Flublok or Fluzone With Advax-CpG55.2 or AF03
Condition: Influenza; Influenza Immunisation
MeSH terms: Influenza, Human
Intervention: AF03; Delta Inulin-CpG55.2; Influenza Virus Quadrivalent Inactivated Vaccine; Quadrivalent Recombinant Seasonal Influenza Vaccine
Intervention description: A squalene-in-PBS emulsion stabilized by nonionic surfactants, sorbitan oleate and macrogol cetostearyl ether; A combination adjuvant supplied as two separate components, Delta Inulin (Sypharma Pty Ltd.) and CpG55.2 (Nikko Denka Avecia and Sypharma Pty Ltd); 2018/2019 Fluzone QIV and 2019/2020 Fluzone QIV vaccines will be given with 90 days interval; 2018/2019 Flublok QIV and 2019/2020 Flublok QIV vaccines will be given with 90 days interval
Intervention MeSH terms: Vaccines
Phase: Phase 1
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 241.0
Sex: All
Minimum age: 18 Years
Maximum age: 45 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Immunogenicity; Influenza; Influenza Vaccine; Phase 1; Quadrivalent; Safety

Summary:

      This is a Phase I, randomized, double blinded, clinical trial in up to 240 males and
      non-pregnant females, 18-45 years of age, inclusive, who are in good health and meet all
      eligibility criteria. This clinical trial is designed to assess the safety, reactogenicity
      and immunogenicity of either the 2018/2019 seasonal Fluzone or Flublok Quadrivalent Influenza
      Vaccine (QIV) manufactured by Sanofi Pasteur (SP) given without adjuvant or with one of two
      adjuvant formulations, AF03 or Advax-CpG55.2. Eight Vaccine and Treatment Evaluation Unit
      (VTEU) sites will be included in the study. Study duration is approximately 18 months, and
      subject participation duration is 12 months. The primary objectives of this study are: 1) to
      assess the safety and reactogenicity of 2018/2019 Fluzone and Flublok with and without AF03
      or Advax-CpG55.2 adjuvant; 2) to assess the serum hemagglutination inhibition (HAI) antibody
      responses against 2018/2019 QIV strains from baseline (Day 1) to approximately Day 29 after
      receipt of 2018/2019 Fluzone and Flublok with and without AF03 or Advax-CpG55.2 adjuvant; 3)
      to assess the serum neuraminidase inhibition antibody (NAI) responses by enzyme-linked lectin
      assay (ELLA) against NA antigens in the 2018/2019 QIV from baseline (Day 1) to approximately
      Day 29 after receipt of 2018/2019 Fluzone and Flublok with and without AF03 or Advax-CpG55.2
      adjuvant; 4) to assess the influenza neutralizing (Neut) antibody titer responses against
      2018/2019 QIV strains from baseline (Day 1) to approximately Day 29 after receipt of
      2018/2019 Fluzone and Flublok with and without AF03 or Advax- CpG55.2 adjuvant.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Provide written informed consent prior to initiation of any study procedures.

          2. Are able to understand and comply with planned study procedures and be available for
             all study visits.

          3. Must agree to the collection of venous blood per protocol.

          4. Are males or non-pregnant females, 18 to 45 years of age, inclusive at time of
             enrollment.

          5. Are in good health*. *As determined by medical history and physical examination to
             evaluate acute or currently ongoing chronic medical or psychiatric diagnoses or
             conditions, defined as those that have been present for at least 90 days, which would
             affect the assessment of the safety of subjects or the immunogenicity of study
             vaccinations. Chronic medical diagnoses or conditions should be stable for the last 60
             days (no hospitalizations, emergency room or urgent care for condition, or invasive
             medical procedure and no adverse symptoms that need medical intervention such as
             medication change/supplemental oxygen). This includes no change in chronic
             prescription medication, dose or in the 60 days prior to enrollment. Any prescription
             change that is due to change of health care provider, insurance company, etc., or that
             is done for financial reasons, as long as in the same class of medication, will not be
             considered a deviation of this inclusion criterion. Subjects may be on chronic or as
             needed (prn) medications if, in the opinion of the site PI or appropriate
             sub-investigator, they pose no additional risk to subject safety or assessment of
             reactogenicity and immunogenicity and do not indicate a worsening or treatment of
             continued symptoms of medical diagnosis or condition. Note: Low dose topical,
             corticosteroids as outlined in the Subject Exclusion Criteria as well as herbals,
             vitamins and supplements are permitted.

          6. Oral temperature is less than 100.0 degrees Fahrenheit.

          7. Pulse is 47 to 100 beats per minute, inclusive.

          8. Systolic blood pressure is 85 to 140 mmHg, inclusive.

          9. Diastolic blood pressure is 55 to 90 mmHg, inclusive.

         10. Screening laboratories (Erythrocyte Sedimentation Rate (ESR), White Blood Cells (WBC),
             Hemoglobin (Hgb), Platelets (PLTs), Alanine Aminotransferase (ALT), Total Bilirubin
             (T. Bili), Aspartate Aminotransferase (AST), Gamma-glutamyl Transferase (GGT),
             Alkaline Phosphatase (ALP) serum lipase, serum amylase and Creatinine (Cr)) are within
             acceptable parameters*.

             *ESR must be below 30 mm/hr; WBC >3.90 K/MM3 and <10.60 K/MM3; Hgb >/= 11.5 g/dl
             (women) or >/= 12.5 g/dl (men); PLTs (EDTA) 140-415 K/MM3; PLTs (Citrate) 125-325
             K/MM3 ALT </= 43 U/L (women) or </= 60 U/L (men); T Bili </=1.20 mg/dl; Cr < 1.1 mg/dl
             (women) or < 1.4 mg/dl (men); AST 10-36 U/L (women) or 10-43 U/L (men); GGT 5--32 U/L
             (women) or 10-49 U/L (men); ALP 30-115 U/L (women) or 43-115 U/L (men); lipase 13-60
             U/L; amylase (Total) 35-121 U/L, for subjects to qualify for randomization and
             vaccination.

         11. Women of childbearing potential* must use an acceptable contraception method** from at
             least 30 days before the first study vaccination until 60 days after the second study
             vaccination.

             *Not sterilized via bilateral oophorectomy, tubal ligation/ salpingectomy,
             hysterectomy, or successful Essure(R) placement (permanent, non-surgical, non-hormonal
             sterilization) with documented radiological confirmation test at least 90 days after
             the procedure, and still menstruating or <1 year has passed since the last menses if
             menopausal.

               -  Includes non-male sexual relationships, full abstinence from sexual intercourse
                  with a male partner, monogamous relationship with vasectomized partner who has
                  been vasectomized for 180 days or more and shown to be azoospermic prior to the
                  subject receiving the study vaccination, barrier methods such as condoms or
                  diaphragms/cervical cap with spermicide, effective intrauterine devices,
                  NuvaRing(R), and licensed hormonal methods such as implants, injectables or oral
                  contraceptives ("the pill").

         12. Women of childbearing potential must have a negative urine or serum pregnancy test
             within 24 hours prior to the first study vaccination.

         13. For a woman with potential to become pregnant, she understands that in the event of
             pregnancy during the study she will be approached to enroll in the Sanofi Pregnancy
             Registry.

         14. Must agree to have residual specimens (i.e. residual/excess of per protocol
             specifications).

        Exclusion Criteria:

          1. Have an acute illness*, as determined by the site Principal Investigator (PI) or
             appropriate sub-investigator, within 72 hours prior to study vaccination.

             *An acute illness which is nearly resolved with only minor residual symptoms remaining
             is allowable if, in the opinion of the site PI or appropriate sub-investigator, the
             residual symptoms will not interfere with the ability to assess safety parameters as
             required by the protocol.

          2. Have any medical disease or condition that, in the opinion of the site PI or
             appropriate sub-investigator, is a contraindication to study participation*.

             *Including acute, subacute, intermittent or chronic medical disease or condition that
             would place the subject at an unacceptable risk of injury, render the subject unable
             to meet the requirements of the protocol, or may interfere with the evaluation of
             responses or the subject's successful completion of this trial.

          3. Have immunosuppression as a result of an underlying illness or treatment, a recent
             history or current use of immunosuppressive or immunomodulating disease therapy.

          4. Use of anticancer chemotherapy or radiation therapy (cytotoxic) within 3 years prior
             to study vaccination.

          5. Have known active or recently active (12 months) neoplastic disease or a history of
             any hematologic malignancy. Non-melanoma, treated, skin cancers are permitted.

          6. Have known human immunodeficiency virus (HIV), hepatitis B or hepatitis C infection.

          7. Have known hypersensitivity or allergy to eggs, egg or chicken protein, squalene-based
             adjuvants, or other components of the study vaccine.

          8. Have a history of severe reactions following previous immunization with licensed or
             unlicensed influenza vaccines.

          9. Have a history of Guillain-Barré Syndrome (GBS).

         10. Have a history of convulsions or encephalomyelitis within 90 days prior to study
             vaccination.

         11. Have a history of Potentially Immune-Mediated Medical Conditions (PIMMCs).

         12. Have a history of alcohol or drug abuse within 5 years prior to study vaccination.

         13. Have any diagnosis, current or past, of schizophrenia, bipolar disease or other
             psychiatric diagnosis that may interfere* with subject compliance or safety
             evaluations.

             *As determined by the site PI or appropriate sub-investigator.

         14. Have been hospitalized for psychiatric illness, history of suicide attempt, or
             confinement for danger to self or others within 5 years prior to study vaccination.

         15. Have taken oral or parenteral (including intra-articular) corticosteroids of any dose
             within 30 days prior to study vaccination.

         16. Have taken high-dose inhaled corticosteroids* within 30 days prior to study
             vaccination.

             *High-dose defined as per age as using inhaled high-dose per reference chart in the
             National Heart, Lung and Blood Institute Guidelines for the Diagnosis and Management
             of Asthma (EPR-3) or other lists published in UPTODATE.

         17. Received or plan to receive a licensed, live vaccine (excluding all licensed, seasonal
             LAIVs) within 30 days before or after the study vaccination.

         18. Received or plan to receive a licensed, inactivated vaccine (excluding all licensed,
             seasonal IIVs) within 14 days before or after each study vaccination.

         19. Have received any 2018/2019 seasonal influenza vaccine within the 6 months prior to
             enrollment.

         20. Plans to receive any 2019/2020 seasonal influenza vaccine within approximately 90 days
             of receipt of the first study vaccination.

         21. Have a known history of documented influenza infection within the past 6 months.

         22. Received immunoglobulin or other blood products (except Rho D immunoglobulin) within
             90 days prior to study vaccination.

         23. Received an experimental agent* within 30 days prior to the study vaccination or
             expect to receive another experimental agent* during the trial-reporting period*.

             *Including vaccine, drug, biologic, device, blood product, or medication.

             **Other than from participation in this trial.

             ***Approximately 12 months after the first study vaccination.

         24. Are participating or plan to participate in another clinical trial with an
             interventional agent* that will be received during the trial-reporting period**.

             *Including licensed or unlicensed vaccine, drug, biologic, device, blood product, or
             medication.

             **Approximately 12 months after the first study vaccination.

         25. Female subjects who are breastfeeding or plan to breastfeed from the time of the first
             study vaccination through 30 days after the last study vaccination.

         26. Plan to travel outside the US (continental US, Hawaii and Alaska) from the time of
             study vaccination through approximately 90 days after the first study vaccination.

         27. Planning to donate blood within 4 months following first vaccination.

        Exclusion Criteria for Second Study Vaccination:

        All study participants will be expected to receive the second study vaccination except
        under the circumstances listed below. The second study vaccination will not be administered
        to a subject if any of the following criteria are met:

          -  Meets the contraindication on the package insert to receipt of licensed influenza
             vaccine.

          -  As deemed necessary by the site principal investigator or appropriate sub-investigator
             for noncompliance or other reasons.

          -  Subject refusal of further study vaccination.

          -  Withdrawal of consent.

          -  Subject is lost to follow-up.

          -  Termination of this trial.

          -  New information becomes available that makes further participation unsafe.