This is a safety and infectivity study of experimental human Norovirus genogroup GII.4 administered to 48 healthy non-pregnant adults, 18-49 years of age, negative for COVID-19 by antigen testing at the time of norovirus challenge. Subjects will be admitted to the Vaccine Research Center inpatient facility and challenged with a dose of human norovirus GII.4 challenge strain. The challenge study will be conducted in 3 cohorts of approximately 16 subjects each, 15 subjects will have a functional FUT-2 gene (secretor positive) and 1 subject will have a non-functional FUT-2 gene (non-secretor). Subjects in Cohort 1 will receive 3.5x10\^3 copies of norovirus, in Cohort 2 will receive 3.5x10\^4 copies of norovirus and in Cohort 3 will receive 3.5x10\^5 copies of norovirus. Based on the illness rate of subjects meeting the primary outcome measure in secretor - positive subjects of the initial cohort, the decision will be made with regards to dosing of the second and the third cohorts. Study duration is approximately 12-18 months with subject participation duration of 6-8 months. The primary objective of this study is to determine the optimal challenge dose of Norovirus GII.4 CIN-3 Batch No.: 01-16C3 to achieve illness in \> / = 50% of subjects (illness is defined as norovirus infection determined by positive Polymerase Chain Reaction (PCR) and either: a) \> / = 3 loose or liquid stools, in a 24-hour period, b) \> / = 300 gm of loose or liquid stool in a 24-hour period or c) and/or any episode of vomiting), during the inpatient period.
This is a double-blind, safety and infectivity study of experimental human Norovirus genogroup GII.4 administered to 48 healthy non-pregnant adults, 18-49 years of age, negative for COVID-19 by antigen testing at the time of norovirus challenge. Subjects will be admitted to the Vaccine Research Center inpatient facility and challenged with a dose of human norovirus GII.4 challenge strain. The challenge study will be conducted in 3 cohorts of approximately 16 subjects each, 15 subjects will have a functional FUT-2 gene (secretor positive) and 1 subject will have a non-functional FUT-2 gene (non-secretor). Subjects in Cohort 1 will receive 3.5x10\^3 copies of norovirus, in Cohort 2 will receive 3.5x10\^4 copies of norovirus and in Cohort 3 will receive 3.5x10\^5 copies of norovirus. Based on the illness rate of subjects meeting the primary outcome measure in secretor - positive subjects of the initial cohort, the decision will be made with regards to dosing of the second and the third cohorts. Subjects will remain in the inpatient facility for at least four days following the challenge and assessed daily for clinical and virologic evidence of norovirus infection. After the discharge, subjects will return to the site for evaluation on Days 6, 15, 30, 45, and 60 post challenge. A final phone call will be performed at day 180 to obtain an interim medical history. Study duration is approximately 12-18 months with subject participation duration of 6-8 months. The primary objective of this study is to determine the optimal challenge dose of Norovirus GII.4 CIN-3 Batch No.: 01-16C3 to achieve illness in \> / = 50% of subjects (illness is defined as norovirus infection determined by positive Polymerase Chain Reaction (PCR) and either: a) \> / = 3 loose or liquid stools, in a 24-hour period, b) \> / = 300 gm of loose or liquid stool in a 24-hour period or c) and/or any episode of vomiting), during the inpatient period. The secondary objectives are: 1) To evaluate the safety of the Norovirus GII.4 CIN-3 Batch No.: 01-16C3 challenge strain; 2) To determine the rate of infection at different challenge doses by detection of norovirus GII.4 in the stool using specific qRT-PCR and Anti-norovirus GII.4 serum IgG by Enzyme-Linked Immunnosorbent Assay (ELISA) (\> / = 4-fold rise from baseline through Day 30); 3) To measure the severity of acute gastroenteritis; 4) To determine the quantity and duration of virus shedding in stool by qRT-PCR.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
TRIPLE
Enrollment
48
Subjects will be NPO (nothing by mouth) for at least 90 minutes followed by ingestion of 60 mL of a 2% sodium bicarbonate solution by mouth. 2 minutes later, subjects will be administered Norovirus GII.4 CIN-3. Five minutes following administration of the challenge dose, subjects will be administered a 60 mL volume of a 2% sodium bicarbonate solution and then remain NPO for at least the next 90 minutes. Subjects will be observed during the 60 minutes after receipt of the challenge by a study team member to detect and treat any immediate adverse reactions.
Cincinnati Children's Hospital Medical Center Vaccine Research Center
Cincinnati, Ohio, United States
The Occurrence of Norovirus-associated Illness in Secretor Positive Participants Through Day 4 After Challenge.
Illness is defined as norovirus infection, determined by a positive PCR, and either a) = 3 loose or liquid stools in a 24-hour period, b) = 300 gm of loose or liquid stool in a 24-hour period, and/or c) any episode of vomiting.
Time frame: Day 1 through Day 4
The Number of Participants With Solicited Adverse Events Through Day 10
Systemic solicited adverse events were collected pre-challenge, post-challenge, and via memory aid through 5 days after discharge from the isolation facility and graded on a scale of 0 (absent), 1 (mild), 2 (moderate) and 3 (severe). Systemic events include headache, nausea, abdominal cramps/discomfort/pain, abdominal gurgling, abdominal bloating, myalgia, malaise/fatigue, anorexia/loss of appetite, and chills.
Time frame: Day 1 through Day 10
The Number of Participants With Unsolicited Serious Adverse Events Reported Through Day 180.
An adverse event or suspected adverse reaction is considered "serious" if, in the view of either the investigator or sponsor, it results in any of the following outcomes: death, a life-threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization (excluding any extended stay during challenge admission due to continued vomiting, diarrhea, etc.), a persistent or significant incapacity of substantial disruption of the ability to conduct normal life functions, a congenital anomaly/birth defect, important medical events that may not result in death, be life-threatening, or require hospitalizations may be considered serious when, based upon appropriate medical judgment they may jeopardize the patient or participant and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.
Time frame: Day 1 through Day 180
The Number of Participants With Unsolicited Grade 3 Adverse Events From Challenge to Day 30
ICH E6 defines an AE as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product regardless of its causal relationship to the study treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of medicinal (investigational) product. The FDA defines an AE as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related.
Time frame: Day 1 through Day 30
The Number of Participants With Infection Through Day 30
Detection of norovirus GII.4 in stool by qRT-PCR at Days 2, 3, 4, 5, 6, 15, or 30; or \>/= 4-fold rise from baseline in GII.4-specific antibody titers in serum IgG by ELISA through Day 30
Time frame: Day 1 through Day 30
Peak Genome Equivalent Copies/mL of Virus in Stool as Measured by qRT-PCR After Challenge Through Day 60
Peak virus in stool as measured by qRT-PCR \[genome equivalent copies per gram of stool (GEC/g)\] is the maximum GEC/g of all available stool samples tested post-challenge.
Time frame: Day 1 through Day 60
Duration (Number of Days) of Viral Secretion as Measured by qRT-PCR After Challenge Through Day 60
Duration is based on the first and last days where norovirus is detected.
Time frame: Day 1 through Day 60
Modified Vesikari Score Through Day 4
The score is made up of the following components: duration of diarrhea (days), maximum number of diarrheal stools per 24 hours, duration of vomiting (days), maximum number of vomiting episodes per 24 hours, fever, and dehydration. Each of the components will be assigned a point value and the points will be summed to create a total score out of a possible 17 for each participant, with 17 being the worst outcome, and 0 being a better outcome.
Time frame: Day 1 through Day 4
Duration (Hours) of Vomiting and/or Diarrhea Through Day 5
The duration of diarrhea will be calculated for participants who had at least three stools classified as having loose or watery consistency, or who have at least two stools classified as having loose or watery consistency with \> 300 gm of loose or watery stools in a study day (from 00:00 to 23:59). The duration will be calculated as the interval between the first time a loose/watery stool is produced on a day the participant met the criteria for diarrhea through the last loose/watery stool on a day the participant met the criteria for diarrhea. The duration of vomiting during the inpatient period will be calculated for participants who had at least two episodes of vomiting in a study day or over two consecutive days. The duration of diarrhea and/or vomiting will be calculated beginning from the first diarrheal stool or episode of vomiting until the last diarrheal stool or episode of vomiting during the inpatient period.
Time frame: Day 1 through Day 5
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