Safety of and Immune Response to an H1N1 Influenza Virus Vaccine in HIV Infected Children and Youth

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier:
NCT00992836
First received: October 8, 2009
Last updated: June 23, 2014
Last verified: June 2014
  Purpose

Children and people infected with HIV are particularly susceptible to influenza infections. This study testED the safety and effectiveness of a vaccine for the new H1N1 influenza virus in children and youth infected with HIV.


Condition Intervention Phase
HIV Infections
H1N1 Influenza Virus
Biological: Influenza A (H1N1) 2009 monovalent vaccine
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: A Phase II Study to Assess the Safety and Immunogenicity of an Inactivated Swine-Origin H1N1 Influenza Vaccine in HIV-1 Perinatally Infected Children and Youth

Resource links provided by NLM:


Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Primary Outcome Measures:
  • The Number of Participants Who Had at Least One Adverse Event (AE) [ Time Frame: Measured up to 7 months after vaccination ] [ Designated as safety issue: Yes ]

    Shows the number of participants who had at least one adverse event (AE) in each category. The AEs include: abnormal laboratory values, signs and symptoms, or diagnoses; solicited local AEs; and solicited systemic AEs.

    Adverse Events were graded using the DAIDS Grading Severity of AEs (see Link under More Information), as follows: grade 1=mild, 2=moderate, 3=severe, 4=life threatening/disabling, 5=death.


  • The Number of Participants Who Had at Least One AE Attributed to the Study Vaccine [ Time Frame: Measured up to 7 months after vaccination ] [ Designated as safety issue: Yes ]
    Shows the number of participants who experienced any events that were thought to be at least possibly related to study treatment. Adverse Events were graded using the DAIDS Grading Severity of AEs (see Link under More Information), as follows: grade 1=mild, 2=moderate, 3=severe, 4=life threatening/disabling, 5=death.

  • Withholding of Second Vaccine Dose Due to Adverse Reactions Attributed to First Dose [ Time Frame: Measured at Day 21 ] [ Designated as safety issue: Yes ]
  • Percent of Participants With a Hemagglutinin Inhibition (HAI) Titer of >=40 [ Time Frame: Measured at 21 days after first dose and 10 days after second dose ] [ Designated as safety issue: No ]
    Antibodies to Influenza A (H1N1) 2009 were measured using an HAI assay. The potential titer read-outs from the assay used were <10 (considered undetectable), 10, 20, 40, 60, 80, 160, 320, 640 and >=1280. Seroprotection was defined as having a titer of >=40 following vaccination.


Secondary Outcome Measures:
  • Percent of Participants With an HAI Titer >=40 at Long-term Follow-up [ Time Frame: Measured at 6 months after second dose ] [ Designated as safety issue: No ]
  • Geometric Mean Antibody Titers (GMT) HAI [ Time Frame: Measured after first and second doses and 6 months after second dose ] [ Designated as safety issue: No ]
    Presents the value of the geometric mean titer at each time point.

  • Cell-mediated Immune Responses, Measured by B-cell and T-cell Enzyme-linked Immunosorbent Spot (ELISPOT) Assay Values [ Time Frame: Measured at entry, 21 days after first dose, and 10 days after second dose ] [ Designated as safety issue: No ]
    The median and interquartile range (IQR) of B-Cell ELISPOT-measured IgG antibody-secreting cells (ASC)/10^6 peripheral blood mononucleated cell (PBMC) and the median and interquartile range (IQR) of T-Cell ELISPOT-measured pH1N1 IFNgamma spot-forming cells (SFC)/10^6 PBMC.

  • HAI Titers Against Seasonal Influenza Viruses Containing Trivalent Influenza Vaccine (TIV) [ Time Frame: Measured at entry, 21 days after first dose, and 10 days and 6 months after second dose ] [ Designated as safety issue: No ]
    Presents the value of the median titer as well as the interquartile range at study entry. Antibodies to seasonal Influenza vaccine were measured using an HAI assay. The potential titer read-outs from the assay used were <10 (considered undetectable), 10, 20, 40, 60, 80, 160, 320, 640, and >=1280.

  • Cell-mediated Immune Responses to Influenza Viruses Contained in TIV and Other Antigens [ Time Frame: Measured at entry, 21 days after first dose, and 10 days after second dose ] [ Designated as safety issue: No ]

    The TIV assay was not performed due to lack of available cells after completion of other planned assays.

    The median and interquartile range (IQR) of T-Cell ELISPOT-measured pH1N1 Granzyme B spot-forming cells (SFC)/10^6 peripheral blood mononucleated cell (PBMC).

    The median and interquartile range (IQR) of T-Cell ELISPOT-measured PHA INFgamma spot-forming cells (SFC)/10^6 PBMC.

    The median and interquartile range (IQR) of T-Cell ELISPOT-measured PHA Granzyme B spot-forming cells (SFC)/10^6 PBMC.



Enrollment: 155
Study Start Date: October 2009
Study Completion Date: August 2010
Primary Completion Date: August 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Influenza A (H1N1) 2009 monovalent vaccine
All participants received two doses of the H1N1 influenza virus vaccine, administered 21 days apart.
Biological: Influenza A (H1N1) 2009 monovalent vaccine
Two doses of vaccine, delivered 21 days apart, with each dose consisting of two 15-microgram intramuscular injections

Detailed Description:

The new H1N1 influenza virus seen in 2009 has been designated a pandemic by the World Health Organization, due to the sustained community outbreaks seen in the United States and Mexico. Based on preliminary data, it appears children and young adults were particularly at risk of the H1N1 virus. People infected with HIV were also more susceptible to severe influenza infections than those who are uninfected. Children with HIV infection, then, have a compounded risk of H1N1 infection. Higher doses of influenza vaccines are associated with the development of higher levels of serum antibodies, which are needed to resist infection. Higher vaccine doses can be used to improve vaccine effectiveness in at-risk populations. This study tested the safety and immune response of HIV infected children and youth to a high dose of a vaccine for the new H1N1 influenza virus.

Participation in this study lasted 7 months and had two steps. The first step involved receiving the first dose of H1N1 virus vaccine, and the second step, occurring 21 days later, involved receiving the second dose of vaccine. Each dose of vaccine was delivered via two intramuscular shots (four total injections). After receiving each dose of the vaccine, participants were given a diary to record any symptoms or reactions. Participants were stratified into three groups by age, including 4 to 9 years, 9 to 18 years, and 18 to 25 years.

Participants completed five scheduled visits, taking place at screening, study entry, Days 21 and 31, and after 7 months. Measurements taken on these visits included a medical history, physical and neurological exams, a blood draw, and, when applicable, a pregnancy test. In addition to these visits, participants received up to three additional phone calls or visits occurring 2 and 10 days after the first dose of vaccine and 2 days after the second dose of vaccine to check for reactions to the vaccine.

  Eligibility

Ages Eligible for Study:   4 Years to 25 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria for Step I:

  • HIV infected
  • HIV-1 was perinatally acquired, in the opinion of the investigator
  • Participants receiving antiretrovirals (ARVs) must have been receiving a stable regimen for 90 days prior to entry with no intention to modify their regimen within 60 days following study entry
  • Participants not receiving ARVs at entry must not have received ARVs within 90 days prior to entry and must NOT plan to initiate ARVs within 60 days following study entry
  • Ability to complete all study immunizations and evaluations, in the opinion of the investigator
  • Agrees to use contraception, if necessary
  • Documented platelet count of more than 50,000 per mm3 and an absolute neutrophil count (ANC) of more than 500 per mm3 within the 30 days prior to study entry
  • Youth of legal age (from 18 to 25 years of age), parent or legal guardian, or participants who are emancipated minors must provide informed consent

Inclusion Criteria for Step II:

  • Received the first dose of Influenza A (H1N1) 2009 monovalent vaccine at least 21 days ago
  • Documented platelet count of more than 50,000 per mm3 and an ANC of more than 500 per mm3 within the 30 days prior to Step II entry
  • If a woman became pregnant after Dose #1, she must be at more than 14 weeks of gestation and have her obstetrician's permission to receive the vaccine

Exclusion Criteria for Step I:

  • Pregnancy
  • Known allergy to egg protein (egg or egg product) or other components in the vaccines (these may include, but are not limited to: neomycin and polymyxin)
  • History, in the opinion of the site investigator, of severe reactions following previous immunization with seasonal influenza vaccines that would contraindicate receipt of any influenza vaccine.
  • History of probable or proven pandemic 2009 Influenza A (H1N1) infection prior to study entry
  • Has received any live licensed vaccine within 4 weeks or inactivated licensed vaccine within 2 weeks prior to study entry
  • Has received a nonlicensed agent (vaccine, drug, biologic, device, blood product, or medication) within 4 weeks prior to study entry or expects to receive another nonlicensed agent during the course of the study
  • Has an acute illness or a documented temperature greater than or equal to 100.0 degrees Fahrenheit within 24 hours prior to study entry
  • Use of anti-cancer chemotherapy or radiation therapy within the 36 months preceding study entry or has immunosuppression as a result of an underlying illness or treatment (other than HIV-1 infection)
  • Has an active neoplastic disease
  • Long-term use of glucocorticoids, including oral or parenteral prednisone or equivalent (at least 2 mg/kg per day or at least 20 mg total dose) for more than 2 weeks in the past 6 months or high-dose inhaled steroids (more than 800 mcg/day of beclomethasone dipropionate or equivalent) within the preceding 6 months. Nasal and topical steroids are allowed.
  • Has received immunoglobulin or other blood products within the 3 months prior to study entry
  • History of Guillain-Barre syndrome in the subject or subject's family, including parents, siblings, half-siblings, and children
  • Onset of a neurological disorder including (but not limited to) absent ankle and patellar deep tendon reflexes in both legs (all four absent) within the past 6 months
  • Disproportionate loss of strength in lower extremity or extremities compared to the upper extremities within the past 6 months
  • Has any condition that would, in the opinion of the site investigator, place the participant at an unacceptable risk of injury or render the participant unable to meet the requirements of the protocol

Exclusion Criteria for Step II:

  • Has received a nonlicensed agent (vaccine, drug, biologic, device, blood product, or medication), other than from participation in this study, since Dose #1 or expects to receive another nonlicensed agent before the end of the study
  • Use of anti-cancer chemotherapy or radiation therapy since Dose #1, new diagnosis of an active malignancy, or is immunosuppressed as a result of an underlying illness (other than HIV-1 infection) or treatment.
  • Use of glucocorticoids, including oral or parenteral steroids (at least 2 mg/kg per day or at least 20 mg total dose) for more than 2 weeks since vaccine Dose #1 or high-dose inhaled steroids (more than 800 mcg/day of beclomethasone dipropionate or equivalent) since Dose #1 (nasal and topical steroids are allowed)
  • Has received immunoglobulin or other blood products since Dose #1
  • Any Grade 3 toxicity or adverse event (AE) experienced by a participant, unless the investigator has received protocol team approval
  • Any Grade 4 toxicity or AE (other than injection site reaction or fever) that is definitely, probably or possibly related to study vaccine
  • Any Grade 4 injection site reactions or fever experienced by a participant, unless the investigator has received protocol team approval
  • Any Grade 4 AEs that are definitely not or probably not related to study vaccine, unless the investigator has received protocol team approval
  • New occurrence or new awareness of Guillain-Barre syndrome in the participant or participant's family (parents, siblings, half-siblings, or children) since Dose #1
  • New onset of a neurological disorder including (but not limited to) absent ankle and patellar deep tendon reflexes in both legs (all four absent) since Dose #1
  • Disproportionate loss of strength in lower extremity or extremities compared to the upper extremities (not thought to be related to pregnancy) since Dose #1
  • Documented infection with 2009 Influenza A (H1N1) since Dose #1
  • Refusal of further vaccination by participant, parent, or guardian
  • Development of any new disease that the investigator judges to be clinically significant or clinically significant findings since Dose #1 that, in the investigator's opinion, would compromise the safety of the subject
  • Withdrawal of consent. Consent may be withdrawn at any time and for any reason, without penalty.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00992836

  Hide Study Locations
Locations
United States, Alabama
UAB Pediatric Infectious Diseases CRS
Birmingham, Alabama, United States, 35233
United States, California
Usc La Nichd Crs
Alhambra, California, United States, 91803
University of California, UC San Diego CRS
La Jolla, California, United States, 92093-0672
Miller Children's Hosp. Long Beach CA NICHD CRS
Long Beach, California, United States, 90806
UCLA-Los Angeles/Brazil AIDS Consortium (LABAC) CRS
Los Angeles, California, United States, 90095-1752
Univ. of California San Francisco NICHD CRS
San Francisco, California, United States, 94143
Harbor UCLA Medical Ctr. NICHD CRS
Torrance, California, United States, 90502
United States, Colorado
Univ. of Colorado Denver NICHD CRS
Aurora, Colorado, United States, 80045
United States, District of Columbia
Children's National Med. Ctr. Washington DC NICHD CRS
Washington, District of Columbia, United States, 20010
Howard Univ. Washington DC NICHD CRS
Washington, District of Columbia, United States, 20060
United States, Florida
South Florida CDTC Ft Lauderdale NICHD CRS
Fort Lauderdale, Florida, United States, 33316
Univ. of Florida Jacksonville NICHD CRS
Jacksonville, Florida, United States, 32209
Pediatric Perinatal HIV Clinical Trials Unit CRS
Miami, Florida, United States, 33136
USF - Tampa NICHD CRS
Tampa, Florida, United States, 33606
United States, Illinois
Ann & Robert H. Lurie Children's Hospital of Chicago (LCH) CRS
Chicago, Illinois, United States, 60614-3393
Rush Univ. Cook County Hosp. Chicago NICHD CRS
Chicago, Illinois, United States, 60612
United States, Maryland
Johns Hopkins Univ. Baltimore NICHD CRS
Baltimore, Maryland, United States, 21287
Univ. of Maryland Baltimore NICHD CRS
Baltimore, Maryland, United States, 21201
United States, Massachusetts
Children's Hosp. of Boston NICHD CRS
Boston, Massachusetts, United States, 02115
Boston Medical Center Ped. HIV Program NICHD CRS
Boston, Massachusetts, United States, 02118
WNE Maternal Pediatric Adolescent AIDS CRS
Worcester, Massachusetts, United States, 01605
United States, Michigan
Children's Hospital of Michigan NICHD CRS
Detroit, Michigan, United States, 48201
United States, New Jersey
Rutgers - New Jersey Medical School CRS
Newark, New Jersey, United States, 01703
United States, New York
Bronx-Lebanon CRS
Bronx, New York, United States, 10457
Jacobi Med. Ctr. Bronx NICHD CRS
Bronx, New York, United States, 10461
Columbia IMPAACT CRS
New York, New York, United States, 10032
Metropolitan Hosp. NICHD CRS
New York, New York, United States, 10029
Nyu Ny Nichd Crs
New York, New York, United States, 10016
Strong Memorial Hospital Rochester NY NICHD CRS
Rochester, New York, United States, 14642
SUNY Stony Brook NICHD CRS
Stony Brook, New York, United States, 11794-8111
United States, North Carolina
DUMC Ped. CRS
Durham, North Carolina, United States, 27710
United States, Pennsylvania
The Children's Hosp. of Philadelphia IMPAACT CRS
Philadelphia, Pennsylvania, United States, 19104
United States, Tennessee
St. Jude Children's Research Hospital CRS
Memphis, Tennessee, United States, 38105-3678
United States, Texas
Texas Children's Hospital CRS
Houston, Texas, United States, 77030-2399
United States, Washington
Seattle Children's Research Institute CRS
Seattle, Washington, United States, 98101
Puerto Rico
San Juan City Hosp. PR NICHD CRS
San Juan, Puerto Rico, 00936
University of Puerto Rico Pediatric HIV/AIDS Research Program CRS
San Juan, Puerto Rico, 00935
Sponsors and Collaborators
Investigators
Study Chair: Pat Flynn, MD St. Jude Children's Research Hospital
  More Information

Additional Information:
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00992836     History of Changes
Other Study ID Numbers: P1088, 10840, IMPAACT P1088
Study First Received: October 8, 2009
Results First Received: August 23, 2011
Last Updated: June 23, 2014
Health Authority: United States: Food and Drug Administration
United States: Federal Government

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Influenza A Virus, H1N1 Subtype
Vaccine
Children
Adolescents
HIV-Infected
Perinatal HIV Infection
Treatment experienced

Additional relevant MeSH terms:
Infection
Influenza, Human
HIV Infections
Acquired Immunodeficiency Syndrome
Orthomyxoviridae Infections
RNA Virus Infections
Virus Diseases
Respiratory Tract Infections
Respiratory Tract Diseases
Lentivirus Infections
Retroviridae Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases

ClinicalTrials.gov processed this record on September 22, 2014