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CompletedNCT01943305Updated Apr 20, 2016

The Role of Pre-existing Cross-reactive Antibodies in Determining the Efficacy of Vaccination in Humans

A Phase 2 interventional study of Japanese Encephalitis vaccine and Yellow Fever vaccine in Yellow Fever and Encephalitis, Japanese, sponsored by Singapore General Hospital. Completed at 1 site in Singapore. Open to participants aged 21 Years to 50 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2016-04-20.

Sponsored by Singapore General Hospital · Phase 2 and Interventional

Phase
Phase 2
Study type
Interventional
Enrollment
84
Allocation
Randomized
Ages
21 Years to 50 Years
Sex
All
01

Study summary

Epidemic viral diseases have become more prevalent in recent years. Among the various strategies to prevent such epidemics, vaccination is the most cost-effective. However, populations that are immunized are typically already exposed to multiple previous vaccinations or natural infections. Studies from this and other laboratories have revealed that pre-existing dengue antibodies can either inhibit or enhance subsequent dengue infection depending on the pre-existing antibody levels. While cross-reactive antibody is potentially pathogenic in dengue, how it impacts immune response to vaccination is unclear. Indeed, aggregated at the site of vaccination and the respective draining lymph nodes are antigen-presenting and immune regulatory cells that express Fc receptors and play pivotal roles in determining the magnitude and polarity of the immune response. Vaccine uptake by these antigen-presenting cells may thus be either inhibited or enhanced when vaccines are opsonized with cross-reactive antibodies.

In view of the limited knowledge on how cross-reactive antibodies affect vaccination outcome, investigators propose here a study that exploits the known cross reactivity between Japanese encephalitis (JE) virus antibody and yellow fever (YF) vaccine. Investigators hypothesize that cross-reactive antibodies impacts antibody response to YF at the point vaccination in a concentration-dependent manner by altering both vaccine uptake and the innate immune response by antigen presenting cells. Investigators will structure an open label clinical trial on sequential vaccination with JE and YF vaccines, with different time intervals between vaccinations. This would test immune response to YF vaccination in subjects with different titer of cross-reactive JE vaccine-derived antibodies.

Read the detailed description

The primary objective of this clinical study is to examine the role of cross-reactive antibodies in modulating immune responses to vaccines.

  1. Hypothesis: Antibody response to YF vaccination is influenced by the heterologous antibody titer at the point of YF vaccination.
  2. Hypothesis : Heterologous antibody to YF affect magnitude of vaccine uptake through the Fc receptors and alters the quality and magnitude of the innate immune response following YF vaccination, which has been previously shown to predictive of immune response to YF vaccination.

Secondary objectives

  1. To determine neutralizing antibody response to YF vaccination in human volunteers at different time intervals following a prior JE vaccination.
  2. To characterize the innate immune response to YF vaccination at different time intervals after a prior JE vaccination.

A total of 100 healthy adults, pre-screened to be negative for anti-dengue antibodies will be enrolled upon written informed consent. 75 subjects in the test arm will received 2 doses of inactivated JE vaccine(Ixiaro), while 25 subjects in the control arm has no JE vaccination.

Subjects in the test arm will be sub-divided into 3 groups who receive YF17D:

Group1.YF vaccination 1-month post-JE vaccination Group 2.YF vaccination 4-months post-JE vaccination Group 3.YF vaccination 9-months post-JE vaccination Subjects in the control arm (group 4) will receive YF vaccination at the same time as group 1.

Blood sampling in relation to YF17D vaccination:

  1. Pre-dose
  2. 1-day after
  3. 3-days after (+ 1 day)
  4. 1-week after (± 2 days)
  5. 1-month after (± 5 days)
  6. 1-year after (± 14 days)

Primary end-point: Difference in geometric mean titre of YF17D neutralizing antibody.

02

Conditions studied

  • Yellow Fever
  • Encephalitis, Japanese

Keywords

  • Yellow Fever
  • vaccination
  • Japanese encephalitis
  • antibodies
03

In context

Encephalitis, Japanese

77 studies on the registry are indexed under Encephalitis, Japanese; 4 are open to participants now.

This study's enrollment of 84 is below the median of 278 across 69 interventional studies indexed under Encephalitis, Japanese.

Browse Encephalitis, Japanese studies →

Lead sponsor

Singapore General Hospital is the lead sponsor of 266 studies on the registry; 57 are open to participants now.

Of its 8 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
21 Years to 50 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Healthy male or female adults, 21-50 years of age at the time of screening.
  • Negative for anti-dengue antibodies by ELISA.
  • Subjects who are willing to comply with the requirements of the study protocol and scheduled visits. (e.g., completion of the subject diary, return for follow-up visits) and who are willing to make themselves available for the duration of the study, with access to a consistent means of telephone contact, which may be either at home or at the workplace, land line, or mobile, but NOT a pay phone or other multiple-user device (i.e. a common-use phone serving multiple rooms or apartments).
  • Subjects who give written informed consent approved by the Ethical Review Board governing the site.
  • Satisfactory baseline medical assessment as assessed by physical examination and a stable health status. The laboratory values must be within the normal range of the assessing site or show abnormalities that are deemed not clinically significant as judged by the investigator. A stable health status is defined as the absence of a health event satisfying the definition of a serious adverse event.
  • Accessible vein the forearm for blood collection.
  • Females of non-child bearing potential due to surgical sterilization (hysterectomy or bilateral oophorectomy or tubal ligation) or menopause.
  • Female subjects of childbearing potential may be enrolled in the study

    1. if they have a negative urine pregnancy test on the day of screening and negative urine dipstick pregnancy tests at the days of the vaccinations
    2. if they use adequate, reliable contraception or abstain from sexual intercourse during the entire study for 1 year

Exclusion criteria

Exclusion Criteria:

  • Presence of acute infection in the preceding 7 days or presence of a temperature ≥ 38.0°C (oral temperature assessment), or acute symptoms greater than of "mild" severity on the scheduled date of first vaccination.
  • History of severe drug and /or food allergies and/or known allergies to the trial product or its components.
  • Any condition that, in the opinion of the investigator, would complicate or compromise the study or wellbeing of the subject.
  • Woman who are pregnant or breast feeding.
  • History or presence of cardiovascular, respiratory, hepatic, renal, gastrointestinal, neuropsychiatric, or immunosuppressive disorders that would be a risk factor when administered the IP.
  • History of thymus gland disease.
  • Diagnosed with cancer or on treatment for cancer within the 3 years prior to the screening.
  • Evidence of clinically significant anaemia and other any significant active haematological disease, or having donated > 450 mL of blood within the past three months.
  • Evidence of substance abuse, or previous substance abuse.
  • Participation in a study involving administration of an investigational compound within the past four months, or planned participation during the duration of this study.
  • Administration of any licensed vaccine, such as MMR and/or Chickenpox immunisation within 30 days before the first study vaccine dose.
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Study design

Phase
Phase 2
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
84 participants (actual)

Study arms

  • Experimental
    Test arm

    A total of 100 healthy adults, pre-screened to be negative for anti-dengue antibodies will be enrolled upon written informed consent. 75 subjects in the test arm will received 2 doses of inactivated Japanese Encephalitis vaccine and 1 dose of Yellow Fever vaccine.

    Biological: Japanese Encephalitis vaccine · Biological: Yellow Fever vaccine

  • Experimental
    Control arm

    A total of 100 healthy adults, pre-screened to be negative for anti-dengue antibodies will be enrolled upon written informed consent. 25 subjects in the control arm will not receive Japanese Encephalitis vaccine but will receive 1 dose of Yellow Fever vaccine.

    Biological: Yellow Fever vaccine

Interventions

  • BiologicalJapanese Encephalitis vaccine

    IXIARO, inactivated, adsorbed vaccine. Two doses (0.5 ml each) of IXIARO one month apart

    Also known as: Ixiaro

  • BiologicalYellow Fever vaccine

    STAMARIL, 1 dose (0.5 ml)

    Also known as: Stamaril

06

What researchers measure

Primary outcomes

  1. Difference in geometric mean neutralizing antibody titer to YF17D as measured by plaque reduction neutralization test (PRNT) in volunteers receiving YF vaccination with or without prior JE vaccination

    Time frame: 1-month and 1-year post YF17D vaccine

Secondary outcomes

  1. Innate immune response to YF vaccination at different time intervals after a prior JE vaccination

    Time frame: transcriptional profiling of PBMC collected 1-day before, 1-, 3- and 7-days post YF17D vaccine

07

Study locations

1 site
  • Singhealth Investigational Medicine Unit
    Singapore, 169608, Singapore
08

References and documents

Publications

  • Low JG, Wijaya L, Li GK, Lim EY, Shum AK, Cheung YB, Ooi EE. The role of pre-existing cross-reactive antibodies in determining the efficacy of vaccination in humans: study protocol for a randomized controlled trial. Trials. 2015 Apr 10;16:147. doi: 10.1186/s13063-015-0651-z. PubMed 25872531 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Apr 20, 2016, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01943305
Lead sponsor
Singapore General Hospital
Collaborators
Duke-NUS Graduate Medical School
Responsible party
Sponsor
First posted
Sep 16, 2013
Start date
Oct 2013
Primary completion
Jun 2015
Completion
Dec 2015
Last update
Apr 20, 2016

Study contacts

Jenny Low Guek Hong
principal investigator · Singapore General Hospital

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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