This Phase 3 open-label study aims to assess the safety and immune response of the MVA-BN mpox vaccine when administered subcutaneously to pregnant and postpartum women in the Democratic Republic of the Congo (DRC), a population at high risk of mpox infection. The study will be conducted in Boende, Tshuapa Province, DRC. A total of 359 maternal participants, aged 16 to 35 and in their second or third trimester of pregnancy, will be enrolled. Participants will be randomly assigned to receive two subcutaneous doses of the MVA-BN vaccine, given 28 days apart, either during pregnancy (Maternal Group 1) or within 72 hours after delivery (Maternal Group 2). Additionally, pregnant women in any trimester who have been recently exposed to a confirmed mpox case will be enrolled in the post-exposure prophylaxis (PEP) arm (Maternal Group 3), receiving the vaccine as soon as possible after exposure-ideally within four days but up to 14 days if they remain asymptomatic. The study will evaluate the safety, reactogenicity, and immune responses of vaccinated pregnant women compared to healthy adults in the POX-MVA-045 study (NCT06549530) through non-inferiority analyses. Participants will be monitored for immunogenicity and safety for 13 months post-delivery, while neonates will be observed for safety over the same period. The trial will also compare outcomes between women vaccinated during pregnancy and those vaccinated postpartum, assess the transfer of maternal immunity to neonates, and explore correlations between maternal antibody levels in serum and breast milk. This study seeks to provide strong evidence supporting the safety and immunogenicity of the MVA-BN mpox vaccine in pregnancy, contributing to global public health efforts to protect at-risk women and their infants in mpox-endemic regions.
This open-label, Phase 3 study aims to evaluate the immunogenicity and safety of the MVA-BN standard regimen (1x10⁸ TCID50 Inf.U./0.5mL) administered subcutaneously in two doses, 28 days apart, to pregnant women and women in the immediate postpartum period (\<72 hours after delivery). As described in the study protocol, the main study consists of the vaccination and safety and immunogenicity follow-up of pregnant and postpartum women. A sub-study will evaluate the transmission of antibodies from mother to child either during pregnancy of via breast milk. The trial plans to enrol 359 participants, aged 16 to 35 years, with a gestational age between 13 and 32 weeks. Participants will be randomised into three groups: Maternal Group 1 (N=215), vaccinated during pregnancy; Maternal Group 2 (N=144), vaccinated within 72 hours postpartum; and Maternal Group 3 (N=convenience sampling), which includes pregnant women exposed to a confirmed mpox case within the past 14 days but who remain asymptomatic and will be offered post-exposure prophylaxis (PEP). The study will be conducted at the General Reference Hospital of Boende, located in Boende, Tshuapa Province, Democratic Republic of Congo (DRC), with two satellite sites (Motema Mosantu and Marie-Louise Health Centres) supporting maternal delivery, vaccination for Maternal Group 2, and immediate postpartum sample collection, where applicable. During the screening visit (SCR), interested participants will undergo an evaluation (test of understanding) to ensure understanding of the study and provide informed consent (or assent for minors). Demographics, vaccination history, and medical history will be recorded. Participants' general health will be evaluated through a physical examination, urine testing, and a gynaecological ultrasound to confirm gestational age. Blood samples will be collected for haematology, biochemistry, and infection screening for HIV, hepatitis B, syphilis, and malaria. After enrolling participants will be randomised to Maternal Group 1 or Maternal Group 2, unless they have been exposed to mpox in the past 14 days, then they will enrolled in Maternal group 3. All AEs, including serious adverse events (SAEs), medically attended adverse events (MAAEs), and adverse events of special interest (AESIs), will be monitored from enrolment until 13 months after delivery. The prenatal visits (PN) are scheduled according to gestational age: PN Visit 1 (15-18 weeks), PN Visit 2 (24-28 weeks), PN Visit 3 (28-32 weeks), and PN Visit 4 (36-38 weeks). The number of visits will depend on the participant's enrolment date. Where feasible and applicable, prenatal visits will be combined with screening and/or vaccination visits. At each visit, vital signs and anthropometric measurements (weight, height, and fundal height) will be recorded to monitor maternal health and foetal growth. Urinary tests for infections will be performed at each visit, and a glucose challenge test (GCT) at 24-28 weeks will screen for gestational diabetes. Ultrasounds will also be performed as needed to evaluate gestational health. All participants will receive Intermittent Preventive Treatment for malaria (IPTp) according to WHO guidelines, with doses spaced at least one month apart. On Day 0, participants' vital signs (blood pressure, heart rate, respiratory rate, and temperature) will be assessed. Blood samples will be collected from mothers to establish baseline immunogenicity, including neutralising antibodies (PRNTs), total binding antibodies (ELISA), and IgG binding antibodies (LUMINEX assay) against vaccinia and mpox viruses. To minimise inconvenience and where possible and applicable, samples for haematology and biochemistry will be collected simultaneously. Afterwards, participants will receive their first dose of the MVA-BN vaccine and a participant journal to record any solicited or unsolicited adverse events (AEs). Seven days after the first vaccine dose (Day 0), the participant will be asked to return with the journal to record data on solicited AEs and unsolicited AEs (UAEs). Ongoing solicited AEs at this visit will be followed up until resolution and UAEs will be followed up until 28 days post-vaccination and inquired about before the second vaccine dose. On Day 28, physical examinations of the mother will be conducted. Participants will receive the second MVA-BN vaccine dose, and blood samples will be collected from mothers to measure neutralising antibodies (PRNTs), total binding antibodies (ELISA), and IgG binding antibodies (LUMINEX assay). Participants will also receive a second participant journal to record any AEs. Seven days after the first vaccine dose (Day 35), the participant will be asked to return with the journal to record data on solicited AEs and unsolicited AEs (UAEs). Ongoing solicited AEs at this visit will be followed up until resolution and UAEs will be followed up until 28 days post-vaccination during a telephone or home visit on Day 56. On Day 42, blood samples will be collected from mothers to evaluate the persistence of vaccine-induced antibodies. On Day 56, ongoing solicited AEs will be followed up and any ongoing or new UAEs be assessed/followed up via telephone or home visit. On delivery day (Dd), a cord blood sample will be collected to measure neutralising antibodies (PRNTs), total binding antibodies (ELISA), and IgG binding antibodies (LUMINEX assay). Within 72 hours postpartum, colostrum (breast milk) samples will be collected to measure IgA antibody levels using the LUMINEX assay, reflecting maternal immunity transfer through breastfeeding. Physical examinations of both the mother and neonate will be conducted. Neonatal assessments will include APGAR scores at 1 and 5 minutes, general appearance, measurements (weight, length, and head circumference), and reflexes. Maternal assessments will focus on recovery and any postpartum complications. Maternal Group 2 will be vaccinated within 72 hours postpartum with the first MVA-BN dose, this will be Day 0 for this Group. All other visits from Day 0-Day 56 will take place for this group as described above. The Day 42 visit corresponds with the 6 week post-partum visit. Activities for both visits will be combined in to one visit. Post-delivery visits will occur at 6 weeks, 12 weeks, 6 months and 13 months post delivery for all participants. Mothers and neonates will undergo follow-up assessments, including physical examinations of neonates to evaluate growth and developmental milestones. Blood samples will be collected from mothers at each visit to monitor the durability of vaccine-induced antibodies. Additionally, breast milk samples will be collected on at 6 weeks, 12 weeks, 6 months and 13 months post delivery to evaluate IgA binding antibody levels. At 6 weeks and 12 weeks postpartum visits, IgG binding antibodies in breast milk will also be determined. Blood samples from neonates will be collected on at 6 weeks, 12 weeks and 6 months after birth to assess neutralising antibodies (PRNTs), total binding antibodies (ELISA), and IgG binding antibodies (LUMINEX assay).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
359
The MVA-BN vaccine, with the active ingredient: Modified Vaccinia Ankara-Bavarian Nordic, will be administered as a standard two-dose regimen at 1x10\^8 TCID50 Inf.U./0.5 mL. The doses will be given 28 days apart (±3 days) via subcutaneous injection into the deltoid muscle, preferably in the non-dominant arm.
MVA-BN. Post Exposure Prophylaxis (PEP) The MVA-BN vaccine, with the active ingredient: Modified Vaccinia Ankara-Bavarian Nordic, will be administered as a standard two-dose regimen at 1x10\^8 TCID50 Inf.U./0.5 mL. The doses will be given 28 days apart (±3 days) via subcutaneous injection into the deltoid muscle, preferably in the non-dominant arm. For Maternal Group 3, MVA-Bn will be administered as PEP as soon as possible after exposure, preferably within 4 days after exposure. However, as per WHO guidelines, PEP will be offered up to 14 days after exposure if the pregnant woman has not yet developed symptoms.
Boende Hôpital Général de Référence
Boende, Province de La Tshuapa, Democratic Republic of the Congo
Main study: Neutralising antibody response post-dose 2 vaccination with MVA-BN
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting neutralising antibodies against the vaccinia virus in women vaccinated during pregnancy compared to adults of the POX-MVA-045 study at 2 weeks after the second dose.
Time frame: 14 days after the second dose
Safety and reactogenicity of the MVA-BN vaccine in pregnant women
To assess the safety and reactogenicity of the MVA-BN standard regimen, administered SC, in pregnant women compared to adults of the POX-MVA-045 study.
Time frame: Throughout the trial period; from first vaccination to 13 months postpartum.
Neonatal/infant safety outcomes in offspring of vaccinated mothers
To assess the safety in neonates/infants born to mothers vaccinated during pregnancy and mothers vaccinated postpartum.
Time frame: Throughout the trial period; from delivery to 13 months postpartum.
Maternal, fetal, and neonatal outcomes in vaccinated women
To describe maternal, foetal and neonatal outcomes in the cohort vaccinated during pregnancy, compared to the cohort vaccinated postpartum (control) and, if possible, the outcomes of pregnancy surveillance in Boende for the duration of the study.
Time frame: From vaccination to 13 months postpartum
Sub-study. Maternal immunity transferred via breastmilk
To assess immunogenicity in infants at birth by measuring the amount of total binding antibodies against the vaccinia virus, neutralising antibodies against the vaccinia virus, IgG binding antibodies against the vaccinia and mpox viruses in cord blood from women vaccinated during pregnancy compared to women vaccinated in the postpartum.
Time frame: At delivery
Immunogenicity in maternal serum post-vaccination
To assess the immunogenicity in mothers of the MVA-BN standard regimen, administered SC, in eliciting IgG binding antibodies against vaccinia and monkeypox virus in maternal blood from women vaccinated during pregnancy compared to women vaccinated in the postpartum at baseline (prior to vaccination), 2 weeks after the second dose, at delivery (when not the same as baseline), and at 6 weeks, 12 weeks, 6 months, and 13 months postpartum.
Time frame: Baseline to 13 months postpartum
Maternal immunity transferred via breastmilk (IgA antibodies)
To assess maternal immunity transferred via breastmilk by measuring IgA binding antibodies against vaccinia and monkeypox virus in breastmilk samples from women vaccinated during pregnancy compared to women vaccinated in the postpartum period in colostrum, at 6 weeks, 12 weeks, 6 months and 13 months postpartum.
Time frame: Delivery to 13 months postpartum
Maternal immunity transferred via breastmilk (IgG antibodies)
To assess maternal immunity transferred via breastmilk by measuring IgG binding antibodies against vaccinia and monkeypox virus in breastmilk samples from women vaccinated during pregnancy compared to women vaccinated in the postpartum period at 6 weeks and 12 weeks postpartum.
Time frame: 6 weeks and 12 weeks postpartum
Persistence of maternal immunity in infants
To assess persistence of maternal immunity in infants by measuring neutralising antibodies against the vaccinia virus, total binding antibodies against the vaccinia virus, IgG binding antibodies against vaccinia and monkeypox viruses in the infant's blood born from women vaccinated during pregnancy compared to women vaccinated in the postpartum at 6 weeks, 12 weeks, and 6 months postpartum.
Time frame: 6 weeks to 6 months postpartum
Neutralising antibody response in women vaccinated during pregnancy and adult of the POX-MVA-045 study
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting neutralising antibodies against the vaccinia virus in women vaccinated during pregnancy compared to adults of the POX-MVA-045 study at baseline and all blood collection time points after the second dose.
Time frame: Baseline to 13 months postpartum
Neutralising antibody response in women vaccinated in the immediate postpartum and adult of the POX-MVA-045 study
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting neutralising antibodies against the vaccinia virus in women vaccinated in the immediate postpartum period compared to adults of the POX-MVA-045 study at baseline and all blood collection time points after the second dose.
Time frame: Delivery to 13 months postpartum
Neutralising antibody response in women vaccinated during pregnancy and women vaccinated in the immediate postpartum
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting neutralising antibodies against the vaccinia virus in women vaccinated during pregnancy compared to women vaccinated in the postpartum, at baseline, 6 weeks, 12 weeks, 6 months and 13 months after delivery.
Time frame: Baseline to 13 months postpartum
Binding antibody reponse in women vaccinated during pregnancy and adults of the POX-MVA-045 study
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting total binding antibodies against the vaccinia virus in women vaccinated during pregnancy compared to adults of the POX-MVA-045 study at baseline and all blood collection time points after the second dose.
Time frame: Baseline to 13 months postpartum
Binding antibody reponse in women vaccinated in the immediate postpartum period and adults of the POX-MVA-045 study
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting total binding antibodies against the vaccinia virus in women vaccinated in the immediate postpartum period compared to adults of the POX-MVA-045 study at baseline and all blood collection time points after the second dose.
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Time frame: Throughout the trial period; from first vaccination to 13 months postpartum
Binding antibody reponse in women vaccinated during pregnancy and women vaccinated in the immediate postpartum
To assess the immunogenicity of the MVA-BN standard regimen, administered SC, in eliciting total binding antibodies against the vaccinia virus in women vaccinated during pregnancy compared to women vaccinated in the immediate postpartum period, at baseline, 2 weeks after the second dose, delivery, 6 weeks (if different from 2 weeks after the second dose), 12 weeks, 6 months and 13 months after delivery.
Time frame: Delivery to 13 months postpartum
Safety and reactogenicity of the MVA-BN in women vaccinated in the immediate postpartum and adults of the POX-MVA-045 study
To assess the safety and reactogenicity of the MVA-BN standard regimen administered to women in the immediate postpartum compared to adults (POX-MVA-045).
Time frame: Throughout the trial period; from first vaccination to 13 months postpartum.
Safety and reactogenicity of the MVA-BN in women vaccinated during pregnancy and women vaccinated in the immediate postpartum
To assess the safety and reactogenicity of the MVA-BN standard regimen administered in pregnant women compared to women in the immediate postpartum period.
Time frame: Throughout the trial period; from enrolment to 1 year after second dose
Correlation between maternal IgG in serum and IgA antibody levels in breastmilk
To explore whether there is a correlation between maternal IgG antibody levels against the vaccinia and mpox virus in serum and maternal IgA antibody levels against the vaccinia and mpox virus in breastmilk of women vaccinated during pregnancy or women vaccinated in the postpartum at delivery and at 6 weeks, 12 weeks, and 6 months, 13 months postpartum.
Time frame: From delivery to 13 months postpartum
Correlation between maternal IgG antibody levels in serum and breastmilk in the first 12 weeks postpartum
To explore whether there is a correlation between maternal IgG antibody levels against the vaccinia and mpox virus in serum and breastmilk of women vaccinated during pregnancy or women vaccinated in the postpartum at 6 and 12 weeks postpartum.
Time frame: 6 weeks and 12 weeks postpartum
Correlation between maternal IgA and IgG antibody levels in breastmilk
To explore whether there is a correlation of maternal IgA and IgG antibodies against the vaccinia and mpox virus in breastmilk in women vaccinated during pregnancy or women vaccinated in the postpartum at 6 weeks and 12 weeks.
Time frame: Baseline to 13 months postpartum