Clinical trial NCT00219401: Neonatal Immunization With Pneumococcal Conjugate Vaccine in Papua New Guinea
Official title: Neonatal Immunization With Pneumococcal Conjugate Vaccine in Papua New Guinea
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Pneumonia
Meningitis
Otitis Media
Keywords: Pneumococcal vaccine
Antibody responses
Cellular immunology
Th1/Th2 immune responses
Paediatric
Neonatal
Infectious diseases
Papua New Guinea
Lead sponsor: Papua New Guinea Institute of Medical Research
Sponsor class: OTHER_GOV
Collaborators: name: The University of Western Australia
First posted: 2005-09-22
Enrollment: 318
Sex: ALL
Minimum age (years): 1
Maximum age (years): 3
Standard ages: CHILD
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The National Health Plan 2001-2010 calls for investigation of the feasibility of pneumococcal vaccines for Papau New Guinea. The Papua New Guinea (PNG) Institute of Medical Research, the Telethon Institute for Child Health Research and the Department of Paediatrics, University of Western Australia will collaborate to examine very closely the safety of neonatal vaccination, particularly with regard to impact on the development of immunity and response to other vaccines given to infants. This study will also provide a unique opportunity for training of PNG and Australian scientists in both countries.

Detailed description: In order to obtain the earliest possible protection against invasive pneumococcal disease, achieve optimal coverage and reduce burden of early carriage, neonatal pneumococcal conjugate vaccine (PCV) immunization needs to be considered. This study in the PNG highlands will enrol 312 infants at birth, who will be randomised to receive PCV either at 1-2-3 months (infant schedule according to PNG national EPI schedule) or 0-1-2 months of age (neonatal schedule) or receive only routine immunizations (controls). Blood samples will be taken at birth-2-3-4 months of age, pre- and post-pneumococcal polysaccharide booster (23vPPV) at 9-10 months of age (to assess immune memory) and at 18 months at study completion. Carriage will be assessed weekly for the first month of life and at regular intervals thereafter. There will be ongoing surveillance for respiratory and other diseases throughout the study. In addition to serotype-specific IgG, we will examine IgG avidity, IgG subclasses, mucosal IgA and T-cell cytokine responses to PCV and pneumococcal protein antigens. To ensure immunological safety, particularly for neonatal PCV, immune responses to concomitant vaccines and viral and environmental antigens will also be examined as well as overall T-cell maturation.

Eligibility criteria: Inclusion Criteria:

New born babies with birth weight \>2000 g (2 kgs) and parents giving consent

Exclusion Criteria:

1. Acute neonatal infection;
2. Severe congenital abnormality;
3. Children of mothers known to be HIV positive will be excluded;
4. Serious asphyxia at birth;
5. Intended migration in the next 2 years;
6. Parents withdraw consent;

Primary outcomes:
measure: Immunogenicity and Safety
timeFrame: 5 yrs
Secondary outcomes:
measure: Immunogenicity
timeFrame: 5 years
measure: Pneumococcal-specific acquired immunity
timeFrame: 5 years
Other outcomes:
Locations:
city: Goroka
country: Papua New Guinea
facility: Papua New Guinea Institute of Medical Research
state: EHP
Study officials:
affiliation: Papua New Guinea Institute of Medical Research
name: Peter Siba, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Telethon Institute for Child Health Research
name: Deborah Lehmann, MBBS, Msc
role: PRINCIPAL_INVESTIGATOR
References:
citation: van den Biggelaar AH, Richmond PC, Pomat WS, Phuanukoonnon S, Nadal-Sims MA, Devitt CJ, Siba PM, Lehmann D, Holt PG. Neonatal pneumococcal conjugate vaccine immunization primes T cells for preferential Th2 cytokine expression: a randomized controlled trial in Papua New Guinea. Vaccine. 2009 Feb 25;27(9):1340-7. doi: 10.1016/j.vaccine.2008.12.046. Epub 2009 Jan 14.
citation: van den Biggelaar AH, Pomat W, Bosco A, Phuanukoonnon S, Devitt CJ, Nadal-Sims MA, Siba PM, Richmond PC, Lehmann D, Holt PG. Pneumococcal conjugate vaccination at birth in a high-risk setting: no evidence for neonatal T-cell tolerance. Vaccine. 2011 Jul 26;29(33):5414-20. doi: 10.1016/j.vaccine.2011.05.065. Epub 2011 Jun 7.
citation: Francis JP, Richmond PC, Pomat WS, Michael A, Keno H, Phuanukoonnon S, Nelson JB, Whinnen M, Heinrich T, Smith WA, Prescott SL, Holt PG, Siba PM, Lehmann D, van den Biggelaar AH. Maternal antibodies to pneumolysin but not to pneumococcal surface protein A delay early pneumococcal carriage in high-risk Papua New Guinean infants. Clin Vaccine Immunol. 2009 Nov;16(11):1633-8. doi: 10.1128/CVI.00247-09. Epub 2009 Sep 23.
citation: van den Biggelaar AHJ, Richmond PC, Fuery A, Anderson D, Opa C, Saleu G, Lai M, Francis JP, Alpers MP, Pomat WS, Lehmann D. Pneumococcal responses are similar in Papua New Guinean children aged 3-5 years vaccinated in infancy with pneumococcal polysaccharide vaccine with or without prior pneumococcal conjugate vaccine, or without pneumococcal vaccination. PLoS One. 2017 Oct 13;12(10):e0185877. doi: 10.1371/journal.pone.0185877. eCollection 2017.
citation: Francis JP, Richmond PC, Michael A, Siba PM, Jacoby P, Hales BJ, Thomas WR, Lehmann D, Pomat WS, van den Biggelaar AHJ. A longitudinal study of natural antibody development to pneumococcal surface protein A families 1 and 2 in Papua New Guinean Highland children: a cohort study. Pneumonia (Nathan). 2016 Aug 15;8:12. doi: 10.1186/s41479-016-0014-x. eCollection 2016.
citation: Aho C, Michael A, Yoannes M, Greenhill A, Jacoby P, Reeder J, Pomat W, Saleu G, Namuigi P, Phuanukoonnon S, Smith-Vaughan H, Leach AJ, Richmond P, Lehmann D; Neonatal Pneumococcal Conjugate Vaccine Trial Study Team. Limited impact of neonatal or early infant schedules of 7-valent pneumococcal conjugate vaccination on nasopharyngeal carriage of Streptococcus pneumoniae in Papua New Guinean children: A randomized controlled trial. Vaccine Rep. 2016 Dec;6:36-43. doi: 10.1016/j.vacrep.2016.08.002.
citation: Pomat WS, van den Biggelaar AH, Phuanukoonnon S, Francis J, Jacoby P, Siba PM, Alpers MP, Reeder JC, Holt PG, Richmond PC, Lehmann D; Neonatal Pneumococcal Conjugate Vaccine Trial Study Team. Safety and immunogenicity of neonatal pneumococcal conjugate vaccination in Papua New Guinean children: a randomised controlled trial. PLoS One. 2013;8(2):e56698. doi: 10.1371/journal.pone.0056698. Epub 2013 Feb 22.