A Phase 2 interventional study of Fluzone Influenza Vaccine (2007-2008) in Influenza, sponsored by PATH. Completed. Open to participants aged 65 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2012-07-13.
Sponsored by PATH · Phase 2, Interventional, and Prevention
This randomized trial compared the immunogenicity of 60% dose intradermal (ID) influenza vaccination to standard intramuscular (IM) vaccination of full-dose or 60% dose vaccine. Pre- and postvaccination measurements in the hemagglutination inhibition antibody (HAI) titer were compared. Participants who received reduced-dose vaccine were revaccinated with full-dose IM vaccine.
This study was an open-label randomized trial consisting of community-dwelling adults 65 years and older living in Puget Sound area in Washington State. Subjects were enrolled and randomly assigned to receive licensed, 2007-2008 Northern Hemisphere TIV vaccine (Fluzone, lot U2440AA; Sanofi Pasteur) containing concentrations of hemagglutinin of each of A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), and B/Malaysia/2506/2004 (B): 15 ug/0.5 mL by the IM route, 9 ug/0.3 mL by the ID or IM route, or 4.5 ug/0.15 mL given twice by ID route to the nondominant arm. A block randomization scheme (1:1:1:1), stratified by sex, was used. For IM vaccination, 0.3 mL or 0.5 mL of vaccine was removed from a multidose (5 mL) vial through a 25-gauge, 1-inch detachable needle (Becton Dickinson) and was injected into the deltoid muscle at a 90 degree angle to the skin. For ID vaccination, 0.3 mL or 0.15 mL was drawn by a TB syringe through a 25-gauge, 5/8-inch needle (Terumo Medical). The needle was inserted at a 15 degree angle to the skin overlying the deltoid of the arm. The vaccine was slowly injected until all material was expelled and induration appeared. Subjects randomized to the 0.15-mL group received 2 side-by-side ID injections 3 cm apart. Participants returned at 4 weeks to determine postvaccination antibody titers. At this follow-up visit, those assigned to reduced dose IM or ID influenza vaccinations then received full-dose IM influenza vaccination. These participants returned in another 4 weeks to repeat HAI titers. A nonrandomized subset of subjects (based on availability and willingness to participate) returned at 14 days after initial vaccination for T cell assays in an exploratory substudy to examine cellular immune response.
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Exclusion Criteria:
60% dose - 0.3 mL delivered intradermally with needle and syringe
Biological: Fluzone Influenza Vaccine (2007-2008)
60% dose - 0.15 mL delivered twice intradermally with needle and syringe
Biological: Fluzone Influenza Vaccine (2007-2008)
100% dose - 0.5mL delivered intramuscularly with needle and syringe
Biological: Fluzone Influenza Vaccine (2007-2008)
60% dose - 0.3 mL delivered intramuscularly with needle and syringe
Biological: Fluzone Influenza Vaccine (2007-2008)
Manufactured by Sanofi Pasteur
Also known as: Fluzone
Seroprotection Pre- and Post- Vaccination
Seroprotection before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) Intramuscular (IM) or Reduced-Dose (9 mg) Intradermal (ID) Injections for A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
Time frame: 1 month
Geometric Mean Titer (GMT) Pre- and Post- Vaccination
GMT before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) IM or Reduced-Dose (9 mg) ID Injections. A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
Time frame: 1 month
Assessment of Reactogenicity
Maximum solicited systemic and local signs and symptoms during the week after initial vaccination, by Dose and Randomization Assignment
Time frame: 1 week
| Milestone | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID |
|---|---|---|---|---|
| Started | 65 | 64 | 64 | 65 |
| Completed | 65 | 64 | 63 | 65 |
| Not completed | 0 | 0 | 1 | 0 |
| Withdrew: Discrepant chart documentation re route | 0 | 0 | 1 | 0 |
Seroprotection before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) Intramuscular (IM) or Reduced-Dose (9 mg) Intradermal (ID) Injections for A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
| % of Participants | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID |
|---|---|---|---|---|
| A/H1N1 Seroprotection Prevaccination | 18.5 (34.6 to 66.5) | 12.5 (40.0 to 73.4) | 19.1 | 15.4 |
| A/H1N1 Seroprotection 4 weeks after vaccination | 65.6 | 57.8 | 68.9 | 67.2 |
| A/H3N2 Seroprotection Prevaccination | 47.7 | 46.9 | 49.2 | 47.7 |
| A/H3N2 Seroprotection 4 weeks after vaccination | 76.6 | 75.0 | 75.4 | 75.0 |
| B Seroprotection Prevaccination | 15.4 | 12.5 | 14.3 | 20.0 |
| B Seroprotection 4 weeks after vaccination | 26.6 | 17.2 | 16.5 | 25.0 |
GMT before and 4 Weeks after Vaccination by Full- or Reduced-Dose (9 mg) IM or Reduced-Dose (9 mg) ID Injections. A/Solomon Islands/3/2006 (A/H1N1), A/Wisconsin/67/2005 (A/H3N2), B/Malaysia/2506/2004 (B)
| GMT | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID |
|---|---|---|---|---|
| A/H1N1 Prevaccination | 12.5 (9.8 to 16.0) | 11.3 (8.9 to 14.3) | 13.6 (10.7 to 17.4) | 11.2 (9.1 to 13.9) |
| A/H1N1 4 weeks after vaccination | 54.2 (40.0 to 73.4) | 41.8 (29.5 to 59.2) | 48.0 (34.6 to 66.5) | 48.6 (36.2 to 65.2) |
| A/H3N2 Prevaccination | 33.7 (23.9 to 47.6) | 27.1 (20.1 to 36.4) | 29.4 (21.1 to 40.8) | 29.0 (21.2 to 39.7) |
| A/H3N2 4 weeks after vaccination | 79.1 (57.6 to 108.6) | 62.4 (46.6 to 83.5) | 57.5 (42.4 to 78.1) | 72.6 (53.2 to 99.1) |
| B Prevaccination | 10.7 (8.6 to 13.2) | 10.1 (8.2 to 12.5) | 9.8 (7.8 to 12.3) | 12.8 (9.9 to 16.5) |
| B 4 weeks after vaccination | 16.5 (12.7 to 21.4) | 12.4 (10.0 to 15.5) | 10.8 (8.5 to 13.8) | 15.9 (12.1 to 20.9) |
Maximum solicited systemic and local signs and symptoms during the week after initial vaccination, by Dose and Randomization Assignment
| participants | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID |
|---|---|---|---|---|
| Fever, >=38.0C and <39.0C | 0 | 1 | 0 | 3 |
| Fever, >=39 | 0 | 0 | 0 | 1 |
| Chills, present but easily tolerated | 1 | 1 | 1 | 6 |
| Chills, interferes with normal activities | 1 | 1 | 0 | 1 |
| Fatigue, present but easily tolerated | 4 | 6 | 3 | 8 |
| Fatigue, interferes with normal activity | 2 | 1 | 0 | 6 |
| General body ache/pain, present but easily tolerat | 6 | 5 | 3 | 11 |
| General body ache/pain, interferes with normal a | 1 | 2 | 2 | 4 |
| Headache, present but easily tolerated | 10 | 5 | 4 | 9 |
| Headache, interferes with normal activity | 0 | 1 | 0 | 5 |
| Nausea, present but easily tolerated | 3 | 2 | 2 | 3 |
| Nausea, interferes with normal activity | 1 | 1 | 0 | 0 |
| Redness or Discoloration, <=8 cm | 9 | 7 | 45 | 52 |
| Redness or Discoloration, >8 cm | 0 | 0 | 3 | 4 |
| Localized swelling, <=8 cm | 13 | 4 | 37 | 44 |
| Localized swelling, >8 cm | 0 | 0 | 3 | 4 |
| Pain at injection site, present but easily tolerat | 7 | 11 | 7 | 14 |
| Pain at injection site, interferes with normal act | 0 | 0 | 0 | 0 |
| Itching at injection site, present but tolerated | 4 | 5 | 15 | 19 |
| Itching at injection site, interferes with normal | 0 | 0 | 0 | 2 |
| Arm motion limitation, some limitiation | 1 | 1 | 0 | 0 |
| Arm motion limitation, interferes normal activity | 0 | 0 | 0 | 0 |
Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Full-dose 0.5 mL IM | — | 0/65 (0%) | 0/65 (0%) |
| 60% Dose 0.3 mL IM | — | 2/64 (3.1%) | 0/64 (0%) |
| 60% Dose 0.3 mL ID | — | 1/64 (1.6%) | 0/64 (0%) |
| 60% Dose 0.15 mL x 2 ID | — | 3/65 (4.6%) | 0/65 (0%) |
| Event | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID |
|---|---|---|---|---|
| Acute coronary syndromeCardiac disorders | 0/65 | 1/64 | 0/64 | 0/65 |
| AppendicitisGastrointestinal disorders | 0/65 | 1/64 | 0/64 | 0/65 |
| anemia and arrhythmiaCardiac disorders | 0/65 | 0/64 | 1/64 | 0/65 |
| small bowel obstructionGastrointestinal disorders | 0/65 | 0/64 | 0/64 | 1/65 |
| complicated fallInjury, poisoning and procedural complications | 0/65 | 0/64 | 0/64 | 1/65 |
| nausea and vomitingGastrointestinal disorders | 0/65 | 0/64 | 0/64 | 1/65 |
| Age, Categorical(Participants) | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID | Total |
|---|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 0 | 0 | 0 | 0 | 0 |
| >=65 years | 65 | 64 | 63 | 65 | 257 |
| Age Continuous(years) | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID | Total |
|---|---|---|---|---|---|
| Mean | 75.6 ± 6.8 | 75.2 ± 7.7 | 73.6 ± 6.3 | 74.7 ± 6.3 | 74.8 ± 6.8 |
| Sex: Female, Male(Participants) | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID | Total |
|---|---|---|---|---|---|
| Female | 11 | 11 | 11 | 11 | 44 |
| Male | 54 | 53 | 52 | 54 | 213 |
| Ethnicity (NIH/OMB)(Participants) | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 0 | 1 | 1 | 1 | 3 |
| Not Hispanic or Latino | 65 | 63 | 62 | 64 | 254 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Full-dose 0.5 mL IM | 60% Dose 0.3 mL IM | 60% Dose 0.3 mL ID | 60% Dose 0.15 mL x 2 ID | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 |
| Asian | 2 | 0 | 2 | 2 | 6 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 4 | 2 | 3 | 5 | 14 |
| White | 56 | 60 | 55 | 53 | 224 |
| More than one race | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 3 | 2 | 3 | 5 | 13 |
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