The purpose of this study is to determine the efficacy of maternal immunization during the third trimester of pregnancy with the RSV F vaccine against medically-significant RSV lower respiratory tract infection (LRTI), as defined by hypoxemia or tachypnea at rest, through the first 90, 120, 150, and 180 days of life in infants.
This is a randomized, observer-blind, placebo-controlled trial enrolling third-trimester pregnant women in the Northern and Southern hemispheres, for up to four consecutive RSV seasons in each hemisphere. The trial could enroll up to 8618 third-trimester pregnant subjects, of which 4,636 were actually enrolled. Women in the third trimester of a singleton uncomplicated low-risk pregnancy and 18 to 40 years of age (inclusive) were enrolled and randomized in a 1:1 ratio into one of two treatment groups, active or placebo, over approximately three months prior to peak RSV season in their locale. After the first global season of enrollment, the randomization scheme was changed to a 2:1 (active/placebo) ratio to enable a more efficient accrual of the safety database. All maternal subjects were to receive a single intramuscular (IM) injection on Day 0 with the assigned test article, the RSV F vaccine, or placebo. Study participation for maternal subjects spanned approximately nine (9) months from the first dose, ending six (6) months post-delivery. Study follow-up for live-born infant subjects spanned approximately one (1) year post-delivery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
4,636
Infants: Percentages of Participants With Medically Significant RSV LRTI With Either Hypoxemia (SpO2 <95% at Sea Level or <92% at Altitudes >1800 Meters) or Tachypnea
Percentages of infants with medically-significant RSV LRTI from delivery through 90, 120,150, and 180 days of life, as defined by: * The presence of RSV infection confirmed by detection of RSV genome by RT-PCR on respiratory secretions (obtained within the continuous illness episode which fulfills the other criteria listed below); AND * At least one manifestation of lower respiratory tract infection (LRTI) from among the following: cough, nasal flaring, lower chest wall indrawing, subcostal retractions, stridor, rales, rhonchi, wheezing, crackles/crepitations, or observed apnea; AND * Evidence of medical significance as defined by the presence of: * EITHER hypoxemia (peripheral oxygen saturation \[SpO2\] \< 95% at sea level or \< 92% at altitudes \> 1800 meters) OR * Tachypnea (≥ 70 breaths per minute \[bpm\] in infants 0 to 59 days of age and ≥ 60 bpm in infants ≥ 60 days of age).
Time frame: Delivery to 180 days after delivery
Infants: Number of Participants With RSV LRTI With Severe Hypoxemia (Sp02 <92% at Sea Level or <87% at Altitudes >1800 Meters) or Documented Use of Oxygen by High Flow Nasal Cannula or Other Advanced Respiratory Support Through 90 Days of Life
The number of infants with RSV LRTI with EITHER severe hypoxemia (SpO2 \< 92% at sea level or \< 87% at altitudes \> 1800 meters) OR the documented use of oxygen by high flow nasal cannula OR CPAP OR BiPAP OR Bubble CPAP OR bag-mask ventilation OR intubation with subsequent mechanical (or manual) ventilation OR ECMO from delivery through 90, 120, 150, and 180 days of life.
Time frame: Delivery to 180 days after delivery
Infants: Percentages of Participants With RSV LRTI With Hospitalization From Delivery
Percentages of infants with RSV LRTI with hospitalization from delivery through 90, 120, 150, and 180 days of life.
Time frame: Delivery to 180 days after delivery
Infant: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) During the Neonatal Period and Through the First Year of Life
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Research Site US115
Birmingham, Alabama, United States
Research Site US035
Cullman, Alabama, United States
Research Site US130
Fort Defiance, Arizona, United States
Research Site US123
Phoenix, Arizona, United States
Research Site US103
Tucson, Arizona, United States
Research Site US129
Whiteriver, Arizona, United States
Research Site US092
Colton, California, United States
Research Site US114
Huntington Park, California, United States
Research Site US127
Los Angeles, California, United States
Research Site US091
Madera, California, United States
...and 78 more locations
Number of infants with AEs and SAEs (with special attention to congenital anomalies; respiratory failure other than RSV-associated hospitalization; neonatal death; infant death; sudden infant death syndrome; asphyxia; neonatal or hypoxic-ischemic encephalopathy; or other adverse events or complications of adverse events that necessitate hospitalization) during the neonatal period and through the first year of life.
Time frame: Delivery to 364 days after delivery
Infants: Number of Participants With Potential Developmental Delay
Number of infants with potential developmental delay (a term used to describe a delay in a child's development), as measured by the outcome of testing with the Ages and Stages Questionnaire-3 at 6 months and at 1 year, in infants of RSV F vaccinees as compared to placebo.
Time frame: Day 180 after delivery
Maternal: Number of Participants With Solicited Injection Site and Systemic Reactogenicity
A number of maternal participants with solicited injection site and systemic reactogenicity within seven days of vaccination.
Time frame: Day 0 to Day 7
Maternal: Number of Participants With Unsolicited Adverse Events, Medically-attended Adverse Events (MAEs), Significant New Medical Conditions (SNMCs) and Serious Adverse Events (SAEs)
Number of maternal participants with unsolicited (local and systemic) adverse events (AEs), unscheduled medically-attended adverse events (MAEs), significant new medical conditions (SNMCs), and serious adverse events (SAEs) through delivery and six (6) months thereafter.
Time frame: Delivery to 180 days after delivery
Maternal: Number of Participants With Caesarean, Vaginal, or Instrument Assisted Vaginal Modes of Delivery
Number of maternal subjects that had either Caesarean, vaginal, or instrument-assisted vaginal modes of delivery.
Time frame: Delivery
Maternal: Immunogenicity of RSV F Vaccine and Placebo Expressed as GMFR
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Maternal Participants from Day 14 until Delivery
Time frame: Day 14 to Delivery
Maternal: Percentage of Participants With a Seroresponse to RSV F Vaccine and Placebo
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Maternal Participants from Day 14 until Delivery
Time frame: Day 14 to Delivery
Maternal: Percentage of Participants Who Seroconverted (2 Fold Increase) as Determined by Immunogenicity of RSV F Vaccine and Placebo
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Maternal Participants from Day 14 until Delivery
Time frame: Day 14 to Delivery
Maternal: Percentage of Participants Who Seroconverted (4 Fold Increase) as Determined by Immunogenicity of RSV F Vaccine and Placebo
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Maternal Participants from Day 14 until Delivery
Time frame: Day 14 to Delivery
Immunogenicity of RSV F Vaccine and Placebo Expressed as GMT
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Infant Participants from Delivery until Day 180
Time frame: Delivery to Day 180
Infants: Percentage of Participants With a Seroresponse to RSV F Vaccine and Placebo
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Infant Participants from Delivery until Day 180
Time frame: Delivery to Day 180
Infant: Immunogenicity of RSV F Vaccine and Placebo Expressed as GMR
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG, PCA, and RSV Types A and B - MN assays) among Infant Participants from Day 14 until Day 180
Time frame: Day 14 to Day 180
Infants: Mean Length of Participants at Birth
Length of Infant participants measured at delivery expressed in centimeters
Time frame: At Delivery
Infants: Mean Weight of Participants at Birth
Weight of infant participants measured at delivery expressed in kilograms.
Time frame: At Delivery
Infants: Mean Frontal-occipital Head Circumference of Participants at Birth
Frontal-occipital Head Circumference measured in infant participants at delivery expressed as centimeters
Time frame: At Delivery
Infants: Mean APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Score of Participants at Birth
The APGAR test measures the infant's Appearance, Pulse, Grimace, Activity, and Respiration. Any score of 7 or above is considered a good APGAR score. The maximum APGAR score is 10 and the minimum score is 1.
Time frame: At Delivery
Maternal: Number of Participants With Post-immunization Onset of Specific Complications of Third-trimester Pregnancy and Delivery
Number of maternal participants with post-immunization onset of specific complications of third-trimester pregnancy and delivery including Pregnancy complications, Labor and delivery complications.
Time frame: Day 0 to Delivery
Infants: Number of Participants With Developmental Delay
Number of infants with developmental delay (a term used to describe a delay in a child's development.), as measured by the outcome of testing at 1 year, in infants of RSV F vaccinees as compared to placebo.
Time frame: Day 364 after delivery
Maternal: Immunogenicity of Anti-RSV F IgG and Placebo Expressed as GMEU (Geometric Mean ELISA Units/mL)
Immunogenicity of RSV F Vaccine and Placebo (Anti-F IgG) among Maternal Participants from Screening until Delivery
Time frame: Pre-dose to Delivery +180 days
Maternal: Immunogenicity of RSV F Vaccine and Placebo Expressed as GMC (Geometric Mean Concentration)
Immunogenicity of RSV F Vaccine and Placebo (Palivizumab-competitive antibodies (PCA)) among Maternal Participants from Screening until Delivery
Time frame: Pre-dose to Delivery +180 days
Maternal: Immunogenicity of RSV F Vaccine and Placebo Expressed as GMT (Geometric Mean Titers)
Immunogenicity of RSV F Vaccine and Placebo (RSV/A microneutralization titers expressed as GMT) among Maternal Participants from Screening until Delivery
Time frame: Pre-dose to Delivery +180 days
Maternal: Immunogenicity of RSV F Vaccine and Placebo Expressed as GMTs
Immunogenicity of RSV F Vaccine and Placebo (RSV/B microneutralization titers expressed as GMT) among Maternal Participants from Screening until Delivery
Time frame: Pre-dose to Delivery +180 days