The purpose of this study was to evaluate the efficacy of the Norwalk virus-like particle (VLP) vaccine as determined by the illness rate of viral acute gastroenteritis (AGE) during the inpatient stay.
The drug being tested in this study is called intranasal Norwalk virus-like particle (VLP) vaccine. Norwalk VLP vaccine is being tested to prevent viral acute gastroenteritis (AGE). This study will look at the illness rate of AGE in people who are administered the Norwalk VLP vaccine. The study enrolled 98 patients and was conducted in 2 stages: the Vaccination Stage and the Challenge Stage. In the Vaccination Stage participants were randomly assigned (by chance, like flipping a coin) to one of the two treatment groups-which remained undisclosed to the patient and study doctor during the study (unless there is an urgent medical need): * Norwalk VLP Vaccine (100 µg VLP) intranasally * Placebo (dummy inactive powder) - this is a powder that looks like the study drug but has no active ingredient During the Challenge Stage participants were administered live Norwalk virus and were monitored for AGE. This multi-center trial was conducted in the United States. The overall time to participate in this study was up to 29 weeks Participants made multiple visits to the clinic and were contacted by telephone 6 months after last dose of study drug for a follow-up assessment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
98
Norwalk VLP vaccine dry powder
Mannitol and sucrose as placebo-matching Norwalk VLP Vaccine dry powder
Norwalk virus solution
SNBL
Baltimore, Maryland, United States
Cincinnati Childrens Hospital Medical Center
Cincinnati, Ohio, United States
Baylor College of Medicine
Houston, Texas, United States
Percentage of Participants with Viral Acute Gastroenteritis (AGE)
Viral AGE was a composite endpoint for the analysis of clinical illness and was defined as meeting one or more definitions of Norwalk Virus Infection and one or more of the definitions of AGE. Norwalk Virus Infection: * PAN-Immunoglobulin (Ig) Enzyme Linked Immunosorbent Assay (ELISA) for anti-Norwalk Virus Antibody IgM, IgG and IgA, ≥4-fold rise in titer in serum on Challenge Day 30 compared to Pre-Challenge. * Reverse Transcription Polymerase Chain Reaction (RT-PCR), a single positive post-challenge stool sample. * Norwalk Virus Antigen, a single positive post-challenge stool sample. Acute Gastroenteritis: -\>200 grams of watery feces in 24-hour collection that immediately takes the shape of the container. * Vomiting and watery feces ≤200 grams on the same or consecutive days. * One vomiting episode plus one of the following symptoms: abdominal cramps or pains, nausea, bloating, loose feces, fever ≥99.7° Fahrenheit, or myalgia on the same or consecutive days.
Time frame: 7 Days Post-Challenge
Percentage of Participants with Norwalk Virus Infection Anytime Post Challenge
Norwalk Virus Infection was defined as meeting one or more of the following criteria: * Norwalk Virus Antigen, a single positive post-challenge stool sample. * Reverse Transcription Polymerase Chain Reaction (RT-PCR), a single positive post-challenge stool sample. * PAN-Immunoglobulin (Ig) Enzyme Linked Immunosorbent Assay (ELISA) for anti-Norwalk Virus Antibody IgM, IgG and IgA, ≥4-fold rise in titer in serum on Challenge Day 30 compared to Pre-Challenge.
Time frame: Up to 30 Days Post-Challenge
Severity of Viral AGE using the Modified Vesikari Scale
Vesikari Scoring System assesses the following symptoms: duration of diarrhea (days), maximum number of diarrheal stools/24 hours, duration of vomiting (days), maximum number of vomiting episodes/24 hours, fever and dehydration. Since the typical inpatient phase was four days in length, the duration of diarrhea scoring was modified to fit this time frame. Modified Vesikari Scale Total Score=17. Higher numbers are worse.
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Time frame: Up to 30 Days Post-Challenge
Duration of Viral AGE Among Challenged Participants
Duration of symptoms was determined by a blinded committee review of each participant's symptoms. Participants not ill are included in the calculations with a duration=0.
Time frame: Up to 30 Days Post-Challenge
Percentage of Participants with Norwalk Virus Antigen Detected in the Stool
Stool samples were collected following challenge with Norwalk Virus. A positive test for antigen in post challenge stool sample was considered evidence of Norwalk Virus infection.
Time frame: Days 1 thru 4, 7, 21 and 30 in the Challenge Stage
Percentage of Participants with Seroconversion in Serum Anti-Norwalk Virus
Seroconversion was defined as a 4-fold rise in Pan-Ig ELISA Assay (Combined IgG + IgA + IgM) from Pre-Challenge to Day 30 Post Challenge.
Time frame: Pre-Challenge to 30 Days Post-Challenge
Percentage of Participants with Norwalk RT-PCR Positive Titer in Stool Anytime Post Challenge
RT-PCR was carried out to detect Norwalk Virus RNA in stool samples. A single positive test was taken as evidence of a Norwalk Virus infection.
Time frame: Days 1 thru 4, 7, 21 and 30 in the Challenge Stage
Percentage of Participants with Any Local Intranasal Symptoms during the Vaccination Stage
Local symptoms included nasal stuffiness, nasal itching, sneezing, runny nose/nasal discharge, nasal pain/discomfort, blood tinged nasal mucus and nose bleed.
Time frame: 7 Days Post Dose 1 and 2
Percentage of Participants with Any Systemic Solicited Symptoms Anytime Post-Challenge
Systemic signs or symptoms were defined as headache, fever, nausea, vomiting, abdominal cramps, diarrhea, malaise, and loss of appetite.
Time frame: Up to 21 Days Post-Challenge
Percentage of Participants with Serious Adverse Events (SAEs)
A SAE was any experience that suggests a significant hazard, contraindication, side effect or precaution that: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant.
Time frame: 180 days following the last study vaccination (Up to Day 201)
Norwalk PAN-Ig Serum-ELISA Geometric Mean Titer (GMT)
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Norwalk PAN-Ig Serum-ELISA Geometric Mean Fold Rise (GMFR)
GMFR represents the geometric mean fold rise in antibody at post-dose compared to pre-dose 1.
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Percentage of Participants with Norwalk PAN-Ig Serum-ELISA Seroresponse (4-Fold Rise)
4-Fold Rise represents the percentage of participants with at least a 4-Fold Rise in antibody at Day 21 post dose compared to pre-dose 1.
Time frame: Pre-dose 1 and 21 Days Post Dose 1 and 2
Norwalk IgG Serum-ELISA GMT
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Norwalk IgG Serum-ELISA GMFR
GMFR represents the geometric mean fold rise in antibody at post-dose compared to pre-dose 1.
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Percentage of Participants with Norwalk IgG Serum-ELISA Seroresponse (4-Fold Rise)
4-Fold Rise represents the percentage of participants with at least a 4-Fold Rise in antibody at Day 21 post dose compared to pre-dose 1.
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and 2
Norwalk IgA Serum-ELISA GMT
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Norwalk IgA Serum-ELISA GMFR
GMFR represents the geometric mean fold rise in antibody at post-dose compared to pre-dose 1.
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and Dose 2
Percentage of Participants with Norwalk IgA Serum-ELISA Seroresponse
4-Fold Rise represents the percentage of participants with at least a 4-Fold Rise in antibody at Day 21 post dose compared to pre-dose 1.
Time frame: Pre-Dose 1 and 21 Days Post Dose 1 and 2