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The Immune Response to Influenza Vaccinations in Elderly Individuals

Primary Purpose

Influenza

Status
Completed
Phase
Phase 4
Locations
Singapore
Study Type
Interventional
Intervention
Vaxigrip®
Sponsored by
National University Hospital, Singapore
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Influenza focused on measuring Influenza, Influenza Virus Vaccines, Vaxigrip, Respiratory Tract Infections, Orthomyxoviridae Infections, Frailty, Aging, Safety, Immunogenicity

Eligibility Criteria

21 Years - 90 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Aged ≥ 65 years and <90 years on the day of inclusion for the elderly group, and ≥ 21-<40 for the adult group.
  2. Informed consent form has been signed and dated.
  3. Able to attend all scheduled visits and to comply with all trial procedures.
  4. Living at home.
  5. Able to walk without personal assistance and no other physical limitations that can limit participation.
  6. Recruited from the cohort in Singapore Longitudinal Ageing Study-II (SLAS-II), as well as from sites in West Jurong and from Outpatient clinics at National University Hospital (NUH).

Exclusion Criteria:

  1. Participation at the time of study enrollment (or in the 4 weeks preceding trial vaccination) or planned participation during the present trial period in another clinical trial investigating vaccine, drug, medical device, or medical procedure.
  2. Receipt of any vaccine in the 4 weeks preceding the trial vaccination or planned receipt of any vaccine in the 4 weeks following trial vaccination, including influenza vaccination. However, 23-valent pneumococcal vaccine and tetanus vaccine will be allowed during this time window.
  3. Receipt of an influenza vaccine within the 6 months preceding the trial vaccination or planned influenza vaccination during the trial.
  4. Known or suspected congenital or acquired immunodeficiency or receipt of immunosuppressive therapy, such as anti-cancer chemotherapy or radiation therapy, within the preceding 6 months; or long-term systemic corticosteroid therapy (prednisone or equivalent for more than 2 consecutive weeks within the past 3 months).
  5. Systemic hypersensitivity to eggs, chicken proteins, or any of the vaccine components or a history of a life-threatening reaction to Vaxigrip® or to a vaccine containing any of the same substances.
  6. Deprived of freedom by an administrative or court order, or in an emergency setting, or hospitalized involuntarily.
  7. Current alcohol or drug addiction.
  8. Chronic illness that, in the opinion of the investigator, is at a stage where it might interfere with trial conduct or completion.
  9. Identified as an Investigator or employee of the Investigator or study centre with direct involvement in the proposed study, or identified as an immediate family member (i.e. parent, spouse) of the Investigator or employee with direct involvement in the proposed study.
  10. Severe audio-visual impairment.
  11. Dementia, severe cognitive impairment (MMSE <18), major depression or other psychotic disorders.
  12. Progressive, degenerative neurologic disease: e.g. Alzheimer's disease.
  13. Rapidly progressive or terminal illness under palliative care with life expectancy less than 12 months.
  14. Primary severely muscle/joint disorders resulting in physical disability interfering with the physical performance tests needed for the study.
  15. Hospital admission in the past 6 weeks.
  16. (Relevant for the healthy young adults subjects group). Subject is pregnant (or positive urine pregnancy test), or lactating, or of childbearing potential (to be considered of non-childbearing potential, a female must be postmenopausal for at least 1 year, surgically sterile, or using an effective method of contraception or abstinence from at least 4 weeks prior to vaccination and until at least 4 weeks after vaccination).
  17. Self-reported thrombocytopenia, contraindicating intramuscular vaccination
  18. Bleeding disorder, or receipt of anticoagulants in the 3 weeks preceding vaccination, contraindicating intramuscular vaccination upon investigator's judgement.

Sites / Locations

  • Moral Neighbourhood Link @ Telok Blangah
  • National University Hospital
  • THK Seniors Activity Centre @ Henderson (Satellite 93)
  • Moral Neighbourhood Link (Bukit Merah View)
  • THK Seniors Activity Centre @ Beo Crescent
  • SARAH Senior Activity Centre
  • THK Seniors Service @ Taman Jurong
  • TaRa @ Jurong Point, Jurong West Central 2
  • Outpatient Clinic, St Luke's Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Healthy Adult

Healthy Elderly

Healthy Elderly Pre-Frail

Healthy Elderly Frail

Arm Description

Healthy adult participants aged 21-40 years will be vaccinated with Vaxigrip® influenza vaccine

Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.

Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.

Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.

Outcomes

Primary Outcome Measures

The Immune Responsiveness of Elderly Subjects when Administered Influenza Vaccination as Measured by HAI
Hemagglutination Inhibition (HAI) titer

Secondary Outcome Measures

Cellular Immune Response and Inflammatory Profile of elderly subjects when administered influenza vaccination - Flu-Specific T cells
% Flu-specific T cells out of total PBMCs
Flu-Specific B Cell Response
No. of flu-specific B cells quantified out of 1x105 PBMCs
Inflammatory Markers
Quantitative (pg/mL analyte, picogram of analyte per milliliter of plasma)

Full Information

First Posted
September 20, 2016
Last Updated
August 27, 2017
Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore, Agency for Science, Technology and Research, Sanofi Pasteur, a Sanofi Company
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1. Study Identification

Unique Protocol Identification Number
NCT03266237
Brief Title
The Immune Response to Influenza Vaccinations in Elderly Individuals
Official Title
Multi-parameter Immune Profile Associated With the Humoral Response to Influenza Vaccine, Vaxigrip® in Healthy and Frail Elderly Subjects Aged 65-90 Years in Singapore
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Completed
Study Start Date
December 2013 (undefined)
Primary Completion Date
May 2016 (Actual)
Study Completion Date
May 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore, Agency for Science, Technology and Research, Sanofi Pasteur, a Sanofi Company

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of this study is to characterize the immune profile of frail and healthy aged individuals and investigate their immune responsiveness including the response to influenza vaccine over an 18-month period. The project will include a longitudinal study to define immune signatures and multi-parameter profiles associated with frailty and may lead to the identification of predictive markers of evolution to frailty and Immunosenescence in the elderly.
Detailed Description
With better healthcare available and improved accessibility, people are living longer. However, a majority of older persons cannot be considered to be aging well. Approximately 70% of those aged 85 years or older require frequent long hospitalizations because of their increased susceptibility to infections, cancers, dementia, and other age-related health problems, along with overall loss of function and autonomy associated with old age. Previous studies have shown that vaccination against influenza, which significantly reduces all-cause mortality in the elderly (65 years and older), was less immunogenic and effective with age. Frailty, a geriatric syndrome associated with low functional activity, weight loss, exhaustion, disability, decreased resilience to stressors, has been shown to increase risk for adverse outcomes and death. Better understanding the relationship between aging and waning immune responsiveness will enable the development of strategies to improve response to vaccination in the elderly and reduce morbidity and eventually mortality associated with age related complications and outcomes such as infectious diseases or frailty. A comprehensive analysis of the immune phenotype and function after antigenic challenge in older individuals would be a unique approach to understand (i) the potential associations between aging, impaired immune function and transition to frailty, (ii) which components of the immune system are altered with aging (innate vs adaptive immunity) and (iii) if early and/or late immune responses are preferentially altered with aging and frailty.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Influenza
Keywords
Influenza, Influenza Virus Vaccines, Vaxigrip, Respiratory Tract Infections, Orthomyxoviridae Infections, Frailty, Aging, Safety, Immunogenicity

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Healthy Adult
Arm Type
Experimental
Arm Description
Healthy adult participants aged 21-40 years will be vaccinated with Vaxigrip® influenza vaccine
Arm Title
Healthy Elderly
Arm Type
Experimental
Arm Description
Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.
Arm Title
Healthy Elderly Pre-Frail
Arm Type
Experimental
Arm Description
Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.
Arm Title
Healthy Elderly Frail
Arm Type
Experimental
Arm Description
Healthy Elderly participants aged 65-90 years will be vaccinated with Vaxigrip® influenza vaccine.
Intervention Type
Drug
Intervention Name(s)
Vaxigrip®
Intervention Description
To describe the humoral immune response to Vaxigrip (IM) vaccination at Day 0 (baseline) and Day 28 according to the age and frailty status at baseline (i.e. in each study group) for each Influenza strain.
Primary Outcome Measure Information:
Title
The Immune Responsiveness of Elderly Subjects when Administered Influenza Vaccination as Measured by HAI
Description
Hemagglutination Inhibition (HAI) titer
Time Frame
18-month period
Secondary Outcome Measure Information:
Title
Cellular Immune Response and Inflammatory Profile of elderly subjects when administered influenza vaccination - Flu-Specific T cells
Description
% Flu-specific T cells out of total PBMCs
Time Frame
18 months
Title
Flu-Specific B Cell Response
Description
No. of flu-specific B cells quantified out of 1x105 PBMCs
Time Frame
18 months
Title
Inflammatory Markers
Description
Quantitative (pg/mL analyte, picogram of analyte per milliliter of plasma)
Time Frame
18 months
Other Pre-specified Outcome Measures:
Title
Clinical Assessments of the elderly subjects - Weight
Description
Quantitative Weight (kg, kilograms)
Time Frame
18 months
Title
Clinical Assessments of the elderly subjects - Height
Description
Quantitative Height (m, meters)
Time Frame
18 months
Title
Clinical Assessments of the elderly subjects - BMI
Description
Quantitative BMI (weight and height will be combined to report in kg/m2)
Time Frame
18 months
Title
Clinical Assessments of the elderly subjects - DXA
Description
Quantitative Dual-Energy X-Ray Absorptiometry (DXA) scan: Standardized Muscle Index (appendicular lean mass / height-squared); T-score based on Bone Mineral Density BMD (appendicular lean mass and height will be combined to report in g/cm2)
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Aged ≥ 65 years and <90 years on the day of inclusion for the elderly group, and ≥ 21-<40 for the adult group. Informed consent form has been signed and dated. Able to attend all scheduled visits and to comply with all trial procedures. Living at home. Able to walk without personal assistance and no other physical limitations that can limit participation. Recruited from the cohort in Singapore Longitudinal Ageing Study-II (SLAS-II), as well as from sites in West Jurong and from Outpatient clinics at National University Hospital (NUH). Exclusion Criteria: Participation at the time of study enrollment (or in the 4 weeks preceding trial vaccination) or planned participation during the present trial period in another clinical trial investigating vaccine, drug, medical device, or medical procedure. Receipt of any vaccine in the 4 weeks preceding the trial vaccination or planned receipt of any vaccine in the 4 weeks following trial vaccination, including influenza vaccination. However, 23-valent pneumococcal vaccine and tetanus vaccine will be allowed during this time window. Receipt of an influenza vaccine within the 6 months preceding the trial vaccination or planned influenza vaccination during the trial. Known or suspected congenital or acquired immunodeficiency or receipt of immunosuppressive therapy, such as anti-cancer chemotherapy or radiation therapy, within the preceding 6 months; or long-term systemic corticosteroid therapy (prednisone or equivalent for more than 2 consecutive weeks within the past 3 months). Systemic hypersensitivity to eggs, chicken proteins, or any of the vaccine components or a history of a life-threatening reaction to Vaxigrip® or to a vaccine containing any of the same substances. Deprived of freedom by an administrative or court order, or in an emergency setting, or hospitalized involuntarily. Current alcohol or drug addiction. Chronic illness that, in the opinion of the investigator, is at a stage where it might interfere with trial conduct or completion. Identified as an Investigator or employee of the Investigator or study centre with direct involvement in the proposed study, or identified as an immediate family member (i.e. parent, spouse) of the Investigator or employee with direct involvement in the proposed study. Severe audio-visual impairment. Dementia, severe cognitive impairment (MMSE <18), major depression or other psychotic disorders. Progressive, degenerative neurologic disease: e.g. Alzheimer's disease. Rapidly progressive or terminal illness under palliative care with life expectancy less than 12 months. Primary severely muscle/joint disorders resulting in physical disability interfering with the physical performance tests needed for the study. Hospital admission in the past 6 weeks. (Relevant for the healthy young adults subjects group). Subject is pregnant (or positive urine pregnancy test), or lactating, or of childbearing potential (to be considered of non-childbearing potential, a female must be postmenopausal for at least 1 year, surgically sterile, or using an effective method of contraception or abstinence from at least 4 weeks prior to vaccination and until at least 4 weeks after vaccination). Self-reported thrombocytopenia, contraindicating intramuscular vaccination Bleeding disorder, or receipt of anticoagulants in the 3 weeks preceding vaccination, contraindicating intramuscular vaccination upon investigator's judgement.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Professor Paul Anantharajah Tambyah, MD
Organizational Affiliation
National University of Singapore
Official's Role
Principal Investigator
Facility Information:
Facility Name
Moral Neighbourhood Link @ Telok Blangah
City
Singapore
ZIP/Postal Code
090003
Country
Singapore
Facility Name
National University Hospital
City
Singapore
ZIP/Postal Code
119228
Country
Singapore
Facility Name
THK Seniors Activity Centre @ Henderson (Satellite 93)
City
Singapore
ZIP/Postal Code
150093
Country
Singapore
Facility Name
Moral Neighbourhood Link (Bukit Merah View)
City
Singapore
ZIP/Postal Code
150118
Country
Singapore
Facility Name
THK Seniors Activity Centre @ Beo Crescent
City
Singapore
ZIP/Postal Code
160044
Country
Singapore
Facility Name
SARAH Senior Activity Centre
City
Singapore
ZIP/Postal Code
160105
Country
Singapore
Facility Name
THK Seniors Service @ Taman Jurong
City
Singapore
ZIP/Postal Code
610337
Country
Singapore
Facility Name
TaRa @ Jurong Point, Jurong West Central 2
City
Singapore
ZIP/Postal Code
648886
Country
Singapore
Facility Name
Outpatient Clinic, St Luke's Hospital
City
Singapore
ZIP/Postal Code
659674
Country
Singapore

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Publication of the data in peer-reviewed journals
IPD Sharing Time Frame
five years approx
IPD Sharing Access Criteria
through a research agreement
Citations:
PubMed Identifier
30455722
Citation
Camous X, Visan L, Ying CTT, Abel B, Nyunt MSZ, Narang V, Poidinger M, Carre C, Sesay S, Bosco N, Burdin N, Tambyah PA, Pin NT, Larbi A. Healthy elderly Singaporeans show no age-related humoral hyporesponsiveness nor diminished plasmablast generation in response to influenza vaccine. Immun Ageing. 2018 Nov 12;15:28. doi: 10.1186/s12979-018-0137-4. eCollection 2018.
Results Reference
derived

Learn more about this trial

The Immune Response to Influenza Vaccinations in Elderly Individuals

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