Safety and immunogenicity of a parenteral trivalent P2-VP8 subunit rotavirus vaccine: a multisite, randomised, double-blind, placebo-controlled trial

• Published in: The Lancet infectious diseases 2020-07, Vol.20 (7), p.851-863
• Main Authors: Groome, Michelle J, Fairlie, Lee, Morrison, Julie, Fix, Alan, Koen, Anthonet, Masenya, Maysseb, Jose, Lisa, Madhi, Shabir A, Page, Nicola, McNeal, Monica, Dally, Len, Cho, Iksung, Power, Maureen, Flores, Jorge, Cryz, Stanley
• Format: Article
• Language: English
• Subjects: Adult; Adults; Age; Antibodies; Antibodies, Neutralizing; Antibody Formation; Antigens; Charities; Child mortality; Child, Preschool; Clinical trials; Dose-Response Relationship, Immunologic; Double-Blind Method; Double-blind studies; Drug dosages; Families & family life; Female; Gestation; HIV; Hospitals; Human immunodeficiency virus; Humans; Immunization; Immunogenicity; Immunogenicity, Vaccine; Immunoglobulin A; Immunoglobulin G; Infant; Infants; Infections; Infectious diseases; Injection; Intestinal obstruction; Laboratories; Low income groups; Male; Malnutrition; Meningitis; Middle Aged; Muscles; Preschool children; Proteins; Randomization; Respiratory tract; Respiratory tract diseases; Rotavirus; Rotavirus - immunology; Rotavirus Vaccines - adverse effects; Rotavirus Vaccines - genetics; Rotavirus Vaccines - immunology; Safety; South Africa; Tetanus; Thigh; United States; Vaccination; Vaccines; Vaccines, Subunit; Viruses; Womens health; Young Adult
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(20)30001-3

A monovalent, parenteral, subunit rotavirus vaccine was well tolerated and immunogenic in adults in the USA and in toddlers and infants in South Africa, but elicited poor responses against heterotypic rotavirus strains. We aimed to evaluate safety and immunogenicity of a trivalent vaccine formulation (P2-VP8-P[4],[6],[8]). A double-blind, randomised, placebo-controlled, dose-escalation, phase 1/2 study was done at three South African research sites. Healthy adults (aged 18–45 years), toddlers (aged 2–3 years), and infants (aged 6–8 weeks, ≥37 weeks' gestation, and without previous receipt of rotavirus vaccination), all without HIV infection, were eligible for enrolment. In the dose-escalation phase, adults and toddlers were randomly assigned in blocks (block size of five) to receive 30 μg or 90 μg of vaccine, or placebo, and infants were randomly assigned in blocks (block size of four) to receive 15 μg, 30 μg, or 90 μg of vaccine, or placebo. In the expanded phase, infants were randomly assigned in a 1:1:1:1 ratio to receive 15 μg, 30 μg, or 90 μg of vaccine, or placebo, in block sizes of four. Participants, parents of participants, and clinical, data, and laboratory staff were masked to treatment assignment. Adults received an intramuscular injection of vaccine or placebo in the deltoid muscle on the day of randomisation (day 0), day 28, and day 56; toddlers received a single injection of vaccine or placebo in the anterolateral thigh on day 0. Infants in both phases received an injection of vaccine or placebo in the anterolateral thigh on days 0, 28, and 56, at approximately 6, 10, and 14 weeks of age. Primary safety endpoints were local and systemic reactions (grade 2 or worse) within 7 days and adverse events and serious adverse events within 28 days after each injection in all participants who received at least one injection. Primary immunogenicity endpoints were analysed in infants in either phase who received all planned injections, had blood samples analysed at the relevant timepoints, and presented no major protocol violations considered to have an effect on the immunogenicity results of the study, and included serum anti-P2-VP8 IgA, IgG, and neutralising antibody geometric mean titres and responses measured 4 weeks after the final injection in vaccine compared with placebo groups. This trial is registered with ClinicalTrials.gov, NCT02646891. Between Feb 15, 2016, and Dec 22, 2017, 30 adults (12 each in the 30 μg and 90 μg groups and six in the pl