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Zinc and/or Probiotic Supplementation of Rotavirus and Oral Polio Virus Vaccines

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ClinicalTrials.gov Identifier: NCT01616693
Recruitment Status : Completed
First Posted : June 12, 2012
Results First Posted : November 30, 2018
Last Update Posted : November 30, 2018
Sponsor:
Collaborators:
Christian Medical College, Vellore, India
Ministry of Science and Technology, India
Information provided by (Responsible Party):
PATH

Brief Summary:

Background: Strategies are needed to improve oral rotavirus vaccine (RV), which provides suboptimal protection in developing countries. Probiotics and zinc supplementation could improve RV immunogenicity by altering the intestinal microbiota and immune function.

This study enrolled infants 5 weeks old living in urban Vellore, India to assess the effects of daily zinc (5 mg), probiotic (1010 Lactobacillus rhamnosus GG) or placebo on the immunogenicity of two doses of RV (Rotarix,GlaxoSmithKline Biologicals) given at 6 and 10 weeks of age. Probiotics and zinc (or placebo) were provided for six weeks. A single dose of test product was administered daily one week prior to first study dose of rotavirus and polio vaccines through 1 week following second study dose of rotavirus and polio vaccines.


Condition or disease Intervention/treatment Phase
Immunity to Oral Rotavirus Vaccine Immunity to Oral Polio Vaccine Shedding of Oral Rotavirus Vaccine Dietary Supplement: Probiotic Dietary Supplement: Zinc Dietary Supplement: Probiotic placebo Dietary Supplement: Zinc placebo Biological: Rotavirus vaccine Biological: Oral polio vaccine Phase 4

Detailed Description:

Co- Primary objectives:

  1. To evaluate the serologic immune response to rotavirus vaccine (sero-conversion or four-fold rise in rotavirus immunoglobulin A (IgA) antibodies) among Indian infants receiving zinc supplementation given daily for a week prior to the administration of the first dose through a week following the second dose of oral rotavirus vaccine compared to those receiving a zinc placebo.
  2. To evaluate the serologic immune response to rotavirus vaccine (sero-conversion or four-fold rise in rotavirus IgA antibodies) among Indian infants receiving probiotic supplementation given daily for a week prior to the administration of the first dose through a week following the second dose of oral rotavirus vaccine compared to those receiving a probiotic placebo.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 620 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Basic Science
Official Title: Supplementation With Zinc and/or Probiotics to Enhance the Immune Response of Oral Rotavirus and Polio Vaccines in Indian Infants
Study Start Date : July 2012
Actual Primary Completion Date : July 2013
Actual Study Completion Date : July 2013

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Zinc and probiotic
Received daily zinc and probiotic supplements, in addition to rotavirus vaccine and trivalent oral polio vaccines.
Dietary Supplement: Probiotic
A capsule that contains at least 1 x 10^9 Lactobacillus rhamnosus GG organisms per capsule. The contents of this capsule were given once daily orally.
Other Name: Culturelle

Dietary Supplement: Zinc
Zinc sulphate syrup is zinc sulphate heptahydrate (concentration 1mg/ml). 5 ml of this suspension was given once daily orally.

Biological: Rotavirus vaccine
1 ml Rotarix®, a lyophilized human rotavirus vaccine reconstituted with calcium carbonate buffer provided orally at 6 and 10 weeks.
Other Name: Rotarix®

Biological: Oral polio vaccine
A liquid trivalent polio vaccine provided orally at 6 and 10 weeks.
Other Name: Biopolio®

Active Comparator: Zinc alone
Received daily zinc and probiotic placebo supplement, in addition to rotavirus vaccine and trivalent oral polio vaccine.
Dietary Supplement: Zinc
Zinc sulphate syrup is zinc sulphate heptahydrate (concentration 1mg/ml). 5 ml of this suspension was given once daily orally.

Dietary Supplement: Probiotic placebo
The probiotic placebo was manufactured by the same company that manufactured the probiotic and contained inulin powder but no Lactobacillus rhamnosus GG. The contents of the capsule were given once daily orally.

Biological: Rotavirus vaccine
1 ml Rotarix®, a lyophilized human rotavirus vaccine reconstituted with calcium carbonate buffer provided orally at 6 and 10 weeks.
Other Name: Rotarix®

Biological: Oral polio vaccine
A liquid trivalent polio vaccine provided orally at 6 and 10 weeks.
Other Name: Biopolio®

Active Comparator: Probiotic alone
Received daily zinc placebo and probiotic supplement, in addition to rotavirus vaccine and trivalent oral polio vaccine.
Dietary Supplement: Probiotic
A capsule that contains at least 1 x 10^9 Lactobacillus rhamnosus GG organisms per capsule. The contents of this capsule were given once daily orally.
Other Name: Culturelle

Dietary Supplement: Zinc placebo
The zinc placebo excluded the zinc sulphate but contained lactose and was diluted to match the taste. 5 ml of this suspension was given orally once daily.

Biological: Rotavirus vaccine
1 ml Rotarix®, a lyophilized human rotavirus vaccine reconstituted with calcium carbonate buffer provided orally at 6 and 10 weeks.
Other Name: Rotarix®

Biological: Oral polio vaccine
A liquid trivalent polio vaccine provided orally at 6 and 10 weeks.
Other Name: Biopolio®

Placebo Comparator: Placebo
Received daily zinc placebo and probiotic placebo, in addition to rotavirus vaccine and trivalent oral polio vaccine.
Dietary Supplement: Probiotic placebo
The probiotic placebo was manufactured by the same company that manufactured the probiotic and contained inulin powder but no Lactobacillus rhamnosus GG. The contents of the capsule were given once daily orally.

Dietary Supplement: Zinc placebo
The zinc placebo excluded the zinc sulphate but contained lactose and was diluted to match the taste. 5 ml of this suspension was given orally once daily.

Biological: Rotavirus vaccine
1 ml Rotarix®, a lyophilized human rotavirus vaccine reconstituted with calcium carbonate buffer provided orally at 6 and 10 weeks.
Other Name: Rotarix®

Biological: Oral polio vaccine
A liquid trivalent polio vaccine provided orally at 6 and 10 weeks.
Other Name: Biopolio®




Primary Outcome Measures :
  1. Number/Percentage of Subjects With Immune Response to Rotavirus Vaccine [ Time Frame: from first dose of rotavirus vaccine to 4 weeks after last dose of vaccine ]

    Defined as an increase in serum anti-rotavirus (RV) VP6 IgA antibodies consistent with seroconversion (detection of serum anti-RV VP6 immunoglobulin A (IgA) antibodies at a concentration ≥20 U/ml in a previously seronegative individual) or a fourfold rise in anti-RV VP6 IgA antibodies between baseline and 14 weeks of age.

    Pre-vaccination blood samples were taken when the subject received the first dose of rotavirus vaccine (when the subject was 6 weeks of age); post-vaccination blood samples were taken 4 weeks after the second dose of rotavirus vaccine was administered (14 weeks of age).


  2. Geometric Mean Concentration of Rotavirus-specific IgA [ Time Frame: from first dose of rotavirus vaccine to 4 weeks after last dose of vaccine ]

    Pre-vaccination blood samples were taken when the subject received the first dose of rotavirus vaccine (when the subject was 6 weeks of age); post-vaccination blood samples were taken 4 weeks after the second dose of rotavirus was administered (14 weeks of age).

    Pre-vaccination blood samples were taken when the subject received the first dose of rotavirus vaccine (when the subject was 6 weeks of age); post-vaccination blood samples were taken 4 weeks after the second dose of rotavirus vaccine was administered (14 weeks of age).



Secondary Outcome Measures :
  1. Number/Percentage of Subjects With Immune Response to Trivalent Oral Poliovirus Vaccine (OPV) [ Time Frame: from first dose of OPV to 4 weeks after last dose of OPV ]

    A serologic immune response to OPV is defined as a neutralizing antibody titer to polio virus subtype 3 greater than or equal to 1:8 at 14 weeks of age. This antigen will be used as a conservative estimate because it gives the lowest immune response of all three polio antigens.

    Pre-vaccination blood samples were taken when the subject received the first dose of OPV vaccine (when the subject was 6 weeks of age); post-vaccination blood samples were taken 4 weeks after the second dose of OPV was administered (14 weeks of age).


  2. Number/Percentage of Subjects Exhibiting Rotavirus Shedding in Stool After Dose 1 [ Time Frame: 0, 4 and/or 7 day post dose 1 of rotavirus vaccine ]
    Shedding of rotavirus following vaccination through detection of rotavirus antigen by ELISA and confirmed as vaccine type by Real-time polymerase chain reaction (RT-PCR). Stool samples were collected on Day 0 (i.e., day of vaccination or -1), Day 4 (±1) and Day 7 (-1 to +2) post vaccination.

  3. Number/Percentage of Subjects Exhibiting Rotavirus Shedding in Stool After Dose 2 [ Time Frame: 0, 4 and/or 7 day post dose 2 of rotavirus vaccine ]
    Shedding of rotavirus following vaccination through detection of rotavirus antigen by ELISA and confirmed as vaccine type by RT-PCR. Stool samples were collected on Day 0 (i.e., day of vaccination or -1), Day 4 (±1) and Day 7 (-1 to +2) post vaccination.

  4. Serious Adverse Events (SAEs) [ Time Frame: from first day of study to 4 weeks after last dose ]
    Field workers documented information on SAEs through the duration of the study during home visits (twice weekly between study clinic visits) or SAEs were documented by study clinicians at the study clinic or hospital. All SAEs occurring at any time during the study were recorded on a SAE Form and were reviewed and evaluated by a study clinician and the local IRB. The relationship of the SAE to study vaccine was evaluated and recorded and reported to the local institutional review board (IRB). All SAEs were followed until satisfactory resolution.



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Ages Eligible for Study:   5 Weeks to 16 Weeks   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Infants 35-41 days old
  • Live in area under surveillance
  • Current weight ≥3.2 kg
  • No syndromic evidence of immunocompromise as determined by medical doctor
  • No prior illness requiring hospitalization
  • No current medical condition as determined by medical doctor which precludes study involvement
  • Available for follow up for duration of study (through approximately 14 weeks of age)
  • Parents/guardians of infant are able to understand and follow study procedures and agree to participate in the study by providing signed informed consent

Exclusion Criteria:

  • Child has history of atopic symptoms
  • Child has a known digestive system defect
  • Child has history of chronic diarrhea
  • Child has major congenital anomalies
  • Child has received a prior dose of rotavirus vaccine
  • Child has received a prior dose of polio vaccine (beyond the birth dose)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01616693


Locations
India
Christian Medical Center, Vellore
Vellore, Tamil Nadu, India, 632 004
Sponsors and Collaborators
PATH
Christian Medical College, Vellore, India
Ministry of Science and Technology, India
Investigators
Principal Investigator: Gagandeep Kang, MD, PhD Christian Medical Center, Vellore, India

Responsible Party: PATH
ClinicalTrials.gov Identifier: NCT01616693     History of Changes
Other Study ID Numbers: CMC ZP 2012; PATH HS-658
First Posted: June 12, 2012    Key Record Dates
Results First Posted: November 30, 2018
Last Update Posted: November 30, 2018
Last Verified: April 2018

Keywords provided by PATH:
rotavirus
polio
zinc supplement
probiotic supplement
rotavirus vaccine shedding

Additional relevant MeSH terms:
Poliomyelitis
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Virus Diseases
Myelitis
Central Nervous System Infections
Central Nervous System Diseases
Nervous System Diseases
Spinal Cord Diseases
Neuromuscular Diseases
Vaccines
Zinc
Immunologic Factors
Physiological Effects of Drugs
Trace Elements
Micronutrients
Growth Substances