Experimental AD4-H5-VTN Vaccine in Healthy Volunteers

• INCLUSION CRITERIA:

All participants (vaccinees, household contacts and intimate contacts) must meet all of the following criteria:

1. Age 18 to 49 years for vaccinees. Age 18 to 65 years for household and intimate contacts.
2. Negative FDA-approved HIV test
3. Able to provide proof of identity to the acceptance of the Principal Investigator or designee during enrollment.
4. Available and willing to participate in follow-up visits and tests for the duration of the study,
5. Willing to have samples stored for future research.

The following inclusion criteria apply to vaccinees and intimate contacts, but not to household contacts:

1. In good general health without clinically significant medical history.
2. Negative Beta-HCG pregnancy test for females presumed to be of reproductive potential.

3. A female must meet one of the following criteria:

   1. No reproductive potential because of menopause (one year without menses) or because of a hysterectomy, bilateral oophorectomy, or tubal ligation.

      or

   2. Participant agrees to be heterosexually inactive or consistently practice contraception at least 21 days prior to enrollment and 28 days following vaccination. Acceptable methods of contraception include the following:

      • condoms, male or female, with a spermicide
      • diaphragm or cervical cap with spermicide
      • contraceptive pills, Norplant, or Depo-Provera
      • male partner has previously undergone a vasectomy for which there is documentation.
      • intrauterine device
4. Male participants must agree to practice abstinence or effective birth control for at least 21 days prior to enrollment and during the first 28 days following vaccination

The following inclusion criteria apply only to vaccinees and not to household or intimate contacts:

1. Willing to receive HIV test results and abide by NIH guidelines for partner notification of positive HIV results.
2. Physical examination and laboratory results without clinically significant findings within the 8 weeks prior to enrollment.
3. Willing to avoid vaccination other than the study agent for 30 days prior to and 30 days after administration of the Ad4-H5-Vtn vaccine.

4. Safety Laboratory Criteria within 8 weeks prior to enrollment:

   Hematopoietic: -White blood cell count and Lymphocyte count plus or minus 25 percent the normal limits for the NIH Clinical Center -Platelet count of least 125,000/mm(3)

   • Hemoglobin > 11.2 g/dL for females and > 13.0 g/dL for males.
   • Renal: BUN < 23 mg/dL; creatinine within normal limits for the NIH Clinical Center
   • Hepatic: Serum total bilirubin less than or equal to 2 mg/dL
   • Metabolic: ALT < 2 times upper limit of normal range
   • Endocrine: Serum glucose within normal range
5. Additional Laboratoy Criteria:

Immunologic: No history of hypogammaglobulinemia

Serologic: Ad4 neutralizing antibody 480% inhibitory dilution < 1:100

The following inclusion criteria apply only to tonsillar vaccinees and not to oral vaccine recipients, household contacts, or intimate contacts:

1. Willing to be hospitalized at the Clinical Center under respiratory precautions for up to 7 days or longer if medically indicated.
2. Either no history of tonsillectomy, OR the presence of tonsils on physical exam.

EXCLUSION CRITERIA

A participant (vaccinees, household contacts, and intimate contacts) will be excluded if they have the following:

1. Any condition that, in the investigator's judgement, places the subject at undue risk by participating in the study.

The following exclusion criterion applies to vaccinees and intimate contacts, but not to household contacts:

1. History of any prior disease or therapy which would affect immune or pulmonary function.
2. Prior malignancy, except curatively-treated basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix.
3. History of radiation therapy or cytotoxic/cancer chemotherapy.
4. History of insulin-dependent diabetes mellitus.
5. Immunodeficiency or autoimmune disease.
6. Acute infection or a recent (within 6 months) history of chronic infection suggestive of immunodeficiency.
7. Taking any medication which may affect immune function, except participants may be taking low doses of nonprescription strength NSAIDS (including e.g. ibuprofen or aspirin) or acetaminophen.
8. Chronic respiratory disorders including asthma, emphysema, interstitial lung disease, pulmonary hypertension, recurrent pneumonia, or recent or ongoing respiratory tract infection. If a respiratory disorder is transient, defer immunization but do not exclude the participant.

9. Active Hepatitis B or C infection, as indicated by the presence of Hepatitis B antigen or Hepatitis C virus (i.e. Hepatitis B or C positive serology with the presence of virus antigen or DNA. Ongoing viral

   replication will be confirmed by a Hepatitis B antigen or Hepatitis C viral load).

10. Female of child-bearing potential who is breast-feeding or planning pregnancy during the 28 days following vaccination.

The following exclusion criteria apply only to vaccinees and not to household or intimate contacts:

1. Any medical, psychiatric, or social condition, or occupational or other responsibility that, in the judgment of the investigator, would interfere with or serve as a contraindication to receipt of live virus vaccine, protocol adherence, or a participant's ability to give informed consent.
2. Psychiatric condition that precludes compliance with the protocol; past or present psychoses; past or present bipolar disorder requiring therapy that has not been well controlled on medication for the past two years; disorder requiring lithium; or suicidal ideation occurring within five years prior to enrollment.

3. Participants that live in the same house or apartment with any of the following will be excluded:

   • An individual under 18 years of age
   • An immunocompromised or immunosuppressed individual
   • An individual with chronic respiratory disease
   • A woman who is currently pregnant or planning a pregnancy during the period of immunization
4. Healthcare worker who has direct contact with immunodeficient, unstable patients, or pediatric patients.

5. Receipt of any of the following:

   • Antiviral medications within 30 days prior to vaccination
   • Blood products within 120 days prior to HIV screening
   • Immunoglobulin within 60 days prior to HIV screening
   • Investigational research drugs or any other investigational agent that in the judgement of the PI might interact with the study vaccine within 30 days prior to initial study vaccine administration
   • Allergy treatment with antigen injections within 30 days of study vaccine administration
6. History of Guillain-Barr syndrome.
7. History of H5 influenza vaccination.