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CompletedNCT01080716Updated Nov 13, 2018Results posted

Safety and Efficacy Study of WRSS1, a Shigella Sonnei Vaccine Candidate

A Phase 1/2 interventional study of Part 1/Arm 1 of Study: WRSS1 vaccine and Part 1/Arm 2 of Study: Placebo vaccine in Dysentery, Shigella and Diarrhea, sponsored by U.S. Army Medical Research and Development Command. Completed at 1 site in Thailand. Open to participants aged 20 Years to 40 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2018-11-13.

Sponsored by U.S. Army Medical Research and Development Command · Phase 1/2, Interventional, and Prevention

Phase
Phase 1/2
Study type
Interventional
Enrollment
30
Allocation
Randomized
Ages
20 Years to 40 Years
Sex
All
01

Study summary

This study is an inpatient trial to determine the safety, immunogenicity and efficacy of the WRSS1 candidate vaccine in healthy Thai adult volunteers.

Read the detailed description

This study is designed as 2 parts.

  • Part 1 is a blinded, placebo-controlled inpatient trial in a total of 20 volunteers (14 vaccinees and 6 controls) to determine the safety and immunogenicity. Volunteers will be vaccinated with a single oral dose of 104 colony forming unit (cfu) of WRSS1 or placebo given with bicarbonate buffer.
  • Part 2 will be started approximately 60 days after WRSS1 vaccination. This part is an inpatient phase II efficacy trial involving a challenge with the S.sonnei 53G of 10 vaccinees from the first part and 10 naïve controls.
02

Conditions studied

  • Dysentery
  • Shigella
  • Diarrhea
03

Who can participate

Ages eligible
20 Years to 40 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  1. 20-40 years old; male or female;
  2. General good health as determined by a screening evaluation no greater than 30 days before admission;
  3. Normal bowel habits (grade 1-2 stools - no more than one to two stools per day with at least one stool per 2 days;
  4. Sexually active females willing to use birth control (birth control pills, injection hormonal contraceptive, implant hormonal contraceptive, hormonal patch, IUD, sterilization for effective contraceptive methods, spermicidal products and barrier methods are considered acceptable)during the entire study (starting from study day -30) and for 3 months after completion of the study (approximately a total of 6 months) or sexually inactive females (no sexual contact). Volunteers who take birth control pills will be required to use additional contraceptive methods for the remaining days of the cycle after discharge from the VTC (alteration of gastrointestinal functions from the oral vaccine or challenge strain may lead to unpredictable efficacy of pills);
  5. Will be available and willing to continue participation in the second part of the study if he/she has been randomly selected;
  6. Pass the Assessment of Understanding of the consent form.

Exclusion criteria

Exclusion Criteria:

  1. An acute or chronic medical condition or a clinically significant abnormality on physical exam that, in the opinion of the investigator, would render vaccination or challenge as unsafe;
  2. Current use of iron or zinc supplements within the past 7 days; current use of antacids (H2 blockers, omeprazole, OTC agents) or immunosuppressive drug;
  3. Unwillingness to follow the study procedures
  4. Currently breastfeeding, pregnant (βHCG +) or planning to become pregnant within 3 months after the completion of the study;
  5. Allergy to quinolone, sulfa, and penicillin classes of antibiotics;
  6. History of any of the following conditions within the past 10 years:

    • Arthritis (two or more episodes of joint pain and swelling),
    • Gastrointestinal disease (diagnosed by a doctor as having irritable bowel disease, Crohn's disease, ulcerative colitis (biopsy confirmed), celiac disease, stomach or intestinal ulcers), or
    • Dyspepsia (digestion or heartburn requiring medication more than once per week);
  7. Lifetime previous history of known/suspected Shigella diarrhea (except for volunteers who receive vaccines from Part 1) ;
  8. Lifetime history of, or active gallbladder disease;
  9. HLA B27 Ag (+); Anti-HIV (+); HBsAg(+); Anti HCV IgG Ab(+); abnormal screening tests judged to be clinically significant as judged by PI or sub-PI (Values are out of the acceptable abnormal range from the table in the protocol) other than mild anemia in females (Hct = 0.33-0.36);
  10. Lifetime history of participation in Shigella study (except for volunteers who receive vaccines from Part 1);
  11. Concurrent participation in another experimental vaccine or drug study within the past 30 days(except for volunteers who receive vaccines from part1);
  12. Serological positive for Shigella sonnei: anti-Shigella sonnei LPS IgG antibody titer in serum >800 (except for volunteers who receive vaccines from Part 1);
  13. Receipt of antimicrobial drugs for any reason or acute illness or fever >=38 oC within 7 days before vaccination or challenge;
  14. Individuals with household contacts that are immunocompromised;
  15. History of major abdominal surgery or laparotomy for any reason in the past 3 years, or abdominal scar of unclear origin;
  16. Presence of significant ova or parasite or Shigella bacteria in the stool;
  17. Receipt of any of the following (does not include the WRSS1 vaccine):

    • a licensed live, attenuated vaccine within the 30 days of challenge
    • a licensed subunit or killed vaccine within the 14 days of the challenge
    • a blood product, including immunoglobulin, in the 90 days before the challenge
04

Study design

Phase
Phase 1 / Phase 2
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Care provider, Investigator)
Enrollment
30 participants (actual)

Study arms

  • Experimental
    Part 1/Arm 1 of Study: WRSS1 vaccine

    WRSS1 is a live attenuated S. sonnei vaccine candidate derived from the Mosely strain of S.sonnei

    Biological: Part 1/Arm 1 of Study: WRSS1 vaccine

  • Placebo comparator
    Part 1/Arm 2 of Study: Placebo vaccine

    Placebo

    Biological: Part 1/Arm 2 of Study: Placebo vaccine

  • Experimental
    Part 2/Arm 1 of Study: S. sonnei 53G

    10 volunteers from Study Arm 1/Part 1 (WRSS1 vaccine) plus 4 alternates from Arm 1/Part 1 are given 53G S. sonnei

    Biological: Part 2/Arm 1 of Study: S. sonnei 53G

  • Active comparator
    Part 2/Arm 2 of Study: S sonnei 53G

    10 subjects (naïve controls) plus 4 alternates are give 53G S sonnei

    Biological: Part 2/Arm 2 of Study: S. sonnei 53G

Interventions

  • BiologicalPart 1/Arm 1 of Study: WRSS1 vaccine

    Single, oral dose of WRSS1

  • BiologicalPart 1/Arm 2 of Study: Placebo vaccine

    Placebo vaccine

  • BiologicalPart 2/Arm 1 of Study: S. sonnei 53G

    Subject from Part 1/Arm 1 of Study are given 53G S. sonnei

  • BiologicalPart 2/Arm 2 of Study: S. sonnei 53G

    10 naïve controls are given S. sonnei 53G

05

What researchers measure

Primary outcomes

  1. Number of Participants With Adverse Events

    Overview of AEs highlighting all AEs, withdrawals and deaths related to AEs

    Time frame: Up to 12 months

  2. Number of Participants With Shigella Induced Clinical Disease in Part 2

    Study Part 2-Frequency of Shigella induced clinical disease defined as one or more of diarrhea, dysentery or fever in vaccinees and controls following challenge with S. sonnei 53G. Transmissibility of disease will be evaluated by the presence of fecal shedding in control subjects.

    Time frame: 0-5 days

Secondary outcomes

  1. Count of Subjects With Normal and Abnormal Clinical Laboratory Values During Parts 1 and 2 of Study

    Count of subjects in Parts 1 and 2 with normal and abnormal clinical laboratory values after samples taken on days 1, 7, 14, and 28. Abnormal lab values are determined clinically significant by the PI

    Time frame: Days 1, 7, 14, and 28

06

Results

Posted Nov 13, 2018

Participant flow

Volunteers were recruited by contacting people from a list of potential volunteers from previous studies, by friend to friend contact, by internal announcement or by presentation booth in the university, community or blood donor sites. Recruitment and screening was performed by the staff at the Vaccine Trial Center, Mahidol University.

Part 1
Participant flow — Part 1
MilestoneArm 1: WRSS1 VaccineArm 1: Placebo VaccineArm 2: S. Sonnei 53GArm 2: S. Sonnei 53G (Naive Subjects)
Started14600
Completed13600
Not completed1000
Withdrew: Physician decision1000
Part 2
Participant flow — Part 2
MilestoneArm 1: WRSS1 VaccineArm 1: Placebo VaccineArm 2: S. Sonnei 53GArm 2: S. Sonnei 53G (Naive Subjects)
Started001010
Completed001010
Not completed0000

Outcome measures

PrimaryNumber of Participants With Adverse Events

Overview of AEs highlighting all AEs, withdrawals and deaths related to AEs

Time frame:
Up to 12 months
Reported as:
Count of participants · Participants
Number of Participants With Adverse Events
ParticipantsPart 1/Arm 1 of Study: WRSS1 VaccinePart 1/Arm 2 of Study: Placebo VaccinePart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)
All Adverse Events95810
All Serious Adverse Events0000
Withdrawals Due to Adverse Events0000
Deaths0000
PrimaryNumber of Participants With Shigella Induced Clinical Disease in Part 2

Study Part 2-Frequency of Shigella induced clinical disease defined as one or more of diarrhea, dysentery or fever in vaccinees and controls following challenge with S. sonnei 53G. Transmissibility of disease will be evaluated by the presence of fecal shedding in control subjects.

Time frame:
0-5 days
Reported as:
Count of participants · Participants
Number of Participants With Shigella Induced Clinical Disease in Part 2
ParticipantsPart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)
Diarrhea — Yes11
Diarrhea — No99
Dysentery — Yes22
Dysentery — No88
Fever — Yes12
Fever — No98
Abdominal Pain — Yes12
Abdominal Pain — No98
Tenesmus — Yes12
Tenesmus — No98
Nausea — Yes11
Nausea — No99
Vomiting — Yes01
Vomiting — No109
Myalgia — Yes22
Myalgia — No88
Joint Pain — Yes00
Joint Pain — No1010
Dizziness — Yes22
Dizziness — No88
Anorexia — Yes11
Anorexia — No99
Malaise — Yes32
Malaise — No78
Headache — Yes21
Headache — No89
Meet Criteria of Clinical Disease — Yes33
Meet Criteria of Clinical Disease — No77
Meet Criteria by External Review — Yes36
Meet Criteria by External Review — No74
Shedding S.sonnei (Fecal) — Yes67
Shedding S.sonnei (Fecal) — No43
SecondaryCount of Subjects With Normal and Abnormal Clinical Laboratory Values During Parts 1 and 2 of Study

Count of subjects in Parts 1 and 2 with normal and abnormal clinical laboratory values after samples taken on days 1, 7, 14, and 28. Abnormal lab values are determined clinically significant by the PI

Time frame:
Days 1, 7, 14, and 28
Reported as:
Count of participants · Participants
Count of Subjects With Normal and Abnormal Clinical Laboratory Values During Parts 1 and 2 of Study
ParticipantsSubjects From Part 1 of StudySubjects From Part 2 of Study
Not Clinically Abnormal2019
Clinically Abnormal01

Adverse events

Collected over 4 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Part 1/Arm 1 of Study: WRSS1 Vaccine—0/13 (0%)9/13 (69.2%)
Part 1/Arm 2: Placebo—0/6 (0%)5/6 (83.3%)
Part 2/Arm 1 of Study: S. Sonnei 53G—0/10 (0%)8/10 (80%)
Part 2/Arm 2 of Study: S Sonnei 53G (Controls)—0/10 (0%)10/10 (100%)
Most frequent other events
Showing 10 of 45
Most frequent other events
EventPart 1/Arm 1 of Study: WRSS1 VaccinePart 1/Arm 2: PlaceboPart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)
Diarrheic stoolGastrointestinal disorders2/134/64/102/10
HeadacheNervous system disorders8/132/64/102/10
Water stoolGastrointestinal disorders2/131/61/106/10
MyalgiaMusculoskeletal and connective tissue disorders1/130/61/105/10
DizzinessNervous system disorders0/130/64/104/10
Abdominal painGastrointestinal disorders1/132/60/101/10
DysmenorrheaReproductive system and breast disorders0/132/60/100/10
Common coldRespiratory, thoracic and mediastinal disorders0/131/62/103/10
FeverishGeneral disorders3/130/62/103/10
MalaiseGeneral disorders0/131/63/102/10

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Part 1/Arm 1 of Study: WRSS1 VaccinePart 1/Arm 2 of Study: Placebo VaccinePart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)Total
<=18 years00000
Between 18 and 65 years136101039
>=65 years00000
Sex: Female, Male
Sex: Female, Male(Participants)Part 1/Arm 1 of Study: WRSS1 VaccinePart 1/Arm 2 of Study: Placebo VaccinePart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)Total
Female835218
Male535821
Region of Enrollment
Region of Enrollment(participants)Part 1/Arm 1 of Study: WRSS1 VaccinePart 1/Arm 2 of Study: Placebo VaccinePart 2/Arm 1 of Study: S. Sonnei 53GPart 2/Arm 2 of Study: S Sonnei 53G (Controls)Total
Thailand136101039
07

Study locations

1 site
  • Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University
    Bangkok, 10400, Thailand
08

References and documents

Publications

  • Pitisuttithum P, Islam D, Chamnanchanunt S, Ruamsap N, Khantapura P, Kaewkungwal J, Kittitrakul C, Luvira V, Dhitavat J, Venkatesan MM, Mason CJ, Bodhidatta L. Clinical Trial of an Oral Live Shigella sonnei Vaccine Candidate, WRSS1, in Thai Adults. Clin Vaccine Immunol. 2016 Jul 5;23(7):564-75. doi: 10.1128/CVI.00665-15. Print 2016 Jul. PubMed 27146000 ↗

Individual participant data

Plan to share: Yes — Mahidol University and National Institutes of Health will have access to study data.

09

Registry details

Key details

Study ID
NCT01080716
Lead sponsor
U.S. Army Medical Research and Development Command
Collaborators
Mahidol University, National Institutes of Health (NIH)
Responsible party
Sponsor
First posted
Mar 4, 2010
Start date
May 2010
Primary completion
Sep 2010
Completion
Dec 2011
Results posted
Nov 13, 2018
Last update
Nov 13, 2018

Study contacts

Ladaporn Bodhidatta, MD
study director · Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences
Punnee Pitisuttithum, MBBS
principal investigator · Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University
Carl Mason, MD
study director · Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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