This is a phase II randomized, observer-blinded, placebo-controlled study with 3 arms enrolling a total of 2,358 participants. The arms are composed of Arm 1, pregnant participants receiving Hecolin® (N=1,104) with immunogenicity subset (n=150), Arm 2, pregnant participants receiving placebo (N=1,104) with immunogenicity subset (n=150), and Arm 3, non-pregnant participants receiving Hecolin® (N=150) of which all participants in this arm will be included in the immunogenicity subset.
Hecolin® is licensed in China and Pakistan indicated to be used for prevention of hepatitis E in healthy adult. The primary goal of this clinical trial is to establish the safety and immunogenicity of Hecolin® during pregnancy. As secondary and exploratory objectives, infant immune response through passive immunization of infants achieved through transplacental transfer of maternal IgG antibodies from the pregnant mother who has received Hecolin® in the second or third trimester will be evaluated. Hecolin® follows a 3-dose schedule (0-1-6 months). For Arm 1 and 2, pregnant participants will receive 2 doses of Hecolin® or placebo at a 4 weeks interval and the third dose will be administered postpartum, approximately 20 weeks after the second dose. The neonates from these Arms will be followed for 24 weeks after birth. For Arm 3, non-pregnant participants will receive Hecolin® at 0-1-6 months schedule. After each dose of IP injection to pregnant/non-pregnant participants, immediate AE (30 minutes post injection), solicited AE (7 days post injection), unsolicited AE (28 days post injection) and AESI/SAE (during the whole study period) will be collected. For the immunogenicity subset, the participants' blood will be drawn before and 4 weeks post each dose of IP injection. At delivery, maternal blood will be drawn. Breast milk samples will be taken at delivery, 6 weeks, and 24 weekss after delivery. All infant AESI/SAE will be collected throughout the study period and developmental assessment will be performed at age of 6 weeks, and 24 weeks. Blood will be drawn from infant immunogenicity subset at the same time points, umbilical cord blood (neonate blood will be collected if cord blood is not available for collection) at delivery, venous blood at age of 6 weeks and 24 weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
Hecolin® will be administered 2 doses administered 4 weeks apart during pregnancy and 1 dose administered after delivery at least 20 weeks following the second dose for the pregnant participants (arm 1), and 0, 1 and 6 months for the non-pregnant participant (arm 3).
Placebo will be administered 2 doses administered 4 weeks apart during pregnancy and 1 dose administered after delivery at least 20 weeks following the second dose for the pregnant participants (arm 2)
The Aga Khan University
Karachi, Sindh, Pakistan
RECRUITINGProportion of pregnancy-related AESI and SAE from vaccination in pregnant participant.
* Proportion of pregnancy-related AESI from the vaccination throughout the entire study in pregnant participants. * Proportion of SAE from the vaccination throughout the entire study in pregnant participants.
Time frame: Throughout the study period, approximately 24 months.
Immunogenicity in pregnant and non-pregnant participants
GMC of anti-HEV IgG at 4 weeks post second dose of Hecolin® administered 4 weeks apart in pregnant women and non-pregnant women.
Time frame: 4 weeks post second dose of Hecolin®
Proportion of AESIs and SAE in neonate/infant participants.
* Proportion of neonatal/infant AESIs. * Proportion of SAE through the 6 months of life in neonate/infant.
Time frame: 6 months of life in neonate/infant
Proportion of immediate adverse events in pregnant and non-pregnant participants
Proportion of immediate adverse events within 30 minutes post each dose of vaccination in pregnant and non-pregnant participants.
Time frame: Within 30 minutes post each dose of vaccination.
Proportion of Solicited local and system adverse events in pregnant and non-pregnant participants
Proportion of solicited local and systemic adverse events within 7 days post each dose of vaccination in pregnant and non-pregnant participants.
Time frame: Within 7 days post each dose of vaccination.
Proportion of unsolicited adverse events in pregnant and non-pregnant participants
Proportion of unsolicited adverse events within 28 days post each dose of vaccination in pregnant and non-pregnant participants.
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PREVENTION
Masking
TRIPLE
Enrollment
2,358
Time frame: Within 28 days post each dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post second dose of Hecolin® administered 4 weeks apart in pregnant and non-pregnant participants.
Time frame: 4 weeks post second dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
GMC of anti-HEV IgG at 4 weeks post third dose of Hecolin® (2 doses in pregnancy and 1 dose after delivery) in pregnant and non-pregnant participants.
Time frame: 4 weeks post third dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post third dose of Hecolin® (2 doses in pregnancy and 1 dose after delivery) in pregnant and non-pregnant participants.
Time frame: 4 weeks post third dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
GMC of anti-HEV IgG at 4 weeks post first dose of Hecolin® in pregnant and non-pregnant participants.
Time frame: 4 weeks post first dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post first dose of Hecolin® in pregnant and non-pregnant participants.
Time frame: 4 weeks post first dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
GMC of anti-HEV IgG at 4 weeks post second dose of Hecolin® in pregnant participants of GA 14-27 weeks (second trimester) and 28-34 weeks (third trimester) and non-pregnant participants as measured by anti HEV IgG ELISA.
Time frame: 4 weeks post second dose of vaccination.
Immunogenicity in pregnant and non-pregnant participants
SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post second dose of Hecolin® in pregnant participants of GA 14-27 weeks (second trimester) and 28-34 weeks (third trimester) and non-pregnant participants.
Time frame: 4 weeks post second dose of vaccination.