Evaluating the Infectivity, Safety, and Immunogenicity of a Single Dose of a Recombinant Live-Attenuated Respiratory Syncytial Virus Vaccine (D46/NS2/N/ΔM2-2-HindIII) in RSV-Seronegative Infants 6 to 24 Months of Age
Condition: Respiratory Syncytial Virus Infections
MeSH terms: Respiratory Syncytial Virus Infections
Intervention: D46/NS2/N/ΔM2-2-HindIII; Placebo
Intervention description: 10^5 plaque-forming units (PFU) per 0.5ml vaccine; administered as nose drops; Isotonic diluent; administered as nose drops
Phase: Phase 1
Study type: Interventional
Primary purpose: Prevention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 32.0
Sex: All
Minimum age: 6 Months
Maximum age: 24 Months
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      The purpose of this study was to evaluate the safety, infectivity, and immunogenicity of a
      single dose of a recombinant live-attenuated respiratory syncytial virus (RSV) vaccine in
      RSV-seronegative infants and children 6 to 24 months of age.

      This study was a companion study to CIR 313.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Good health based on review of the medical record, history, and physical examination,
             without evidence of chronic disease.

          -  Parents/guardians willing and able to provide written informed consent as described in
             the protocol.

          -  Seronegative for RSV antibody, defined as a serum RSV-neutralizing antibody titer less
             than 1:40 at screening from a sample collected no more than 42 days prior to
             inoculation. Note: results from specimens collected during screening for any study of
             an RSV vaccine developed by the Laboratory of Infectious Diseases (LID) (NIAID, NIH)
             were acceptable as long as within the 42-day window.

          -  Growing at a normal velocity for age (as demonstrated on a standard growth chart) AND

               -  If less than 1 year of age: current height and weight above the 5th percentile

               -  If 1 year of age or older: current height and weight above the 3rd percentile for
                  age.

          -  Received routine immunizations appropriate for age (as per national Center for Disease
             Control Advisory Committee on Immunization Practices [ACIP]). Note: if rotavirus
             immunization was delayed, "catch-up" rotavirus immunization was indicated only if the
             participant was age-eligible per ACIP.

          -  Expected to be available for the duration of the study.

          -  If born to an HIV-infected woman, participant must not have been breastfed and must
             have had documentation of 2 negative HIV nucleic acid (RNA or DNA) test results from
             samples collected on different dates with both collected when greater than or equal to
             4 weeks of age and at least one collected when greater than or equal to 16 weeks of
             age, and no positive HIV nucleic acid (RNA or DNA) test; or 2 negative HIV antibody
             tests, both from samples collected at greater than or equal to 24 weeks of age.

        Exclusion Criteria:

          -  Known or suspected HIV infection or impairment of immunological functions.

          -  Receipt of immunosuppressive therapy, including any systemic, including either nasal
             or inhaled, corticosteroids within 28 days of enrollment. Note: Cutaneous (topical)
             steroid treatment was not an exclusion.

          -  Bone marrow/solid organ transplant recipient.

          -  Major congenital malformations (such as congenital cleft palate) or cytogenetic
             abnormalities.

          -  Previous receipt of a licensed or investigational RSV vaccine (or placebo in any
             IMPAACT RSV study) or previous receipt of or planned administration of any anti-RSV
             product (such as ribavirin or RSV immunoglobulin [IG] or RSV monoclonal antibody
             [mAb]).

          -  Previous anaphylactic reaction.

          -  Previous vaccine-associated adverse reaction that was Grade 3 or above.

          -  Known hypersensitivity to any study product component.

          -  Heart disease. Note: Participants with cardiac abnormalities documented to be
             clinically insignificant and requiring no treatment may be enrolled.

          -  Lung disease, including any history of reactive airway disease or medically diagnosed
             wheezing.

          -  Member of a household that contained, or would contain, an infant who was less than 6
             months of age at the enrollment date through Day 28.

          -  Member of a household that contains another child who was, or was scheduled to be,
             enrolled in IMPAACT 2011, 2012 or 2013 or another study evaluating an intranasal
             live-attenuated RSV vaccine, AND there had been or would be an overlap in residency
             during that other child's participation in the study's Acute Phase (Days 0 to 28).

          -  Member of a household that contained an immunocompromised individual, including, but
             not limited to:

               -  a person who was greater than or equal to 6 years of age with HIV-related
                  immunodeficiency, defined as having a most recent CD4 T lymphocyte cell count
                  less than 300 cells/mm^3. CD4 T lymphocyte count must have been measured within 6
                  months prior to enrollment, or

               -  a person age 1 year up to less than 6 years with HIV-related immunodeficiency,
                  defined as having a most recent CD4 T lymphocyte cell percentage less than 25 or
                  CD4 T lymphocyte count less than 750 cells/mm^3 (if both values are available,
                  use the lower of the two). CD4 T lymphocyte parameter must have been measured
                  within the 6 months prior to enrollment; or

               -  a person age less than 1 year with HIV-related immunodeficiency, defined as
                  having a most recent CD4 T lymphocyte cell percentage less than 30 or CD4 T
                  lymphocyte count less than 1000 cells/mm^3 (if both values are available, use the
                  lower of the two). CD4 T lymphocyte parameter must have been measured within the
                  6 months prior to enrollment; or

               -  a person who had received chemotherapy within the 12 months prior to enrollment;
                  or

               -  a person receiving immunosuppressant agents; or

               -  a person living with a solid organ or bone marrow transplant.

        Verbal report of CD4 T cell lymphocyte was sufficient documentation if the parent/guardian
        was confident of history.

          -  Attended a daycare facility and shared a room with infants less than 6 months of age,
             and parent/guardian was unable or unwilling to suspend daycare for 28 days following
             inoculation.

          -  Any of the following events at the time of enrollment:

               -  fever (rectal temperature of greater than or equal to 100.4°F (38°C)), or

               -  upper respiratory signs or symptoms (rhinorrhea, cough, or pharyngitis) or

               -  nasal congestion significant enough to interfere with successful inoculation, or

               -  otitis media.

          -  Receipt of the following prior to enrollment:

               -  any inactivated vaccine or live-attenuated rotavirus vaccine within the 14 days
                  prior, or

               -  any live vaccine, other than rotavirus vaccine, within the 28 days prior, or

               -  another investigational vaccine or investigational drug within 28 days prior

          -  Scheduled administration of the following after planned inoculation:

               -  inactivated vaccine or live-attenuated rotavirus vaccine within the 14 days
                  after, or

               -  any live vaccine other than rotavirus in the 28 days after, or

               -  another investigational vaccine or investigational drug in the 56 days after

          -  Receipt of immunoglobulin, any antibody products, or any blood products within the
             past 6 months

          -  Receipt of any of the following medications within 3 days of study enrollment:

               -  systemic antibacterial, antiviral, antifungal, anti-parasitic, or antituberculous
                  agents, whether for treatment or prophylaxis, or

               -  intranasal medications, or

               -  other prescription medication except as listed below

        Permitted concomitant medications (prescription or non-prescription) include nutritional
        supplements, medications for gastroesophageal reflux, eye drops, and topical medications,
        including (but not limited to) cutaneous (topical) steroids, topical antibiotics, and
        topical antifungal agents.

          -  Receipt of salicylate (aspirin) or salicylate-containing products within the 28 days
             prior to enrollment.

          -  Born at less than 34 weeks gestation.

          -  Born at less than 37 weeks gestation and less than 1 year of age at the time of
             enrollment.

          -  Suspected or documented developmental disorder, delay, or other developmental problem.

          -  Previous receipt of supplemental oxygen therapy in a home setting.