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Potential Mechanisms for Intussusception After Rotavirus Vaccine-Pilot Study

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ClinicalTrials.gov Identifier: NCT02542462
Recruitment Status : Completed
First Posted : September 7, 2015
Results First Posted : July 12, 2018
Last Update Posted : July 12, 2018
Sponsor:
Collaborator:
Centers for Disease Control and Prevention
Information provided by (Responsible Party):
Children's Hospital Medical Center, Cincinnati

Brief Summary:
This is a prospective randomized clinical trial that aims to evaluate the potential effects of the first dose of rotavirus vaccines on gastrointestinal motility and anatomy and blood and stool cytokine responses. It will also assess the association between these outcomes and the pattern of the shedding of vaccine strain rotavirus in the stool. Infants will be randomized to one of four arms: monovalent rotavirus vaccine (Rotarix®, RV1) alone, RV1 with other recommended vaccines, pentavalent rotavirus vaccine (RotaTeq®, RV5) alone, or RV5 with other recommended vaccines. Data derived from the pilot study will be used to assess the feasibility of conducting a larger scale study.

Condition or disease Intervention/treatment Phase
Intussusception Rotavirus Infections Drug: Rotarix®, Drug: Rotarix®, with other routine vaccines Drug: RotaTeq®, Drug: RotaTeq®, with other routine vaccines Phase 4

Detailed Description:

Healthy infants 6-13 weeks of age will be randomized (1:1:1:1) to receive either, RV1 alone, RV1 with Advisory Committee on Immunization Practices (ACIP) routinely recommended immunizations (Diphtheria, Tetanus and Pertussis (DTaP), Haemophilus influenza type b (Hib), pneumococcal conjugate (PCV13), Hepatitis B (HBV) and inactivated polio (IPV)), RV5 alone or RV5 with ACIP routinely recommended immunizations. Imaging study personnel and parents will be blinded to the rotavirus vaccine type; parents will be informed about the rotavirus vaccine type at the completion of the study. Up to 100 infants will be enrolled.

Recruitment and enrollment will occur prior to the first clinic visit. There will be four study visits including the recruitment/enrollment visit and three clinic visits. Infants will be randomized to either RV1, RV1 plus other immunizations, RV5 alone, or RV5 plus other immunizations. Clinic Visit 1 (day 0) will include blood, saliva, stool and breast milk collection . The MRI and ultrasound will be performed prior to vaccination. Children will receive the immunizations to which they are randomized. Imaging personnel and parents will be blinded to rotavirus vaccine type; they will be informed about other vaccines administered. A second MRI and ultrasound will be performed at Clinic Visit 2 (day 5) and blood and stool samples collected. Parents will be unblinded at the completion of Clinic Visit 3 (day 14). Arrangements will be made to get remaining doses of same rotavirus vaccine. Daily stool samples will be collected at home during the 15 day study period (on vaccination day 0 and for next 14 days). A memory aid will be completed to collect reactogenicity data on days 0 and for the next 14 days. Remaining stools and reactogenicity data from parents will be collected at Visit 3.

The investigators will assess blood and stool cytokine responses and intestinal anatomy and motility after rotavirus vaccination by comparing pre-vaccination with post-vaccination responses in the study infants. Cytokines and intestinal anatomy and motility will be assessed at baseline (Visit 1, the day of vaccine receipt) and 5 days after vaccination (Visit 2). For both blood and stool, the following cytokines will be tested: IL-2, IL-6, IL-7, IL-8, IL-15, INF-γ and TNF-α. Additional biomarkers may be studied.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 144 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary Purpose: Other
Official Title: Potential Mechanisms for Intussusception After Rotavirus Vaccine-Pilot Study
Actual Study Start Date : November 2015
Actual Primary Completion Date : May 2017
Actual Study Completion Date : May 2017

Arm Intervention/treatment
Active Comparator: Rotarix® alone
monovalent rotavirus vaccine (Rotarix®, RV1)
Drug: Rotarix®,
Single oral dose of licensed rotavirus vaccine given alone
Other Name: Rotavirus vaccine

Active Comparator: Rotarix®,with other routine vaccines
monovalent rotavirus vaccine (Rotarix®, RV1), plus additional immunizations
Drug: Rotarix®, with other routine vaccines
Single oral dose of licensed rotavirus vaccine given with other routine vaccines
Other Name: Rotavirus vaccine

Active Comparator: RotaTeq®, alone
pentavalent rotavirus vaccine (RotaTeq®, RV5)
Drug: RotaTeq®,
Single oral dose of licensed rotavirus vaccine given alone
Other Name: Rotavirus vaccine

Active Comparator: RotaTeq®,with other routine vaccines
pentavalent rotavirus vaccine (RotaTeq®,RV5) plus additional immunizations
Drug: RotaTeq®, with other routine vaccines
Single oral dose of licensed rotavirus vaccine given with other routine vaccines
Other Name: Rotavirus vaccine




Primary Outcome Measures :
  1. The Effects of RV1 and RV5 With or Without Other Routine Immunizations on Gastrointestinal Anatomy [ Time Frame: 4- 6 days ]
    Number of subjects with an increase in the number of abdominal lymph nodes, as measured by abdominal ultrasound, or an increase of 1 mm or more of terminal ileum wall thickness, as measured by abdominal MRI, from Day 0 (Visit 1) to Day 4-6 (Visit 2)

  2. The Feasibility of Conducting a Larger Scale Study as Determined by Study Recruitment Rates (Number of Participants Eligible/Participants Who Enrolled) [ Time Frame: 15 months ]
    Study will be determined to be feasible on a larger scale if 10% or more of eligible subjects enroll in the study

  3. The Feasibility of Conducting a Larger Scale Study as Determined by the Percentage of Participants Who Completed All Study Visits [ Time Frame: 15 months ]
    Study will be determined to be feasible on a larger scale if 70% or more of randomized subjects complete all study visits and remain in the study until completion



Information from the National Library of Medicine

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Ages Eligible for Study:   42 Days to 90 Days   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  1. healthy infant 6 to 13 weeks (12 weeks and 6 days) of age at day of rotavirus vaccine administration
  2. free of obvious health problems as established by medical history and confirmed with infant's primary physician prior to Visit 1
  3. parent/legal guardian willing to have infant feed from a bottle for contrast
  4. parent/legal guardian willing and capable of signing informed consent
  5. parent/legal guardian and infant expected to be available for entire study
  6. parent/legal guardian can be reached by telephone
  7. parent/legal guardian expresses willingness to complete study procedures and receive 2 month immunizations, according to recommended schedule

Exclusion Criteria:

  1. gestational age of <37 weeks
  2. infant unable to fast for 4 hours prior to MRI procedure
  3. receipt of any vaccine except initial HBV (must have at least 28 days between HBV and Visit 1 to be included)
  4. history of severe allergic reaction to HBV vaccine
  5. contraindications for any of the routine vaccines

    1. Severe Combined Immune Deficiency
    2. history of intussusception
  6. precautions for either RV1 or RV5 (may interfere with study outcomes)

    a. altered immunocompetence i. infants with primary and acquired immunodeficiency states, cellular immunodeficiency, hypogammaglobulinemic and dysgammaglobulinemic states ii. infants with blood dyscrasias, leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic system iii. infants on immunosuppressive therapy (including high-dose systemic corticosteroids) iv. infants who are HIV-exposed or infected b. acute gastroenteritis c. moderate or severe acute illness with or without fever d. pre-existing chronic gastrointestinal diseases (e.g., congenital malabsorption syndromes, Hirschsprung's disease, or short-gut syndrome) e. infants with spina bifida or bladder exstrophy (latex rubber is contained in the RV1 oral applicator)

  7. sensitivity to latex (latex rubber is contained in the RV1 oral applicator)
  8. febrile illness within previous 14 days (axillary temperature of 100.4◦ F or higher)
  9. history of vomiting (forceful expulsion of partially digested milk/food) and/or diarrhea (3 watery stools) within 14 days of Visit 1
  10. receipt of any steroids, immunoglobulins, other blood products/transfusion
  11. receipt of non-steroidal anti-inflammatory drugs in previous 72 hours (may affect cytokine response)
  12. receipt of an antipyretic medication (acetaminophen or ibuprofen) within 72 hours prior to the first dose of rotavirus vaccine or is already planning to administer a prophylactic antipyretic medication on the day of and the day following vaccination (this exclusion does not apply if the caretaker indicates he/she might administer antipyretics after vaccination to reduce a fever)
  13. is enrolled or plans to enroll in another clinical trial with an investigational product while participating in this study (observational studies are allowed)
  14. any condition which, in the opinion of the investigators, may post a health risk to the subject or interfere with the MRI or vaccine evaluation
  15. currently receiving medication for gastroesophageal reflux (GERD) or any other gastrointestinal condition including colic
  16. infant who is a relative of any research study personnel
  17. allergy to barium
  18. failed newborn hearing screening

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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): NCT02542462


Locations
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United States, Ohio
Cincinnati Children's Hosptital Medical Center
Cincinnati, Ohio, United States, 45219
Sponsors and Collaborators
Children's Hospital Medical Center, Cincinnati
Centers for Disease Control and Prevention
Investigators
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Principal Investigator: Mary A. Staat, MD, MPH Children's Hospital Medical Center, Cincinnati
Principal Investigator: Karen Broder, MD Centers for Disease Control and Prevention
  Study Documents (Full-Text)

Documents provided by Children's Hospital Medical Center, Cincinnati:
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Responsible Party: Children's Hospital Medical Center, Cincinnati
ClinicalTrials.gov Identifier: NCT02542462    
Other Study ID Numbers: 2015-2754
First Posted: September 7, 2015    Key Record Dates
Results First Posted: July 12, 2018
Last Update Posted: July 12, 2018
Last Verified: July 2018
Keywords provided by Children's Hospital Medical Center, Cincinnati:
mechanisms for intussusception
rotavirus vaccine
Additional relevant MeSH terms:
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Rotavirus Infections
Intussusception
Intestinal Obstruction
Intestinal Diseases
Gastrointestinal Diseases
Digestive System Diseases
Reoviridae Infections
RNA Virus Infections
Virus Diseases
Vaccines
Immunologic Factors
Physiological Effects of Drugs