An open-label, dose-ranging influenza challenge study in healthy adult volunteers to determine the optimal infection dose and safety of a recombinant H3N2 (A/Texas/ A/Texas/71/2017 (H3N2, clade 3C3a) influenza strain. The goal of this study is to find a challenge virus dose that is safe and can achieve a symptomatic influenza Attack Rate (AR) that will be sufficiently high for utilization in future vaccine or intervention studies. The optimal dose of the three considered is broadly defined as the minimum challenge virus dose that elicits the highest AR without meeting safety-stopping criteria. Additionally, viral recovery, clinical symptoms, and immune responses over the post-challenge period will be described by challenge dose group. This study will last for up to 1 year depending upon the number of challenge cohorts enrolled given the adaptive dose-escalation design. The populations are healthy males and non-pregnant, non-breastfeeding females aged = 18 and \< 46 years of age with a serum HAI antibody titer of \</=1:40 against influenza A/Texas/71/2017 (H3N2), clade 3C3a. The study will enroll and challenge up to 106 (plus 8 shams) healthy adult volunteers with the H3N2 (A/Texas/71/2017 (H3N2), clade 3C3a) influenza virus challenge strain. The primary objectives are: 1) To determine the optimal infectious dose of a recombinant influenza virus (A/Texas/71/2017 (H3N2), clade 3C3a) to be used as a clinical challenge strain in future vaccine efficacy or intervention studies as assessed by viral shedding and clinical symptoms. 2) To describe viral detection by quantitative and qualitative Reverse Transcription - Polymerase Chain Reaction (RT-PCR) from study subjects at baseline and post-challenge. 3) To document clinical symptoms from self-reported surveys and standardized symptom scales at baseline and post-challenge.
An open-label, dose-ranging influenza challenge study in healthy adult volunteers to determine the optimal infection dose and safety of a recombinant H3N2 (A/Texas/ A/Texas/71/2017 (H3N2, clade 3C3a) influenza strain. The goal of this study is to find a challenge virus dose that is safe and can achieve a symptomatic influenza Attack Rate (AR) that will be sufficiently high for utilization in future vaccine or intervention studies. The optimal dose of the three considered is broadly defined as the minimum challenge virus dose that elicits the highest AR without meeting safety-stopping criteria. Additionally, viral recovery, clinical symptoms, and immune responses over the post-challenge period will be described by challenge dose group. This study will last for up to 1 year depending upon the number of challenge cohorts enrolled given the adaptive dose-escalation design. The populations are healthy males and non-pregnant, non-breastfeeding females aged = 18 and \< 46 years of age with a serum HAI antibody titer of \</=1:40 against influenza A/Texas/71/2017 (H3N2), clade 3C3a. The study will enroll and challenge up to 106 (plus 8 shams) healthy adult volunteers with the H3N2 (A/Texas/71/2017 (H3N2), clade 3C3a) influenza virus challenge strain. Subjects will be pre-screened for study inclusion to have serological HAI antibody titers of \</=1:40 against the clinical challenge strain. Eligible participants will be enrolled sequentially into dosing cohorts and will be randomly assigned to receive a single dose of either placebo (sham inoculum) or a virus dose between 104 to 106 Median Issue Culture Infectious Dose (TCID50) (in an allocation of 1:12 to 1:17). Dose titration will be conducted under an adaptive escalation schedule whereby dosing will start at the lowest dose 104 TCID50 and only escalate to the next dose if a pre-determined infection and symptomatic attack rate are not met and the dose is determined to be safe and no pre-defined halting rule is met. The attack rate (AR), defined as the percentage of subjects meeting shedding and symptom criteria for symptomatic influenza virus infection (see clinical case definition below), will be determined for each challenge dose group in order to identify the optimal infectious dose (55%-80% AR). This adaptive, dose-ranging approach allows adjustments to challenge dose group size and escalation dose schedule to be informed by the AR and safety results. The primary objectives are: 1) To determine the optimal infectious dose1 of a recombinant influenza virus (A/Texas/71/2017 (H3N2), clade 3C3a) to be used as a clinical challenge strain in future vaccine efficacy or intervention studies as assessed by viral shedding and clinical symptoms. 2) To describe viral detection by quantitative and qualitative Reverse Transcription - Polymerase Chain Reaction (RT-PCR) from study subjects at baseline and post-challenge. 3) To document clinical symptoms from self-reported surveys and standardized symptom scales at baseline and post-challenge. The secondary objectives are: 1) To assess the safety profile of a live recombinant influenza strain (A/Texas/71/2017 (H3N2), clade 3C3a) following challenge in healthy adult volunteers. 2) To describe the host serum hemagglutination inhibition and microneutralization antibody responses at baseline and post-challenge. 3) To describe anti-Hemagglutination(HA)-stalk antibody titer at baseline and post-challenge.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
TRIPLE
Enrollment
60
RG-A/Texas/71/2017 (H3N2) is an infectious influenza virus and requires handling at BioSafety Level 2. The challenge virus will be administered intranasally in a volume of approximately 0.5 mL per nostril. Intranasal challenge will be carried out using the Intranasal Mucosal Atomization ( MAD Nasa(TM)) Device attached to a 1 mL syringe.
Sucrose phosphate glutamate (SPG) inoculum
University of Maryland, School of Medicine, Center for Vaccine Development and Global Health
Baltimore, Maryland, United States
Duke University Trent Drive
Durham, North Carolina, United States
Number and Percentage of Participants With Symptomatic Influenza Virus Infection After Challenge.
Symptomatic influenza virus infection is defined as meeting both of the following criteria: 1. Viral shedding (as determined by a positive qualitative RT-PCR result or a detectable quantitative RT-PCR result) on at least two days beginning 24 hours after challenge until Study Day 8. 2. A cumulative symptom score = 6 from daily component symptoms computed across any consecutive 5-day window through Day 8 beginning on Day 2 post challenge using a Modified Jackson Score (MJS). MJS ranges from 0 to 36, with higher scores corresponding to worse outcomes.
Time frame: Day 2 through Day 8
Number and Percentage of Participants With Detected Viral Shedding in Nasopharyngeal (NP) Swabs Each Day Post-challenge.
Viral shedding status (yes/no) is determined by at least one of: a positive qualitative reverse transcription-polymerase chain reaction (RT-PCR) result from multiplex assay, or a detectable quantitative RT-PCR result.
Time frame: Day 1 through discharge from the inpatient unit (Day 8 to Day 10)
Mean Peak Viral Load (VL) After Challenge
The magnitude of viral shedding is measured via quantitative RT-PCR. Peak VL post-challenge is computed for each participant as the maximum log-10 viral copies/mL.
Time frame: Day 2 through Day 8
Mean Duration of Viral Shedding
Viral shedding status (yes/no) for each day during the challenge period is determined by at least one of: a positive qualitative RT-PCR result from multiplex assay, or a detectable quantitative RT-PCR result. The duration of shedding for each participant was computed as the number of days from the initial positive NP swab until the day after the final positive NP swab. Intermittent negative results were ignored for this computation.
Time frame: Day 2 through Day 8
Mean Maximum Cumulative Modified Jackson Score (MJS)
The cumulative symptom score from daily component symptoms is computed across any consecutive 5-day window through Day 8 beginning on Day 2 post challenge using the Modified Jackson Score (MJS). MJS ranges from 0 to 36, with higher scores corresponding to worse outcomes. The maximum cumulative score post-challenge was computed for each participant.
Time frame: Day 2 through Day 8
Number and Percentage of Participants Symptomatic for Influenza.
Participants were categorized as symptomatic if they reported a cumulative symptom score = 6 from daily component symptoms computed across any consecutive 5-day window through Day 8 beginning on Day 2 post challenge using a Modified Jackson Score (MJS). MJS ranges from 0 to 36, with higher scores corresponding to worse outcomes.
Time frame: Day 2 through Day 8
Number of Adverse Events (AEs) Reported From Challenge Through Day 29
Adverse events were defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of medicinal (investigational) product. Non-serious, unsolicited adverse events were collected from Day 1 through Day 29. Serious adverse events were collected from Day 1 through Day 57. Adverse events were MedDRA coded.
Time frame: Day 1 through Day 29
Number and Percentage of Participants Reporting Any AE From Challenge Through Day 29.
Adverse events were defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of medicinal (investigational) product. Non-serious, unsolicited adverse events were collected from Day 1 through Day 29. Serious adverse events were collected from Day 1 through Day 57. Adverse events were MedDRA coded.
Time frame: Day 1 through Day 29
Number of Serious Adverse Events (SAEs) Reported From Challenge Through Day 57
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, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect. Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the participant and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.
Time frame: Day 1 through Day 57
Number and Percentage of Participants Reporting an SAE at Any Time From Challenge Through Day 57
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, a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital anomaly/birth defect. Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered serious when, based upon appropriate medical judgment, they may jeopardize the participant and may require medical or surgical intervention to prevent one of the outcomes listed in this definition.
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Time frame: Day 1 through Day 57
Number and Percentage of Participants With Serological Conversion for Hemagglutination Inhibition (HAI) Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Serological conversion (seroconversion) is defined as a minimum 4-fold rise in post-challenge antibody titers, compared to baseline. Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day 8, Day 15, and Day 29
Geometric Mean Hemagglutination Inhibition (HAI) Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day -1 (baseline), Day 8, Day 15, and Day 29
Number and Percentage of Participants With Serological Conversion for Microneutralization (MN) Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Serological conversion (seroconversion) is defined as a minimum 4-fold rise in post-challenge antibody titers, compared to baseline. Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day 8, Day 15, and Day 29
Geometric Mean Microneutralization (MN) Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day -1 (baseline), Day 8, Day 15, and Day 29
Number and Percentage of Participants With Serological Conversion for HA-stalk-specific Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Serological conversion (seroconversion) is defined as a minimum 4-fold rise in post-challenge antibody titers against HA group 2 stem domains, compared to baseline. Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day 8, Day 15, and Day 29
Geometric Mean HA-stalk-specific Antibody Titers Against A/Texas/71/2017 (H3N2), Clade 3C3a Virus, by Study Day
Titers for each participant are estimated as the geometric mean of technical replicate results, and the geometric mean is taken again across participants in each challenge dose group.
Time frame: Day -1 (baseline), Day 8, Day 15, and Day 29