Various observational studies have reported an association between influenza vaccination and lower rates of infection with SARS-Cov-2 and less COVID-19 disease severity have been reported in large epidemiological studies in US, Brazil and Italy. Observational studies from the Netherlands showed also strongly reduced COVID-19 infection rates among influenza-vaccinated healthcare workers, with ORs of 0.61 and 0.49 for the first and second wave of COVID-19, respectively. In addition, in-vitro immunological analyses showed that the quadrivalent inactivated influenza vaccine can induce a trained immunity program against SARS-CoV-2 (2). In-vivo vaccination against influenza was also shown to induce improved interferon responses against SARS-CoV-2, with modulation of hyperinflammatory responses. Trained immunity could be the underlying mechanism for the potential protective effect of influenza vaccine, a mechanism that has also been proven for BCG vaccination, and epidemiological evidence suggests similar non-specific effects of MMR and OPV vaccination. Currently, various clinical trials are being conducted to study the impact of BCG, MMR and OPV vaccination on COVID-19, but prospective clinical data on influenza vaccination are lacking. Although specific COVID-19 vaccines have been developed and are proven effective, there are important reasons for assessing in a controlled randomized trial the effect of influenza and MMR vaccine on COVID19: * Specific COVID-19 vaccines are still not yet available for all segments of the population, and especially not for the majority of the population in developing countries. * The emergence of new SARS-CoV-2 variants, especially the P1 variant from Brazil, may very well be associated with reduced response to vaccines. An immunomodulatory protective vaccine that protects in an antigen-independent manner would be of great importance. * It would also be conceptually important to know whether influenza and the MMR vaccine can induce heterologous protection against another viral infection, in the context of future pandemics.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
638
Influenza: 0.5 ml of reconstituted Influenza vaccine will be administered intramuscularly in the left upper arm as recommended by the manufacturer.
MMR: 0.5 ml of reconstituted MMR vaccine will be administered intramuscularly in the left upper arm as recommended by the manufacturer.
Placebo: 0.5 ml of 0.9% NaCl will be administered intradermally in the left upper arm.
Faculdade da Polícia Militar
Goiânia, Goiás, Brazil
Cumulative incidence of SARS-CoV-2 infection during 1 year follow up
COVID-19 will be defined as meeting the following two criteria: 1. signs and symptoms compatible with the disease as judged by the adjudication committee based on the most recent knowledge of COVID-19 2. microbiological or radiological confirmation: meeting any of the following: a. presence of SARS-CoV-2 virus by PCR
Time frame: 3 months after inclusion
Cumulative incidence of SARS-CoV-2 infection
COVID-19 will be defined as meeting the following two criteria: 1. signs and symptoms compatible with the disease as judged by the adjudication committee based on the most recent knowledge of COVID-19 2. microbiological or radiological confirmation: meeting any of the following: a. presence of SARS-CoV-2 virus by PCR
Time frame: 6 months after inclusion
Cumulative incidence of SARS-CoV-2 infection
COVID-19 will be defined as meeting the following two criteria: 1. signs and symptoms compatible with the disease as judged by the adjudication committee based on the most recent knowledge of COVID-19 2. microbiological or radiological confirmation: meeting any of the following: a. presence of SARS-CoV-2 virus by PCR
Time frame: 12 months after inclusion
Severity of SARS-CoV-2 and the incidence of clinically relevant RTI
Cumulative incidence of hospitalization for COVID-19; Cumulative incidence of ICU admission for COVID-19; Cumulative incidence of death due to COVID-19; All parameters combined, measured as number of days or number of deaths will be used to report COVID19 severity.
Time frame: 3, 6 and 12 months after inclusion
Severity of other respiratory tract infections (RTIs)
Cumulative incidence of hospitalization for other RTIs; Cumulative incidence of hospitalization for all infections; Cumulative incidence of death due to other infections; All parameters combined, measured as number of days or number of deaths will be used to report the severity of the infection. Cumulative incidence of hospitalization for all infections
Time frame: 3, 6 and 12 months after inclusion
Incidence and magnitude of plasma/serum antibodies (IgA, M, G) and SARS-Cov-2-specific antibodies at the end of study
The measurement of the antibodies titers will be used together with the self informed questionnaires in order to confirm the incidence of COVID19 and/or other RTIs.
Time frame: 3, 6 and 12 months after inclusion
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