A Phase 2 interventional study of Rotarix and Trivalent P2-VP8 in Diarrhea and Diarrhea Rotavirus, sponsored by Centre for Infectious Disease Research in Zambia. Status unknown at 1 site in Zambia. Open to participants aged 6 Weeks to 10 Weeks, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-07-20.
Sponsored by Centre for Infectious Disease Research in Zambia · Phase 2, Interventional, and Prevention
Despite the widespread introduction of vaccines against Rotavirus, Rotavirus continues to be a cause of significant morbidity and mortality in the developing world. This study will assess protection against rotavirus infection and investigate immune correlates of protection following vaccination with a novel trivalent VP8 subunit rotavirus vaccine used alone or in combination with oral rotavirus vaccine.
This is a randomized, open-label clinical trial of Rotarix and trivalent VP8 subunit vaccine given alone or in combined schedules to 720 infants in Zambia at 6, 10 and 14 weeks followed by challenge at 18 weeks used to assess mucosal immunity.
Potential participants will be identified through antenatal and child health monitoring clinics in selected facilities in Lusaka Zambia. Interested parents will be invited to the clinical research site for informed consent procedures and assessment of eligibility. Children meeting the eligibility criteria with written informed consent for participation will be randomized to one of the four available study arms using simple randomization in block sizes of 8. Blood, stool, and saliva samples will be collected prior to completing vaccination according to randomization arm. All parents/guardians will be provided with post immunisation diary cards to document any reactions following vaccination. Trained study staff will contact parents and guardians of enrolled participants weekly to enquire on the child's health and assist with documentation of solicited reactions following vaccinations.
Enrolled children will be followed up for at least five months following enrollment. Follow up vaccinations will be provided each month until all children have completed all assigned study vaccinations. Upon completion of study vaccination, participants will be challenged with oral rotavirus vaccine, Rotarix TM to assess mucosal immunity.
Primary outcome:
The primary objective of the study will be to detect a reduction in the proportion of children shedding vaccine rotavirus in stool at any timepoint 5-9 days after challenge, among children immunized with P2-VP8 subunit vaccine alone or in combination with Rotarix, compared with infants receiving Rotarix alone. The primary outcomes will be prevalence of rotavirus (Rotarix) shedding at any timepoint in samples collected 5,7 and 9 days after challenge.
Secondary outcomes:
i.) Seroconversion following vaccination: Detection of an increase in seroconversion in either of the combined vaccination arms compared with Rotarix alone.
ii.) Immune boosting. We will compare the number of gut-homing (alpha 4 beta 7+) Immunoglobulin A (IgA) and Immunoglobulin G (IgG) rotavirus VP8-specific Antibody secreting cells (ASCs) 7 days after the third clinic visit in 50 infants from each study arm (i.e. after the first VP8 vaccine booster dose, after the third VP8 vaccine dose (alone or in combination with Rotarix), or after no vaccine (control) in the Rotarix only arm).
852 studies on the registry are indexed under Diarrhea; 78 are open to participants now.
This study's enrollment of 720 is above the median of 136 across 713 interventional studies indexed under Diarrhea.
Browse Diarrhea studies →Centre for Infectious Disease Research in Zambia is the lead sponsor of 37 studies on the registry; 4 are open to participants now.
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Exclusion Criteria:
Rotarix will be administered at 6 and 10 weeks of age following the national Expanded Program for Immunization (EPI) schedule. A challenge dose of Rotarix will be administered at 18 weeks of age and stool samples collected just before challenge and 5, 7 \& 9 days later.
Parenteral P2-VP8 subunit vaccine will be administered at 6, 10 and 14 weeks of age. A challenge dose of Rotarix will be administered at 18 weeks of age and stool samples collected just before challenge and 5, 7 \& 9 days later.
Biological: Trivalent P2-VP8
Rotarix will be administered at 6 and 10 weeks of age, followed by parenteral P2-VP8 subunit vaccine at 14 weeks of age. A challenge dose of Rotarix will be administered at 18 weeks of age and stool samples collected just before challenge and 5, 7 \& 9 days later.
Biological: Rotarix · Biological: Trivalent P2-VP8
Rotarix and parenteral P2-VP8 subunit vaccine will be coadministered at 6 and 10 weeks of age, with an additional dose of P2-VP8 subunit vaccine administered at 14 weeks of age. A challenge dose of Rotarix will be administered at 18 weeks of age and stool samples collected just before challenge and 5, 7 \& 9 days later.
Biological: Rotarix · Biological: Trivalent P2-VP8
Live-attenuated oral human rotavirus vaccine (Rotarix) manufactured by GlaxoSmithKline containing at least 10\^6 CCID50(median cell culture infective doses) of G1P\[8\] rotavirus, RIX4414 strain produced in Vero cells. This vaccine is an oral suspension with a single dose (1.5ml) administered using an oral applicator.
Trivalent P2-VP8 subunit vaccine manufactured by SK Chemicals containing 90ug of each VP8 antigen derived from P\[4\] (DS-1), P\[6\] (1076), and P\[8\] (Wa) rotavirus strains fused to the P2 epitope from tetanus toxoid and adsorbed to aluminium hydroxide. A single dose (0.5ml) of this vaccine is administered intramuscularly through injection.
Vaccine Shedding
to detect a reduction in the proportion of children shedding vaccine rotavirus in stool at any timepoint 5 -9 days after challenge, among children immunized with P2-VP8 subunit vaccine alone or in combination with Rotarix, compared with infants receiving Rotarix alone. We estimate that approximately 50% (range 30-70%) of children previously vaccinated with 2 doses of Rotarix will shed Rotarix detected by Polymerase Chain Reaction (PCR) at any timepoint 5-9 days after challenge
Time frame: 5-9 days after Challenge
Seroconversion following vaccination
Seroconversion After 2 doses of Rotarix in Zambia seroconversion was 60% (130/216) in an earlier study and 45% (10/22) in our Medical Research Council UK MRC-funded pilot of Rotarix challenge, based on IgA to whole virus cell culture lysate (largely anti -VP6 antibodies). Seroconversion based on anti-VP8 antibodies has not been studied after Rotarix administration but may be similar.
Time frame: 14 and 18 weeks of age
Immune boosting
i.) We will compare the number of gut-homing (alpha 4 beta 7+) IgA and IgG rotavirus VP8-specific ASCs 7 days after the third clinic visit in 50 infants from each study arm (i.e. after the first VP8 vaccine booster dose, after the third VP8 vaccine dose (alone or in combination with Rotarix), or after no vaccine (control) in the Rotarix only arm).
Time frame: 7 days after 3rd clinic visit
Plan to share: Yes — Communicate with the participants results of the study and plans to share de-identified data. Disseminate to internal research meetings as well as the Ministry of Health Zambia. Submit manuscripts, publications, in peer review journal and also present at local and international scientific conferences
Supporting information: Study protocol, Sap, Icf
No publications or documents are linked to this record.
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Centre for Infectious Disease Research in Zambia