Official Title
Maternal Immunization To Prevent Infant Otitis Media
Study Type
Interventional

2. Study Status

Record Verification Date
February 2008
Overall Recruitment Status
Completed
Study Start Date
October 2000 (undefined)
Primary Completion Date
December 2004 (Actual)
Study Completion Date
December 2004 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
National Institute on Deafness and Other Communication Disorders (NIDCD)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The main objective of this study is to evaluate whether immunization with 9-valent pneumococcal conjugate vaccine (PNCRM9) during the third trimester of pregnancy interferes with active antibody production in offspring immunized with PNCRM7 (Prevnar) in the first six months of life.
Detailed Description
There were 24.5 million physician visits for otitis media (OM) in 1990 with estimated treatment and indirect costs of $5 billion. Because of its major public health impact and the troubling increase in antibiotic resistant organisms, vaccine strategies to prevent OM are being tested. We previously proposed an efficacy study to determine if immunization with pneumococcal vaccine during pregnancy protects offspring against early infant OM, which is an important predictor for recurrent and chronic OM. Recent data from an efficacy trial in California demonstrated that infants immunized with 7-valent pneumococcal conjugate vaccine (PNCRM7) at 2, 4, 6 and 12 - 15 months were protected against invasive pneumococcal disease after 7 months of age. Since licensure of this vaccine, questions have been raised about whether maternal immunization with a pneumococcal vaccine during pregnancy suppresses active antibody production in offspring who are immunized with 7-valent pneumococcal conjugate vaccine (PNCRM7). The main objective of this study is to investigate that question. We will also evaluate vaccine safety, immunogenicity, and fetal antibody transfer among women who receive 9-valent pneumococcal conjugate vaccine (PNCRM9) at 30 - 35 weeks of pregnancy, determine persistence of maternal and infant antibody 13 months after birth, evaluate opsonic activity of maternal and infant antibody, and determine the relationship between breast milk and serum antibody in lactating women.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Otitis Media
Keywords
Maternal immunization, Pneumococcal conjugate vaccine, Otitis media

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
153 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Active Comparator
Arm Description
Group 1 (experimental)
Arm Title
Group 2
Arm Type
Placebo Comparator
Arm Description
Group 2 (placebo comparator)
Intervention Type
Biological
Intervention Name(s)
PNCRM9
Intervention Description
0.5 mL IM at 30-35 wks gestation
Intervention Type
Biological
Intervention Name(s)
Placebo comparator
Intervention Description
Sucrose cake (NaCl and sucrose) in aluminum phosphate adjuvant diluent at 0.5 mg per 0.5 mL dose IM at 30-35 wks gestation
Primary Outcome Measure Information:
Title
Determine if offspring of women immunized with PNCRM9 or control during the third trimester have equivalent anticapsular polysaccharide (PS) IgG antibody responses to PNCRM7 measured 1 mo after the 3rd injection given at 6 mos of age.
Time Frame
In infants at 7 months of age; In women at 1-7 days post-immunization
Secondary Outcome Measure Information:
Title
Determine if offspring of these women have equivalent antibody responses to PNCRM7 at 13 mos. Sera are analyzed for anti-PS IgG, opsonic activity, IgG1 & IgG2 subclasses (14,6B,19F,23F), & antibodies against Hib-PRP & diphtheria toxoid.
Time Frame
In infants at 13 months of age.

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Maternal inclusion criteria: Pregnant, at least 18 yrs of age and healthy based on medical history. Plans to continue HealthPartners insurance coverage until infant is 13 mos old; mother and child will receive care in staff model clinic participating in the study, and obstetric care will be provided by a HP obstetrician/CNM with delivery at affiliated hospital. Plans to reside in Twin Cities metro area until infant is 13 mos old. Has a residence phone and a back-up phone contact. Provides informed consent. Infant inclusion criteria: Infants born to enrolled women. Exclusion Criteria: Maternal exclusion criteria: Known hypersensitivity to any of the vaccine components or to latex. Prior vaccination with any S. pneumoniae vaccine. Recent (w/in 2 mos) vaccination with diphtheria or tetanus-diphtheria toxoid vaccines. Administration of influenza, or any other vaccine, or RhoGAM in the 2 wks prior to administration of the study product. Known history of life-threatening pneumococcal infection. Known impairment of immunologic function or history of immunodeficiency. Previous child with a major congenital anomaly or fetal malformation. Known to be carrying more than one fetus. Any medical condition or history that, in the opinion of the investigator, may interfere with the evaluation of the study objectives. History of preterm birth or fetal death. Known history of chronic hypertension, severe pre-eclampsia in a previous pregnancy, current pre-eclampsia or any type of diabetes mellitus. Known anatomical defects of the cervix or uterus. Known history of teratogenic drug use or illegal substance abuse during current pregnancy, not including tobacco or alcohol use. Women who have tested positive (based on medical record information) for HIV or hepatitis B infection. Any contraindication specified in the vaccine manufacturer's CIB. History of febrile illness (temp 100.0 degrees F or over) during the 72 hrs prior to vaccine administration. History of significant mental illness (e.g. schizophrenia, psychoses, major depression). Infant exclusion criteria: Hypersensitivity to any component of the vaccine, including diphtheria toxoid. Thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injection. Latex sensitivity. Known impaired immune responsiveness, whether due to the use of immunosuppressive therapy (including irradiation, corticosteroids, antimetabolites, alkylating agents, and cytotoxic agents), a genetic defect, HIV infection, or other causes that may reduce antibody response to active immunization. Vaccination may be delayed because of a current or recent febrile illness depending largely on the severity of the symptoms and their etiology. Although a severe or even a moderate febrile illness is sufficient reason to postpone vaccinations, minor illnesses, such as a mild upper respiratory infection with or without low-grade fever, are not generally contraindications.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patricia Ferrieri
Organizational Affiliation
University of Minnesota
Official's Role
Principal Investigator
Facility Information:
Facility Name
HealthPartners Research Foundation
City
Bloomington
State/Province
Minnesota
ZIP/Postal Code
55440
Country
United States
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
12953289
Citation
Le CT, Grambsch PM, Giebink GS. Quality control and the identification of vaccine responders using ELISA-derived antibody data. Stat Med. 2003 Sep 30;22(18):2935-42. doi: 10.1002/sim.1530.
Results Reference
background
PubMed Identifier
12850363
Citation
Daly KA, Toth JA, Giebink GS. Pneumococcal conjugate vaccines as maternal and infant immunogens: challenges of maternal recruitment. Vaccine. 2003 Jul 28;21(24):3473-8. doi: 10.1016/s0264-410x(03)00354-2.
Results Reference
background
PubMed Identifier
25444821
Citation
Daly KA, Scott Giebink G, Lindgren BR, Knox J, Haggerty BJ, Nordin J, Goetz S, Ferrieri P. Maternal immunization with pneumococcal 9-valent conjugate vaccine and early infant otitis media. Vaccine. 2014 Dec 5;32(51):6948-6955. doi: 10.1016/j.vaccine.2014.10.060. Epub 2014 Oct 30.
Results Reference
derived

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Maternal Immunization To Prevent Infant Otitis Media

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