The purpose of this study was to evaluate the safety and immunogenicity of a single dose of the recombinant live-attenuated respiratory syncytial virus (RSV) vaccines, RSV ΔNS2/Δ1313/I1314L, RSV 6120/ΔNS2/1030s, and RSV 276, in RSV-seronegative children 6 to 24 months of age.
This study evaluated the safety and immunogenicity of a single dose of the recombinant live-attenuated respiratory syncytial virus (RSV) vaccines, RSV ΔNS2/Δ1313/I1314L, RSV 6120/ΔNS2/1030s, and RSV 276, in RSV-seronegative children 6 to 24 months of age. Participants were randomly assigned to receive a single dose of RSV ΔNS2/Δ1313/I1314L vaccine, RSV 6120/ΔNS2/1030s vaccine, RSV 276 vaccine, or placebo intranasally at study entry. Participants were enrolled in the study outside of RSV season. All participants were to remain on study until they completed the post-RSV season visit in the calendar year following enrollment. Participants' total study duration was expected to be between 5 and 15 months, depending on when they enrolled in the study and accommodations given for the COVID pandemic. Participants attended several study visits throughout the study, which included physical examinations, blood collection, and nasal washes or swabs, if applicable. Participants' parents or guardians were contacted by study staff at various times during the study to monitor participants' health. The study closed to enrollment prior to fully accruing due to difficulties with slower than expected accrual.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
67
10\^6 plaque-forming units (PFU); administered as nose drops
10\^5 plaque-forming units (PFU); administered as nose drops
10\^5 plaque-forming units (PFU); administered as nose drops
Administered as nose drops
David Geffen School of Medicine at UCLA NICHD CRS
Los Angeles, California, United States
University of California, UC San Diego CRS- Mother-Child-Adolescent HIV Program
San Diego, California, United States
Univ. of Colorado Denver NICHD CRS
Aurora, Colorado, United States
Emory University School of Medicine NICHD CRS
Atlanta, Georgia, United States
Rush Univ. Cook County Hosp. Chicago NICHD CRS
Chicago, Illinois, United States
Lurie Children's Hospital of Chicago (LCH) CRS
Chicago, Illinois, United States
University of Maryland School of Medicine Center for Vaccine Development CRS
Baltimore, Maryland, United States
The Children's Mercy Hospital CRS
Kansas City, Missouri, United States
Center for Vaccine Development CRS
St Louis, Missouri, United States
SUNY Stony Brook NICHD CRS
Stony Brook, New York, United States
...and 4 more locations
Percentage With Grade 1 or Higher Solicited Adverse Events (AEs)
Solicited adverse events include fever, otitis media, upper respiratory illness (URI), and lower respiratory illness (LRI) and are graded following a protocol-defined grading system. Adverse events were graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. All solicited AEs with at least mild severity were included. Percentage with 95% exact confidence intervals using the Clopper-Pearson method were calculated.
Time frame: Day 0 through Day 28
Percentage With Grade 2 or Higher Lower Respiratory Illnesses (LRIs)
LRIs graded following a protocol-defined grading system. Adverse events were graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. All solicited LRIs with at least moderate severity were included. Percentage with 95% exact confidence intervals using the Clopper-Pearson method were calculated.
Time frame: Day 0 through Day 28
Percentage With Serious AEs
Serious adverse events are defined according to Version 2.0 of the DAIDS EAE Manual. A serious event is one that requires or lengthens hospitalization, that is life-threatening, that results in death, that results in a significant disability, or that is a congenital anomaly or birth defect. Percentage with 95% exact confidence intervals using the Clopper-Pearson method were calculated.
Time frame: Day 0 through Day 56
Percentage With a Greater Than or Equal to 4-fold Rise in Serum RSV-neutralizing Antibody Titer
Antibody responses were defined as a greater than or equal to 4-fold increase in titer in paired specimens, between pre-study product administration and Day 56 time points. Percentage with 95% exact confidence intervals (CIs) using the Clopper-Pearson method were calculated. The upper limit of the CI was compared to an a priori limit of 70%. An upper limit above 70% was considered a good vaccine candidate.
Time frame: Measured at pre-study product administration (screening) through Day 56
Percentage With a Greater Than or Equal to 4-fold Rise in Serum RSV F Immunoglobulin G (IgG)
RSV F IgG responses were defined as a greater than or equal to 4-fold increase in titer in paired specimens, between pre-study product administration and Day 56 time points. Percentage with 95% exact CIs using the Clopper-Pearson method were calculated. The upper limit of the CI was compared to an a priori level of 70%. An upper limit above 70% was considered a good vaccine candidate.
Time frame: Measured at pre-study product administration (screening) and Day 56
Titer of Serum RSV F IgG
Serum F IgG antibodies were assessed by Enzyme-linked Immunosorbent Assay (ELISA). Titers below the limit of detection (1:50) were assigned a value equal to half the corresponding limit of detection (1:25) and evaluated as reciprocals of the titer (log2).
Time frame: Measured at the Day 56 Visit
Titer of Serum RSV-neutralizing Antibodies
Serum RSV-neutralizing antibody titers were assessed by RSV-plaque reduction neutralization titer (RSV-PRNT) assay. Titers below the limit of detection (1:10) were assigned a value equal to half the corresponding limit of detection (1:5) and evaluated as reciprocals of the titer (log2).
Time frame: Measured at the Day 56 Visit
Percentage With RSV-associated Medically Attended Acute Respiratory Illness (RSV-MAARI)
The percentage and 95% exact Clopper-Pearson CI of participants who had RSV-associated, symptomatic, medically attended respiratory and febrile illness (MAARI) among those who had indicators of natural infection with wt RSV were presented. Natural infection with wild type (wt) RSV during the RSV season surveillance period was defined as having either RSV detected in nasal samples collected during illness visits for MAARI events or through site reporting. RSV-associated upper respiratory tract illness, lower respiratory tract illness, otitis media, or fever were graded following a protocol-defined grading system.
Time frame: Measured through the last day of the RSV season, which will occur between 5 and 15 months after study entry, depending on when the participant enrolls in the study
Maximum Grade (if More Than One Illness Within a Participant) of RSV-MAARI
The number of participants who had RSV-MAARI among those who had indicators of natural infection with wt RSV were presented. Natural infection with wt RSV during the RSV season surveillance period was defined as having either RSV detected in nasal samples collected during illness visits for MAARI events or through site reporting. A participant was only counted once in the line corresponding to the highest grade MAARI event they experienced. These events were graded following a protocol-defined grading system. Adverse events were graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death.
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Time frame: Measured through the last day of the RSV season, which will occur between 5 and 15 months after study entry, depending on when the participant enrolls in the study
Percentage With RSV-associated Medically Attended Acute Lower Respiratory Illness (RSV-MAALRI)
The percentage and 95% exact Clopper-Pearson CI of participants who had RSV-associated, symptomatic, medically attended acute lower respiratory tract illness (MAALRI) among those who had indicators of natural infection with wt RSV were presented. Natural infection with wt RSV during the RSV season surveillance period was defined as having either RSV detected in nasal samples collected during illness visits for MAALRI events or through site reporting. RSV-associated lower respiratory tract illness graded following a protocol-defined grading system.
Time frame: Measured through the last day of the RSV season, which will occur between 5 and 15 months after study entry, depending on when the participant enrolls in the study
Maximum Grade (if More Than One Illness Within a Participant) of RSV-MAALRI
The number of participants who had RSV-MAALRI among those who had indicators of natural infection with wt RSV were presented. Natural infection with wt RSV during the RSV season surveillance period was defined as having either RSV detected in nasal samples collected during illness visits for MAALRI events or through site reporting. A participant was only counted once in the line corresponding to the highest grade MAALRI event they experienced. These events were graded following a protocol-defined grading system. Adverse events were graded on a scale from 1-5: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death.
Time frame: Measured through the last day of the RSV season, which will occur between 5 and 15 months after study entry, depending on when the participant enrolls in the study