Streptococcus Pneumoniae Infection Clinical Trial
Official title:
Effect of 2 Versus 3 Pneumococcal Conjugate Vaccinations Prevnar on Nasopharyngeal Carriage, Transmission and Herd-immunity;a Randomized, Controlled Study
Two( 2) or three (3) instead of four vaccinations before the age of 6 months with pneumococcal conjugate vaccine are presumed to protect children against invasive pneumococcal disease like meningitis, at least on the short term till 18-24 months of age. The current hypothesis in this study is 2 or 3 vaccinations will protect against IPD but will not alter pneumococcal nasopharyngeal carriage in infants, and consequently not change pneumococcal transmission and induce no herd-immunity. Furthermore, antibody development and memory may benefit from carriage of vaccine type S. pneumoniae
Two(2 and 4 months) and three vaccinations (2,4 and 11 months) with 7-valent pneumococcal
conjugate vaccine Prevnar in infants are presumed to provide about 90% protection against
invasive pneumococcal disease (IPD) for vaccine type pneumococci, at least until 18-24
months of age. Licensure of the vaccine however is based on studies with 3 vaccinations
before 6 months and a booster vaccination half a year later (3+1 scheme). Cost-effectiveness
in national infant vaccination programs (NIPs)is much improved by high herd-immunity
effects,as observed in the USA after licensure of Prevnar in 2000, both for IPD and AOM.
However, overall pneumococcal carriage reduction (and nasopharyngeal replacement) has not
been assessed in studies with reduced doses. With reduced carriage reduction, effects on
respiratory tract infections and herd immunity may be significantly less.
The primary aim of the current study is to compare effect of 2-doses (at ages 2 and 4
months) with a 3-doses scheme(2+1, at 2, 4 and 11 months) on nasopharyngeal pneumococcal
carriage and replacement and family transmission(sibs and caregivers), in order to allow
modelling for herd-immunity.
The secondary aim is to determine the effect of a reduced doses scheme on serum
antipneumococcal antibody levels at the age of 12 and 24 months.
A third aim is to determine antipneumococcal antibody levels and memory B-cell development
after booster vaccination at 24 months of age, after 2 or 2+1 doses and compare these with a
first vaccination at 24 months of age.
Opportunities are the determination of nasopharyngeal colonizing pneumococci in unvaccinated
infants in the Netherlands before implementation of Prevnar in the NIP, evaluation of
replacing pneumococci in the nasopharynx after vaccinations and analysis of effects on other
colonizing bacteria like H.influenzae, M. catarrhalis and S.aureus. Furthermore, the
relation between colonizing pneumococci and serotypes causing IPD in the Netherlands can be
evaluated.
Methods : 1000 infants and families will be included in a randomized,controlled study with 3
interventions groups
1. Prevnar at 2 and 4 months
2. Prevnar at 2, 4 and 11 months
3. Prevnar at 24 months (controls)
The children will be followed until 2 years of age with nasopharyngeal swabs for bacterial
culture before the first vaccination, at 6, 12, 18 and 24 months of age. One sibling and one
parent/caregiver will be swabbed when the infant is 12 and 24 months. Blood for antibody
determination will be obtained from 80 children of groups 1 and 2, and from 30 children in
the control group. Questionnaires on health and respiratory infections and antibiotic
prescription for RTI will be obtained.
At 24 months of age, all children of groups 1 and 2 will be offered a booster vaccination.
Antibody levels will be measured before and 4 weeks after this vaccination at 2 years of age
in a subset of 80 children per group and compared with 80 children who received a first
vaccination at 24 months of age.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention
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