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Natural History of Anthrax: a Study of Primary Infected, Recovered, and Exposed Individuals (SPoRE); and Evaluation of AVA-Vaccinated Recipients

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ClinicalTrials.gov Identifier: NCT00050310
Recruitment Status : Recruiting
First Posted : December 4, 2002
Last Update Posted : December 14, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )

Tracking Information
First Submitted Date December 3, 2002
First Posted Date December 4, 2002
Last Update Posted Date December 14, 2020
Actual Study Start Date November 7, 2002
Primary Completion Date Not Provided
Current Primary Outcome Measures
 (submitted: October 16, 2019)
evaluate the natural history of anthrax and immune responseto anthrax antigens over time [ Time Frame: 2 years ]
This study is intended to evaluate the natural history of anthrax and the immune response to anthrax antigens over time in four subpopulations of men, women and children with:--acute infection (confirmed or suspected)--recovering phase of infection--exposure to infection--no known or no exposure to infection but a history of anthrax vaccination (AVA) (since no children have received AVA, they will beexcluded from this subgroup)
Original Primary Outcome Measures Not Provided
Change History
Current Secondary Outcome Measures Not Provided
Original Secondary Outcome Measures Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Natural History of Anthrax: a Study of Primary Infected, Recovered, and Exposed Individuals (SPoRE); and Evaluation of AVA-Vaccinated Recipients
Official Title Natural History of Anthrax: A Study of Primary Infected, Recovered, and Exposed (SPoRE) Individuals and Evaluation of AVA Vaccinated Recipients
Brief Summary

This study will examine pathophysiology and immune response of anthrax in infected or exposed individuals to learn more about the disease symptoms, prevention and response to treatment. In addition, it will evaluate immune response to the anthrax vaccine AVA (Anthrax Vaccine Adsorbed) in healthy, non-infected individuals.

The following individuals may be eligible for this study:

  1. People with confirmed or suspected anthrax (inhalational, cutaneous or gastrointestinal, either acute or recovering);
  2. People exposed to anthrax who have no clinical symptoms.
  3. Healthy people who have not been exposed to anthrax and have been vaccinated with AVA.

Those enrolled in the study will undergo the following tests and procedures.

Infected and exposed individuals:

  • Symptomatic participants will have the following clinical procedures if medically necessary:
  • a) blood tests for cell counts, chemistries and evidence of anthrax bacteria;
  • b) nasal swab to test for evidence of anthrax
  • c) chest X-ray;
  • d) computed tomography (CT) scan (special X-rays to examine the lungs or abdomen);
  • e) echocardiogram to examine the heart
  • f) magnetic resonance imaging (MRI), a special imaging test using a magnetic field and radio waves to examine the infected area of skin and soft tissue for patients with cutaneous anthrax.
  • All subjects (with or without symptoms) will have the following research procedures:
  • a) blood tests to examine immune response to anthrax;
  • b) throat swab to test for evidence of anthrax
  • c) nasopharyngeal wash to test for anthrax. Water is sprayed into the nostrils and then allowed to drain for collection in a cup;
  • d) induced sputum to test for presence of and immune response to anthrax. A mask with a saline mist is placed over the subject s mouth and nose, causing the subject to cough and produce sputum from the lungs. The sputum is collected in a cup this is for individuals 18 and older who do not undergo bronchoscopy, described below.
  • Participants 18 years of age and older may have the following optional research procedures:
  • a) leukapheresis or plasmapheresis (see description under non-infected, vaccinated individuals above);
  • b) lymph node biopsy. A sample of lymph node tissue is surgically removed under local anesthetic;
  • c) bronchoalveolar lavage. This 15- to 30-minute procedure is done in the intensive care unit. The mouth, nasal passages, throat and airways are numbed with lidocaine and a thin flexible tube is passed through the nose into the lung airways. Samples of cells and secretions are obtained by rinsing (lavage) the airways with salt water. The fluid is analyzed for infection, inflammatory cells and inflammatory chemicals.

All infected and exposed individuals will have periodic medical history and physical exam evaluations and be offered treatment or prophylaxis (treatment to prevent infection) with antibiotics, according to the guidelines of the Centers for Disease Control and Prevention (CDC). Patients will be monitored for at least 24 months after antibiotic treatment, or longer if circumstances warrant.

Non-infected, vaccinated individuals

  1. medical history and physical examination
  2. blood tests-- between 10 and 50 ml (2-10 teaspoons) of blood will be drawn at a time, and not more than 450 ml will be taken in a 6-week period. Based on the blood test results, other optional research procedures may be requested
  3. leukapheresis to collect white blood cells and plasmapheresis to collect plasma (the liquid part of the blood). For both of these procedures, blood is collected through a needle placed in an arm vein. The blood flows into a special machine that separates it into its components by spinning. The desired components (white cells or plasma) are removed and the rest of the blood is returned to the body through the same needle or a second needle in the other arm.
Detailed Description The intentional use of Bacillus anthracis in 2001 as a bioterrorism weapon with fatal consequences renewed interest in past epidemiologic and animal research about pathogenesis and posed new dilemmas about diagnosis and treatment. Cases in the October 2001 US outbreak were theoretically exposed via one dispersal method: aerosolization of Ames strain spores. While some developed the cutaneous anthrax form, others sustained the more serious inhalational disease. Inhaled spores are known to travel to alveolar macrophages and then onto the mediastinal lymph nodes where germination to the bacterium form and toxin release are thought to occur. Infective dose, significance of dormant spores after long-term antibiotic therapy, spectrum of disease and even precise cause of death remain unknown. This observational, prospective natural history study was developed during the 2001 outbreak and is set up to follow participants from the time of exposure through post-recovery (greater than ten years). Healthy vaccinated participants have been included to evaluate serum titers and cell markers in relation to dose and frequency of AVA vaccine.
Study Type Observational
Study Design Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration Not Provided
Biospecimen Not Provided
Sampling Method Non-Probability Sample
Study Population Individuals who have recovered from anthrax infection. Cohorts are based on route of infection.
Condition
  • Anthrax
  • Bacillus Infections
Intervention Not Provided
Study Groups/Cohorts
  • Acute Infection
    adults and children with acute anthrax infection
  • AVA Recipient/Healthy Volunteer
    healthy adults who have received AVA vaccine
  • Recovered
    adults and children in recovering phase of anthrax infection
  • Suspected Exposure
    adults and children with suspected exposure to anthrax
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Recruiting
Estimated Enrollment
 (submitted: June 23, 2005)
200
Original Enrollment Same as current
Study Completion Date Not Provided
Primary Completion Date Not Provided
Eligibility Criteria
  • INCLUSION CRITERIA:

Subjects of any age, including pregnant women, are eligible for inclusion if they meet one of the five criteria listed below, are hemodynamically and clinically stable, and agree to stored samples. Women of child-bearing age or potential will not be excluded from participation but pregnancy status will be determined at time of enrollment in order to optimize subsequent evaluation and care.

  1. Inhalation Anthrax (acute or recovering infection)

    CONFIRMED:

    --nonspecific febrile illness followed by sepsis and/or respiratory failure

    AND

    --B anthracis isolation (via culture) from any site OR 2 supportive lab tests

    OR SUSPECTED:

    --nonspecific febrile illness followed by sepsis and/or respiratory failure with no alternative diagnosis

    AND

    --one supportive lab test OR direct epidemiological link to a confirmed environmental exposure

  2. Cutaneous Anthrax (acute or recovering infection)

    CONFIRMED:

    --characteristic lesion (papule->vesicular->depressed black eschar plus or minus edema, erythema, necrosis or ulceration)

    AND

    --B anthracis isolation (culture) from any site OR 2 supportive lab tests

    SUSPECTED:

    --Characteristic lesion with no alternative diagnosis

    AND

    --one supportive lab test OR direct epidemiological link to a confirmed environmental exposure

  3. Gastrointestinal Anthrax (acute or recovering infection)

    CONFIRMED:

    --Severe abdominal pain often associated with bloody vomiting/diarrhea followed by fever/septicemia

    AND

    --B anthracis isolation (culture) from any site OR 2 supportive lab tests

    SUSPECTED:

    --Severe abdominal pain often associated with bloody vomiting/diarrhea followed by fever/septicemia with no alternative diagnosis

    AND

    --1 supportive lab test OR direct epidemiological link to a confirmed environmental exposure

    These definitions were subsequently updated by the CDC in 2010 to accept clinically compatible symptoms plus one of the following: a positive culture, a positive immunohistochemical stain for antigen, a 4-fold increase in anti-PA IgG or a positive documented exposure with detection of DNA via PCR (26).

  4. Exposed individuals who are clinically asymptomatic.
  5. Past or imminent vaccination in healthy (non-anthrax exposed).
  6. Hemodynamically and clinically stable at time of evaluation at NIH.

    • Hemodynamically: stable vital signs
    • Clinically: no obvious signs of disease progression (e.g. worsening pleural effusions or increasing cutaneous edema)
    • acute/newly recovered patients must be receiving standard antimicrobial therapy
  7. Participant agrees to stored samples.

EXCLUSION CRITERIA:

Inability to sign informed consent or lack of designated Health Power of Attorney.

Sex/Gender
Sexes Eligible for Study: All
Ages 3 Years and older   (Child, Adult, Older Adult)
Accepts Healthy Volunteers No
Contacts
Contact: Rosemary McConnell, R.N. (301) 761-6645 rosemary.mcconnell@fnlcr.nih.gov
Contact: Mary E Wright, M.D. (301) 594-6318 marywright@mail.nih.gov
Listed Location Countries United States
Removed Location Countries  
 
Administrative Information
NCT Number NCT00050310
Other Study ID Numbers 020110
02-I-0110
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement Not Provided
Responsible Party National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )
Study Sponsor National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators Not Provided
Investigators
Principal Investigator: Mary E Wright, M.D. National Institute of Allergy and Infectious Diseases (NIAID)
PRS Account National Institutes of Health Clinical Center (CC)
Verification Date October 26, 2020