This protocol describes a clinical trial to develop and validate a Controlled Human Infection Model (CHIM) for influenza A/Arkansas/08/2020 (pH1N1). The study is designed to determine the optimal infectious dose of the pH1N1 challenge strain for use in future clinical trials evaluating influenza countermeasures. The study will enroll and challenge adult volunteers with the pH1N1 influenza virus challenge or sham inoculations. Given the adaptive design of this trial, the potential number of participants can vary. Depending on the pathway recommended by the PSRT and followed in the Trial Schema, the study population can range from around 30 to 99. The anticipated final sample size will be approximately 90 receiving pH1N1 challenge product plus and 6 persons receiving a sham inoculation. Participants will be pre-screened for health and for serological HAI antibody titers of \</1:40 against the challenge strain. Eligible participants will be enrolled sequentially into challenge cohorts and will be randomly assigned to receive a single dose of either sham inoculation or the interventional study product at a dose between 10\^6 to 10\^7 TCID50 (or 10\^5 TCID50 if needed). Dose titration will be conducted under an adaptive escalation schedule whereby dosing will start at 10\^6 TCID50 and escalate to the next dose if a pre-determined symptomatic influenza attack rate and clinical symptom score thresholds are not met and if the dose is determined to be safe with no pre-defined halting criteria being met. The primary objectives of this study are to determine the optimal infectious dose of a pH1N1 viral challenge to cause laboratory-confirmed clinical influenza and to assess the safety profile of pH1N1 viral challenge.
This protocol describes a clinical trial to develop and validate a Controlled Human Infection Model (CHIM) for influenza A/Arkansas/08/2020 (pH1N1). The study is designed to determine the optimal infectious dose of the pH1N1 challenge strain for use in future clinical trials evaluating influenza countermeasures. The study will enroll and challenge adult volunteers with the pH1N1 influenza virus challenge or sham inoculations. Given the adaptive design of this trial, the potential number of participants can vary. Depending on the pathway recommended by the PSRT and followed in the Trial Schema, the study population can range from around 30 to 99. The anticipated final sample size will be approximately 90 participants receiving pH1N1 challenge product and 6 persons receiving a sham inoculation. Participants will be pre-screened for health and for serological HAI antibody titers of \</=1:40 against the challenge strain. Eligible participants will be enrolled sequentially into challenge cohorts and will be randomly assigned to receive a single dose of either sham inoculation or the interventional study product at a dose between 10\^6 to 10\^7 TCID50 (or 10\^5 TCID50 if needed). Dose titration will be conducted under an adaptive escalation schedule whereby dosing will start at 10\^6 TCID50 and escalate to the next dose if a pre-determined symptomatic influenza attack rate and clinical symptom score thresholds are not met and if the dose is determined to be safe with no pre-defined halting criteria being met. The primary objectives of this study are to determine the optimal infectious dose of a pH1N1 viral challenge to cause laboratory-confirmed clinical influenza and to assess the safety profile of pH1N1 viral challenge. The secondary objectives are to describe clinical symptoms following pH1N1 viral challenge, to describe viral detection by qualitative reverse transcription polymerase chain reaction (RT-PCR) and to describe the host serum influenza hemagglutination inhibition and microneutralization antibody responses.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
QUADRUPLE
Enrollment
90
GMP-grade, cell-based influenza A (pH1N1) virus (Lot #24-005), derived via reverse genetics for use in controlled human infection studies.
Sterile diluent containing 1X Sucrose Phosphate Glutamate (SPG), 1% arginine, and 1% hydrolyzed gelatin, used as a sham comparator in the human challenge trial.
University of Maryland, School of Medicine, Center for Vaccine Development and Global Health
Baltimore, Maryland, United States
RECRUITINGDuke Vaccine and Trials Unit
Durham, North Carolina, United States
RECRUITINGNumber and percentage of participants reporting a related SAE at any time from the time of the first challenge inoculation.
Time frame: Through Day 57
Number and percentage of participants reporting any related AE from the time of the first challenge inoculation.
Time frame: Through Day 29
Number and percentage of participants with symptomatic influenza virus infection.
"Symptomatic influenza virus infection" is defined as meeting both of these criteria: 1. Viral shedding detected in NP swab specimens by qualitative RT-PCR; and 2. A cumulative symptom score \>/=6 using a Modified Jackson Score.
Time frame: Day 2 through Day 6
Number of related adverse events (AE) reported from the time of the first challenge inoculation.
Time frame: Through Day 29
Number of related serious adverse events (SAE) from the time of the first challenge inoculation.
Time frame: Through Day 57
Duration of viral shedding quantified by number of days of qualitative RT-PCR influenza detections in NP swab samples
Using qualitative RT-PCR by dose and study day
Time frame: Day 2 through Day 6
Geometric Mean Fold Rise (GMFR).
Time frame: Day 6 through 29
Geometric Mean Titers (GMTs).
Time frame: Day 6 through 29
HAI and MN antibody geometric mean titers (GMTs) at baseline.
Time frame: Before Day 0
Investigator-assessed clinical symptoms as measured by Modified Jackson Score, post challenge through antiviral administration.
Time frame: Through Day 6
Investigator-assessed clinical symptoms as measured by Modified Jackson Score, post challenge.
By dose, qualitative RT-PCR detection status, and clinical case definition status
Time frame: Through Day 15
Number and percentage of participants with seroconversion by dose.
Seroconversion is defined as a minimum 4-fold rise in serum antibodies
Time frame: Day 6 through 29
Percentage of participants with influenza virus detected in nasopharyngeal (NP) swab sample.
Using qualitative RT-PCR by dose
Time frame: Day 2 through Day 6
Self-reported clinical symptoms as measured by FLU-PRO/Validation Diary, post challenge through antiviral administration.
Time frame: Through Day 6
Self-reported clinical symptoms as measured by FLU-PRO/Validation Diary, post challenge.
By dose, qualitative RT-PCR detection status, and clinical case definition status
Time frame: Through Day 15
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