Influenza Vaccination of HIV Infected Pregnant Women: Safety and Immunogenicity - Full Text View

Purpose

This randomized, placebo controlled trial will evaluate the safety and immunogenicity of Trivalent Influenza Vaccine (TIV) in HIV-infected pregnant women, dynamics of transplacental anti-influenza antibody transfer to their newborns and kinetics thereof during early infancy.

Condition	Intervention	Phase
Influenza	Biological: Trivalent influenza vaccine Biological: Normal saline	Phase 2 Phase 3

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Prevention
Official Title:	Trivalent Influenza Vaccine in HIV-infected Pregnant Women and Kinetics of Transplacental Anti-influenza Antibody Transfer and Persistence in Young Infants: A Randomized Controlled Phase II Trial Evaluating Safety and Immunogenicity

Resource links provided by NLM:

MedlinePlus related topics: Flu HIV/AIDS

Drug Information available for: Influenza Vaccines

U.S. FDA Resources

Further study details as provided by University of Witwatersrand, South Africa:

Primary Outcome Measures:

Humoral immune responses to influenza strains in the vaccine will be measured to assess the immunogenicity of TIV in HIV-infected pregnant women vaccinated between 20-34 weeks of gestational age [ Time Frame: 1 month post vaccination, delivery (+7 days), 24 weeks post delivery ] [ Designated as safety issue: No ]
Humoral immunity will be measured by hemagglutination inhibition (HAI) assay. Blood will be collected at enrolment (pre-vaccination), one month post vaccination, delivery (+7 days) and 24 weeks post delivery. Humoral immune response definitions: HAI titers < 1:10 = seronegative; ≥ 1:10 = seropositive; > 1:40 = protected against influenza; Response to TIV = serconversion (from <1:10 to ≥1:10) and/or 4-fold increase of HAI titers.
The proportion of newborns born to HIV-infected mothers with hemagglutination inhibition (HAI) antibody titers of ≥1:40 to TIV strain will be determined and compared to newborns born to TIV-vaccinated HIV-uninfected women (parallel trial) [ Time Frame: Delivery (+7 days) ] [ Designated as safety issue: No ]
Determine the proportion of newborns with hemagglutination inhibition (HAI) antibody titers of ≥1:40 to each of the three TIV strains born to HIV-infected mothers and compared to newborns born to TIV-vaccinated HIV-uninfected women

Secondary Outcome Measures:

Hemagglutinin (HA) antibody measurements in blood taken from mother and infants up to 24 weeks post delivery will be used to assess dynamics and kinetics of transplacentally acquired antibodies [ Time Frame: 24 weeks post partum ] [ Designated as safety issue: No ]
Hemagglutinin (HA) antibody measurements in blood taken from mother at birth and infants at birth, 8,16 and 24 weeks post delivery will be used to assess dynamics and kinetics of transplacentally acquired antibodies
The number of laboratory-confirmed or clinical influenza like illness cases in infants born to HIV infected mothers who received TIV or placebo will be used to determine efficacy of TIV vaccination of pregnant women against ILI in their infants [ Time Frame: 24 weeks of age ] [ Designated as safety issue: No ]
All infants (up to 24 weeks of age) born to women enrolled on trial will be assessed by study staff if they have any signs or symptoms (including fever, hospitalisation, apnea, cough, nasal catarrh/ congenstion, tachypnea) which could indicate influenza like illness. Nasopharyngeal aspirate samples collected at illness visits will be processed for viruses using real time reverse transcriptase-polymerase chain reaction (rRTPCR) assays.
The number of laboratory-confirmed influenza illnesses and clinical ILI cases in maternal participants during pregnancy and for 24 weeks post-partum will be used to assess efficacy of TIV against laboratory confirmed and clinical ILI [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
All maternal participants with signs and/ or symptoms of influenza like illness (ILI) will have nasopharyngeal and oropharyngeal swabs collected at illness visits and processed by rRTPCR assays. Participants from whom influenza virus is isolated at illness visits will be included in analysis to evaluate the efficacy of TIV against laboratory-confirmed influenza illness in mothers during pregnancy and until 24 weeks post-partum. Participants with no influenza isolated will be included in analysis of clinical ILI.
Cell-mediated immune (CMI) responses to influenza strains in the vaccine will be measured to define CMI responses to TIV in HIV infected pregnant women [ Time Frame: 1 month post vaccination ] [ Designated as safety issue: No ]
Cell mediated immunity will be measured by ELISPOT response to TIV. Blood will be collected at enrollment (pre-vaccination) and one month post vaccination
CD4+ and HIV-viral load will be measured at baseline and one-month post vaccination to evaluate effect of TIV. [ Time Frame: 1 month post vaccination ] [ Designated as safety issue: Yes ]
Evaluate the effect of TIV on CD4+ and HIV-viral load changes comparing baseline levels to one-month post vaccination.

Enrollment:	194
Study Start Date:	March 2011
Study Completion Date:	July 2012
Primary Completion Date:	June 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Trivalent Influenza vaccine 0.5ml of TIV will be administered into deltoid muscle of non dominant arm	Biological: Trivalent influenza vaccine 0.5 ml of trivalent influenza vaccine administered into deltoid muscle of non dominant arm Other Name: Vaxigrip
Placebo Comparator: Normal saline 0.5ml of normal saline administered into deltoid muscle of non dominant arm	Biological: Normal saline 0.5ml normal saline administered into deltoid muscle of non dominant arm Other Name: NaCl

Show Detailed Description

Eligibility

Ages Eligible for Study:	18 Years to 39 Years
Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

Pregnant women age > 18 years to < 39 years.
Gestational age ≥ 20 weeks to < 34 weeks documented by the approximate date of the last menstrual period and corroborated by physical exam.
Documented to be HIV-infected on two assays prior to study-enrollment.
Able to understand and comply with planned study procedures.
Provides written informed consent prior to initiation of study.

Exclusion Criteria

In HIV-infected women features of WHO clinical category 3 or 4 of AIDS at the time of enrollment.
Receipt of TIV, other than through the study, during the current influenza season documented by medical history or record.
Receipt of any live licensed vaccine ≤ 28 days or inactivated licensed vaccine ≤ 14 days prior to study-vaccine.
Receipt of a non-licensed agent (vaccine, drug, biologic, device, blood product, or medication) ≤ 28 days prior to vaccination in this study, or expects to receive another non-licensed agent before delivery unless study approval is obtained.
Any significant (in the opinion of the site investigator) acute illness and/or oral temperature greater than or equal to 38 degrees C ≤ 24 hours prior to study entry.
Use of anti-cancer systemic chemotherapy or radiation therapy ≤ 48 weeks of study enrollment, or has immunosuppression as a result of an underlying illness or treatment.
Long term use of glucocorticoids, including oral or parenteral prednisone ≥ 20 mg/day or equivalent for more than 2 consecutive weeks (or 2 weeks total) ≤ 12 weeks of study entry, or high-dose inhaled steroids (> 800 mcg/day of beclomethasone dipropionate or equivalent) ≤ 12 weeks before study entry (nasal and topical steroids are allowed).
Receipt of corticosteroids for preterm labor ≤ 14 days before study entry.(ix) Receipt of immunoglobulin or other blood products (with exception of Rho D immune globulin) ≤ 12 weeks prior to enrollment in this study or is scheduled to receive immunoglobulin or other blood products (with the exception of Rho D immune globulin) during pregnancy or for the first 24 weeks after delivery.
Receipt of IL2, IFN, GMCSF or other immune mediators ≤ 12 weeks before enrollment.
Uncontrolled major psychiatric disorder.
History of a severe adverse reaction to previous TIV.
Any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol.
Pregnancy complications (in the current pregnancy) such as pre-term labor, hypertension (systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mm Hg) or pre-eclampsia

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01306682

Locations

South Africa
RMPRU, Chris Hani Baragwanath Hospital
Soweto, Johannesburg, Gauteng, South Africa, 2013

Sponsors and Collaborators

University of Witwatersrand, South Africa

Bill and Melinda Gates Foundation

Emory University

University of Colorado, Denver

Investigators

Study Chair:	Shabir A Madhi, MD, PhD	University of the Witwatersrand
Study Director:	Keith P Klugman, MD, PhD	Emory University
Study Director:	Adriana Weinberg, PhD	University of Colorado, Denver

More Information

No publications provided

Responsible Party:	Michelle Groome, Medical officer, University of Witwatersrand, South Africa
ClinicalTrials.gov Identifier:	NCT01306682 History of Changes
Other Study ID Numbers:	Maternal_flu_HIVpos_101107
Study First Received:	March 1, 2011
Last Updated:	February 6, 2013
Health Authority:	South Africa: Human Research Ethics Committee South Africa: National Health Research Ethics Council

Additional relevant MeSH terms:

Influenza, Human
Orthomyxoviridae Infections
RNA Virus Infections

Virus Diseases
Respiratory Tract Infections
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on May 23, 2013

Influenza Vaccination of HIV Infected Pregnant Women: Safety and Immunogenicity (MatfluHIVpos)