Primary objective- To assess the safety of nasal inoculation of healthy volunteers with B. pertussis with antibiotic therapy given to eradicate colonisation at 6 weeks after inoculation or at symptom onset, whichever occurs first Secondary objectives - To measure the rate of natural clearance of carriage of B. pertussis following nasal inoculation * To assess the kinetics of B. pertussis colonisation density following nasal inoculation * To describe the microevolution of B. pertussis and adaptation of the resident microbiome during B. pertussis carriage * To measure B. pertussis-specific antibody and cellular immunological responses in healthy volunteers during colonisation with B. pertussis - To identify biomarkers that correlate with natural clearance of B. pertussis carriage after induced B. pertussis colonisation * To detect transmission of B. pertussis to bedroom contacts of inoculated volunteers during prolonged asymptomatic colonisation
This is a prospective controlled human challenge study; Challenge group: The challenge volunteers will be healthy volunteers, aged 18-55 years, not having close contact with people having increased risk of severe pertussis complications or increased risk of transmitting to vulnerable individuals. Eligible volunteers must be willing to abide by infection control measures during social contact and to attend immediately if they become symptomatic. People who live in institutions in which multiple people share dormitory facilities, such as boarding schools or military barracks will be excluded. The standard inoculum, a dose of 105 cfu, determined in Phase A of the Bp human challenge study, will be used. Participants will be followed up weekly and colonisation will be measured in nasal washes. If culture of the nasal wash taken at week 5 following nasal inoculation is positive for B. pertussis, then eradication therapy will be given at week 6. Early eradication therapy will be given if a participant presents with symptoms of early B. pertussis disease. Recruitment will continue until 10 challenge volunteers have been colonised and then completed study participation to week 6 as per protocol. Volunteers who withdraw from the study early or have colonisation cleared with antibiotic treatment given for any reason will be replaced. Assuming a colonisation fraction of at least 30% and allowing for study withdrawal the investigator expect a maximum number of 36 volunteers to be inoculated. Contact group: A group of contact volunteers, maximum 36 individuals, will be enrolled to assess transmission by monitoring for colonisation with the challenge strain of B. pertussis. These contact volunteers will be bedroom sharers of challenge volunteers and will give informed consent for their participation in the study, prior to inoculation of the corresponding challenge volunteer. Eradication therapy will be given at week 6 if the culture of nasal wash is positive for B. pertussis at week 5. Early eradication therapy will be given if a contact volunteer presents with symptoms of early B. pertussis disease. Challenge and contact volunteers will be required to agree to infection control measures prior to enrolment in the study. Part of this agreement will be to refrain from bedroom sharing or intimate contact with any individual other than one declared and consented bedroom contact. They will avoid contact with children or people vulnerable to whooping cough such as unimmunised or partially immunised children and infants aged \< 1 year, and pregnant women.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
72
The B. pertussis isolate to be used in this human colonisation model is strain B1917, which is representative of current isolates in Europe. The strain, isolated in 2000 from a Dutch patient with B. pertussis disease, expresses Pertactin (PRN), Pertussis Toxin (PT) and Filamentous Haemagglutinin (FHA). This strain has been extensively characterised in the mouse model as well as by proteomics and transcriptomics and has a closed genome available. It is fully sensitive to azithromycin in vitro.
A 3 day course of azithromycin will be administered to all colonised volunteers at week 6, or sooner if early pertussis disease is suspected
NIHR Clinical Research Facility
Southampton, Hampshire, United Kingdom
RECRUITINGTo assess the incidence of solicited adverse events during prolonged colonisation with Bordetella pertussis following nasal inoculation of healthy adult volunteers
• Participants will be asked about the occurrence of solicited adverse events at standardised visits. Any symptoms will be recorded and assessed by a study doctor. If deemed necessary by the study doctor further tests will be requested
Time frame: 6 weeks.
To assess the incidence of unsolicited adverse events during prolonged colonisation with Bordetella pertussis following nasal inoculation of healthy adult volunteers
Participants will be asked about the occurrence of unsolicited adverse events at standardised visits. Any symptoms will be recorded and assessed by a study doctor. If deemed necessary by the study doctor further tests will be requested
Time frame: 6 weeks.
To establish the rate of natural clearance of Bordetella pertussis colonisation as detected by nasal wash.
Bordetella pertussis colonisation will be measured weekly by culture of nasal washes. Putative positive cultures will be confirmed by polymerase chain reaction (PCR).
Time frame: 6 weeks.
To establish the rate of natural clearance of Bordetella pertussis colonisation as detected by nasopharyngeal swab
Bordetella pertussis colonisation will be measured weekly by culture of nasopharyngeal swabs. Putative positive cultures will be confirmed by polymerase chain reaction (PCR).
Time frame: 6 weeks.
To establish the change in colonisation density of Bordetella pertussis during prolonged colonisation as measured from nasal wash samples
Bordetella pertussis colonisation density will be measured weekly by culture of nasal washes. Putative positive cultures will be confirmed by polymerase chain reaction (PCR).
Time frame: 6 weeks.
To establish the change in colonisation density of Bordetella pertussis during prolonged colonisation as measured by nasopharyngeal swab samples
Bordetella pertussis colonisation density will be measured weekly by culture of nasopharyngeal swabs. Putative positive cultures will be confirmed by polymerase chain reaction (PCR).
Time frame: 6 weeks.
To establish the occurrence of transmission to close contacts during prolonged Bordetella pertussis colonisation
Bordetella pertussis colonisation density will be measured weekly by culture of nasal washes. Putative positive cultures will be confirmed by polymerase chain reaction (PCR).
Time frame: 6 weeks.
To establish any association between baseline anti-PT IgG level and protection from colonisation with Bordetella pertussis
Anti-PT IgG will be measured in blood at baseline (Day 0)
Time frame: Day 0
To establish any association between baseline anti-PRN IgG level and protection from colonisation with Bordetella pertussis
Anti-PRN IgG will be measured in blood at baseline (Day 0)
Time frame: Day 0
To establish any association between baseline anti-FHA IgG level and protection from colonisation with Bordetella pertussis
Anti-FHA IgG will be measured in blood at baseline (Day 0)
Time frame: Day 0
To establish any association between baseline anti-FIM IgG level and protection from colonisation with Bordetella pertussis
Anti-FIM IgG will be measured in blood at baseline (Day 0)
Time frame: Day 0
To monitor change in anti-PT IgG levels during prolonged colonisation with Bordetella pertussis
Anti-PT IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-PRN IgG levels during prolonged colonisation with Bordetella pertussis
Anti-PRN IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-FHA IgG levels during prolonged colonisation with Bordetella pertussis
Anti-FHA IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-FIM IgG levels during prolonged colonisation with Bordetella pertussis
Anti-FIM IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-PT IgG levels associated with natural clearance of Bordetella pertussis
Anti-PT IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-PRN IgG levels associated with natural clearance of Bordetella pertussis
Anti-PRN IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-FHA IgG levels associated with natural clearance of Bordetella pertussis
Anti-FHA IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
To monitor change in anti-FIM IgG levels associated with natural clearance of Bordetella pertussis
Anti-FIM IgG will be measured in blood at standardised timepoints
Time frame: 6 weeks.
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