This is a randomized, multicenter, double-blind, placebo-controlled Phase III study that will evaluate efficacy and safety of a live attenuated, tetravalent, lyophilized dengue vaccine produced by Butantan Institute. The study will be carried out in multiple sites in Brazil. The study will be community-based in select urban areas where there's dengue transmission. Study's intervention will be a single dose of the tetravalent dengue vaccine or placebo in a ratio 2:1. For efficacy analysis will be considered all dengue cases occurring after 28 days post-vaccination in the entire population of 16944 participants. For safety analysis participants will be divided in three age groups: 18 to 59 ys, 7-17 ys and 2 to 6 ys. In each of these age groups there will be a minimum of 4992 participants. The age groups of 18 to 59 ys and 7 to 17 ys will start first. Once safety data for the first 21 days after vaccination is analysed for 450 participants in 7-to17-ys age group, the following group, of 2 to 6 ys, will start. The study's hypothesis is that the vaccine under investigation and produced by Butantan Institute is safe and provides protection against dengue symptomatic disease of 80% or more with a lower bound of the 95% confidence interval of 25%. This way, the expected number of dengue cases virologically confirmed is 24 or more which will provide a response in terms of vaccine efficacy. All participants will be followed up for five years to verify dengue incidence, regardless severity.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
16,935
Dose 1000 PFU per virus (1,2,3,4) Route:subcutaneous
Route:subcutaneous
Fundação de Medicina Tropical Doutor Heitor Vieira Dourado
Manaus, Amazonas, Brazil
Universidade Federal do Ceará
Fortaleza, Ceará, Brazil
Instituto Gonçalo Muniz - Fiocruz Bahia
Simões Filho, Estado de Bahia, Brazil
Universidade de Brasília
Brasília, Federal District, Brazil
Universidade Federal de Mato Grosso do Sul
Campo Grande, Mato Grosso do Sul, Brazil
Universidade Federal de Minas Gerais
Belo Horizonte, Minas Gerais, Brazil
Hospital Universitário Júlio Müller da Universidade Federal de Mato Grosso
Cuiabá, Mount, Brazil
Centro de Pesquisas Aggeu Magalhães - Fiocruz Pernambuco
Recife, Pernambuco, Brazil
Hospital Escola da Universidade Federal de Pelotas (HEUFPel)
Pelotas, Rio Grande do Sul, Brazil
Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul
Porto Alegre, Rio Grande do Sul, Brazil
...and 7 more locations
Efficacy (incidence density of symptomatic dengue cases, virologically confirmed)
The primary efficacy outcome is incidence density of symptomatic dengue cases, virologically confirmed, after 28 days post-vaccination. Virological confirmation might be done by viral isolation, RT-PCR and/or detection of NS1.
Time frame: Five years post vaccination, all cases after 28 days post-vaccination
Safety (adverse reactions)
The primary safety outcome is the frequency of local and systemic adverse reactions, solicited and non-solicited in the three age groups, within the first 21 days post-vaccination. Adverse reactions are defined as adverse events that have a reasonable causal relationship with vaccination.
Time frame: In the first 21 days post-vaccination
Efficacy (incidence density of dengue cases confirmed virologically, regarding previous exposure to dengue viruses. )
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding previous exposure to dengue viruses. To demonstrate previous exposure or not to dengue viruses, validated serological methods such as: Elisa IgG Indirect, hemagglutination inhibition test or neutralizing antibodies (e.g., VRNT) or another validated test will be used. In case of doubtful results, more than one technique may be used to confirm the diagnosis.
Time frame: at five years post vaccination, all cases after 28 days post-vaccination
Efficacy (incidence density of dengue cases confirmed virologically, regarding the viral serotype)
The incidence density of dengue cases confirmed virologically after 28 days of vaccination, regarding the viral serotype. Virological diagnosis of the viral serotype will be performed using the viral isolation technique or RT-PCR.
Time frame: Five years post vaccination, all cases after 28 days post-vaccination
Efficacy (incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not)
Incidence density of cases of severe dengue and/or with alarm signs, including cases hospitalized or not, after 28 days of vaccination. Laboratory confirmation of these cases will occur through serological and/or virological tests.
Time frame: Five years post vaccination, all cases after 28 days post-vaccination
Safety ( frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses )
The frequency of solicited and unsolicited local and systemic adverse reactions in participants regarding previous exposure to dengue viruses during the 21-day period after vaccination.
Time frame: In the first 21 days post-vaccination
Safety (frequency of unsolicited adverse reactions)
The frequency of unsolicited adverse reactions after 21 days of vaccination until the end of the study.
Time frame: Five years post vaccination, all cases after the first 21 days post-vaccination
Immunogenicity (consistency of the immune response to different batches of the vaccine )
The geometric mean of neutralizing antibody titers for each serotype in the fourth week after vaccination in a subgroup of adult participants without previous exposure to dengue immunized with three consecutive batches of dengue vaccine 1,2,3,4 (attenuated).
Time frame: 4 weeks post vaccination
Immunogenicity (non-inferiority between simplified formulation vs. conventional formulation)
The geometric mean of titers of neutralizing antibodies for each serotype at Week 4 postvaccination in a subgroup of adult participants without previous prior exposure to dengue and vaccinated with the conventional formulation and the simplified formulation of the dengue 1, 2, 3, 4 (attenuated) vaccine.
Time frame: 4 weeks post vaccination
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.