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Study of Immune Responses in Healthy Adults Receiving Live Influenza Virus Vaccines

Primary Purpose

Influenza, Human

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
A/swine/Missouri/4296424/2006 (H2N3) x A/Ann Arbor/6/60 ca (H2N3 MO 2006/AA ca)
A/chicken/Hong Kong/G9/97 (H9N2) x A/Ann Arbor/6/60 ca (H9N2 G9/AA ca)
2012-2013 trivalent seasonal live attenuated influenza vaccine (FluMist®)
Vaccine placebo (Leibovitz-15 [L-15])
Vaccine placebo (FluMist®)
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, Human

Eligibility Criteria

18 Years - 42 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • General good health, without significant medical illness, physical examination findings, or significant laboratory abnormalities as determined by the investigator
  • Agree to storage of blood specimens for future research
  • Available for the duration of the trial. For the inpatient component of the study, participants must be willing and able to remain within the Isolation Unit for the specified duration of confinement. For the outpatient component of the study, participants must be willing and able to make daily outpatient follow-up visits as specified by the protocol.
  • Willingness to participate in the study as evidenced by signing the informed consent document
  • Female participants must agree to use effective birth control methods for the duration of the study (for example, pharmacologic contraceptives including oral, parenteral, and transcutaneous delivery; condoms with spermicide; diaphragm with spermicide; intrauterine device; abstinence from heterosexual intercourse; or surgical sterilization). All female participants will be considered being of child-bearing potential except those who have undergone hysterectomy and those in whom menopause occurred at least 1 year prior to the study.

Exclusion Criteria:

  • Pregnancy as determined by a positive human choriogonadotropin (beta-HCG) test
  • Currently breastfeeding
  • Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, autoimmune, or renal disease by history, physical examination, and/or laboratory studies including urine testing. Clinically significant alanine aminotransferase (ALT) levels, as determined by the Principal Investigator, will be exclusionary at baseline, prior to vaccination.
  • Behavioral or cognitive impairment or psychiatric disease that in the opinion of the investigator affects the ability of the subject to understand and cooperate with the study protocol
  • Previous enrollment in an H2 or H9 influenza vaccine trial or in any study of an avian influenza vaccine
  • For the inpatient arm, seropositive to the H2N3 influenza A virus or the H9N2 influenza A virus (serum HAI titer >1:8). For the outpatient arm, seropositive to the H3N2 component of seasonal LAIV (serum hemagglutination inhibition [HAI] titer greater than 1:8).
  • Positive urine drug toxicology test indicating narcotic use/dependency
  • Have medical, occupational, or family problems as a result of alcohol or illicit drug use during the past 12 months
  • Other condition that in the opinion of the investigator would jeopardize the safety or rights of a participant participating in the trial or would render the subject unable to comply with the protocol
  • History of anaphylaxis
  • Allergy to oseltamivir as determined by subject report
  • Current diagnosis of asthma or reactive airway disease (within the past 2 years)
  • History of Guillain-Barré Syndrome
  • Positive ELISA and confirmatory Western blot tests for human immunodeficiency virus-1 (HIV-1)
  • Positive ELISA and confirmatory test (e.g., recombinant immunoblot assay) for hepatitis C virus (HCV)
  • Positive hepatitis B virus surface antigen (HBsAg) by ELISA
  • Known immunodeficiency syndrome
  • Use of corticosteroids (excluding topical preparations) or immunosuppressive drugs within 30 days prior to vaccination
  • Receipt of a live vaccine within 4 weeks or a killed vaccine within 2 weeks prior to study vaccination
  • History of a surgical splenectomy
  • Receipt of blood or blood-derived products (including immunoglobulin) within 6 months prior to study vaccination
  • Current smoker unwilling to stop smoking for the duration of the study

    • A current smoker includes anyone stating he/she currently smokes any amount of a tobacco product
    • The decision to exclude a potential participant is determined by medical history and a clinician's clinical judgment based on the physical examination
    • After admission to the unit, nicotine patches will be provided to current smokers who request them for the inpatient portion of the study
  • Travel to the Southern Hemisphere within 14 days prior to study vaccination
  • Travel on a cruise ship within 14 days prior to study vaccination
  • Receipt of another investigational vaccine or drug within 30 days prior to study vaccination
  • Allergy to eggs or egg products

Sites / Locations

  • University of Rochester Medical Center: Facility for Evaluation of Flu Vaccines

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Group 1 (Inpatient, H2N3 MO 2006/AA ca)

Group 2 (Inpatient, H9N2 G9/AA ca)

Group 3 (Outpatient, seasonal LAIV [FluMist®])

Group 4 (Both inpatient and outpatient, placebo)

Arm Description

Participants will receive one dose of vaccine on Day 0, with 0.2 mL being delivered by Accuspray device (0.1 mL per nostril).

Participants will receive one dose of vaccine on Day 0, with 0.5 mL being delivered as nose drops (0.25 mL per nostril) using a sterile, needle-less tuberculin syringe.

2012-2013 trivalent seasonal live attenuated influenza vaccine (FluMist®)

Participants will receive either the L-15 placebo delivered by nose drops or the FluMist® placebo delivered as a nasal spray.

Outcomes

Primary Outcome Measures

Area under the curve (AUC) of nasal virus shedding after vaccine dose as assessed by liquid titration of nasal secretions on Madin Darby Canine Kidney (MDCK) cells
Development of serum antibody as assessed by either HAI or microneutralization (MN) assays

Secondary Outcome Measures

Development of a significant increase in nasal secretion hemagglutinin (HA)-specific antibody assessed by enzyme-linked immunosorbent assay (ELISA)
Detection of influenza-specific immunoglobulin G (IgG) or immunoglobulin A (IgA) secreting B cells assessed by antibody secreting cells (ASC) assay
Development of greater than 200 influenza-specific interferon-gamma-secreting cells per million lymphocytes as assessed by enzyme-linked immunospot assay (ELISPOT)

Full Information

First Posted
August 23, 2012
Last Updated
December 14, 2015
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
University of Rochester
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1. Study Identification

Unique Protocol Identification Number
NCT01674205
Brief Title
Study of Immune Responses in Healthy Adults Receiving Live Influenza Virus Vaccines
Official Title
Exploratory Evaluation of Host Biomarkers That Predict the Vaccine Virus Replication and Immunogenicity of Seasonal and Pandemic Formulations of Live Attenuated Influenza A Virus Vaccines Based on the A/Ann Arbor/6/60 ca Master Donor Virus (MDV)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
September 2012 (undefined)
Primary Completion Date
June 2013 (Actual)
Study Completion Date
June 2013 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study seeks to understand the host factors that affect the replication and immune response of seasonal and candidate pandemic live attenuated influenza vaccine (LAIV) in humans and to develop biomarkers that can predict the viral shedding and immune response to LAIVs.
Detailed Description
Influenza A viruses are widely distributed in nature and exist as many different subtypes. Pandemics of influenza can occur, and vaccine development is focused on those subtypes that are predicted to represent the greatest pandemic threat to the human population. This study seeks to understand the host factors that affect the replication and immune response of seasonal and candidate pandemic LAIVs in humans and to develop biomarkers that can predict the viral shedding and immune response to LAIVs. Three vaccines will be evaluated: the licensed seasonal LAIV, with a focus on the H3N2 component; the H9N2 G9/AA ca vaccine, which is among the most immunogenic of the candidate pandemic LAIVs evaluated to date; and the H2N3 MO 2066/AA ca vaccine, which is among the least immunogenic of the candidate pandemic LAIVs evaluated to date. The seasonal LAIV will be evaluated in an outpatient setting, while the other two vaccines will be evaluated in an inpatient setting. In each setting, some participants will receive a placebo vaccine. Study participants will be assigned to one of four groups. Participants who are seronegative to both H9N2 G9/AA ca and H2N3 MO 2006/AA ca viruses will be randomly assigned to receive one of those vaccines (Group 1: H9N2 G9/AA ca; Group 2: H2N3 MO 2006/AA ca) or placebo (Group 4) and will remain in an inpatient isolation facility. Participants who are seronegative to the H3 component of seasonal LAIV will be randomly assigned to receive either seasonal vaccine (Group 3) or placebo (Group 4) and will be followed as outpatients. All participants will remain in the study for 56 days. Participants in the inpatient arms will be admitted on Day -2, will receive study vaccine on Day 0, and will undergo a basic history, physical examination, and nasal wash each day until discharge. On some study days, inpatient participants will undergo a blood collection and/or a nasal swab; at the screening visit and on Day -1 or Day -2, participants will give a urine sample. Participants in the outpatient arms will receive study vaccine on Day 0 and will have study visits on Days 1, 2, 3, 4, 5, 6, 7, 14, 28, and 56. On Days 1 through 7, participants will undergo a basic history, physical examination, and nasal wash. On some visits, participants may undergo a blood collection and/or a nasal swab; at the screening visit and on Day -1, participants will give a urine sample. Unused blood or nasal wash samples will be stored and may be used in future research studies.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
36 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1 (Inpatient, H2N3 MO 2006/AA ca)
Arm Type
Experimental
Arm Description
Participants will receive one dose of vaccine on Day 0, with 0.2 mL being delivered by Accuspray device (0.1 mL per nostril).
Arm Title
Group 2 (Inpatient, H9N2 G9/AA ca)
Arm Type
Experimental
Arm Description
Participants will receive one dose of vaccine on Day 0, with 0.5 mL being delivered as nose drops (0.25 mL per nostril) using a sterile, needle-less tuberculin syringe.
Arm Title
Group 3 (Outpatient, seasonal LAIV [FluMist®])
Arm Type
Experimental
Arm Description
2012-2013 trivalent seasonal live attenuated influenza vaccine (FluMist®)
Arm Title
Group 4 (Both inpatient and outpatient, placebo)
Arm Type
Placebo Comparator
Arm Description
Participants will receive either the L-15 placebo delivered by nose drops or the FluMist® placebo delivered as a nasal spray.
Intervention Type
Biological
Intervention Name(s)
A/swine/Missouri/4296424/2006 (H2N3) x A/Ann Arbor/6/60 ca (H2N3 MO 2006/AA ca)
Intervention Type
Biological
Intervention Name(s)
A/chicken/Hong Kong/G9/97 (H9N2) x A/Ann Arbor/6/60 ca (H9N2 G9/AA ca)
Intervention Type
Biological
Intervention Name(s)
2012-2013 trivalent seasonal live attenuated influenza vaccine (FluMist®)
Intervention Type
Biological
Intervention Name(s)
Vaccine placebo (Leibovitz-15 [L-15])
Intervention Type
Biological
Intervention Name(s)
Vaccine placebo (FluMist®)
Primary Outcome Measure Information:
Title
Area under the curve (AUC) of nasal virus shedding after vaccine dose as assessed by liquid titration of nasal secretions on Madin Darby Canine Kidney (MDCK) cells
Time Frame
Measured through Day 9
Title
Development of serum antibody as assessed by either HAI or microneutralization (MN) assays
Time Frame
Measured through Day 56
Secondary Outcome Measure Information:
Title
Development of a significant increase in nasal secretion hemagglutinin (HA)-specific antibody assessed by enzyme-linked immunosorbent assay (ELISA)
Time Frame
Measured through Day 56
Title
Detection of influenza-specific immunoglobulin G (IgG) or immunoglobulin A (IgA) secreting B cells assessed by antibody secreting cells (ASC) assay
Time Frame
Measured at Day 7
Title
Development of greater than 200 influenza-specific interferon-gamma-secreting cells per million lymphocytes as assessed by enzyme-linked immunospot assay (ELISPOT)
Time Frame
Measured at Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
42 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: General good health, without significant medical illness, physical examination findings, or significant laboratory abnormalities as determined by the investigator Agree to storage of blood specimens for future research Available for the duration of the trial. For the inpatient component of the study, participants must be willing and able to remain within the Isolation Unit for the specified duration of confinement. For the outpatient component of the study, participants must be willing and able to make daily outpatient follow-up visits as specified by the protocol. Willingness to participate in the study as evidenced by signing the informed consent document Female participants must agree to use effective birth control methods for the duration of the study (for example, pharmacologic contraceptives including oral, parenteral, and transcutaneous delivery; condoms with spermicide; diaphragm with spermicide; intrauterine device; abstinence from heterosexual intercourse; or surgical sterilization). All female participants will be considered being of child-bearing potential except those who have undergone hysterectomy and those in whom menopause occurred at least 1 year prior to the study. Exclusion Criteria: Pregnancy as determined by a positive human choriogonadotropin (beta-HCG) test Currently breastfeeding Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, autoimmune, or renal disease by history, physical examination, and/or laboratory studies including urine testing. Clinically significant alanine aminotransferase (ALT) levels, as determined by the Principal Investigator, will be exclusionary at baseline, prior to vaccination. Behavioral or cognitive impairment or psychiatric disease that in the opinion of the investigator affects the ability of the subject to understand and cooperate with the study protocol Previous enrollment in an H2 or H9 influenza vaccine trial or in any study of an avian influenza vaccine For the inpatient arm, seropositive to the H2N3 influenza A virus or the H9N2 influenza A virus (serum HAI titer >1:8). For the outpatient arm, seropositive to the H3N2 component of seasonal LAIV (serum hemagglutination inhibition [HAI] titer greater than 1:8). Positive urine drug toxicology test indicating narcotic use/dependency Have medical, occupational, or family problems as a result of alcohol or illicit drug use during the past 12 months Other condition that in the opinion of the investigator would jeopardize the safety or rights of a participant participating in the trial or would render the subject unable to comply with the protocol History of anaphylaxis Allergy to oseltamivir as determined by subject report Current diagnosis of asthma or reactive airway disease (within the past 2 years) History of Guillain-Barré Syndrome Positive ELISA and confirmatory Western blot tests for human immunodeficiency virus-1 (HIV-1) Positive ELISA and confirmatory test (e.g., recombinant immunoblot assay) for hepatitis C virus (HCV) Positive hepatitis B virus surface antigen (HBsAg) by ELISA Known immunodeficiency syndrome Use of corticosteroids (excluding topical preparations) or immunosuppressive drugs within 30 days prior to vaccination Receipt of a live vaccine within 4 weeks or a killed vaccine within 2 weeks prior to study vaccination History of a surgical splenectomy Receipt of blood or blood-derived products (including immunoglobulin) within 6 months prior to study vaccination Current smoker unwilling to stop smoking for the duration of the study A current smoker includes anyone stating he/she currently smokes any amount of a tobacco product The decision to exclude a potential participant is determined by medical history and a clinician's clinical judgment based on the physical examination After admission to the unit, nicotine patches will be provided to current smokers who request them for the inpatient portion of the study Travel to the Southern Hemisphere within 14 days prior to study vaccination Travel on a cruise ship within 14 days prior to study vaccination Receipt of another investigational vaccine or drug within 30 days prior to study vaccination Allergy to eggs or egg products
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Treanor, MD
Organizational Affiliation
University of Rochester
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Rochester Medical Center: Facility for Evaluation of Flu Vaccines
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19210163
Citation
Karron RA, Callahan K, Luke C, Thumar B, McAuliffe J, Schappell E, Joseph T, Coelingh K, Jin H, Kemble G, Murphy BR, Subbarao K. A live attenuated H9N2 influenza vaccine is well tolerated and immunogenic in healthy adults. J Infect Dis. 2009 Mar 1;199(5):711-6. doi: 10.1086/596558.
Results Reference
background
PubMed Identifier
15163507
Citation
Belshe RB. Current status of live attenuated influenza virus vaccine in the US. Virus Res. 2004 Jul;103(1-2):177-85. doi: 10.1016/j.virusres.2004.02.031.
Results Reference
background

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Study of Immune Responses in Healthy Adults Receiving Live Influenza Virus Vaccines

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