Pneumonia Clinical Trial
Official title:
The Effect of Live Attenuated Inactivated Influenza Vaccine on Experimental Human Pneumococcal Carriage Study
The investigators are interested in examining the effect of the Live Attenuated Influenza
(flu) Vaccine (LAIV) upon nasal carriage of bacteria called Streptococcus pneumoniae (also
known as pneumococcus). The nasal spray is a live attenuated vaccine which means that it has
weakened virus that does not cause disease. This vaccine is licenced in the United Kingdom
for children and adolescents from 2 to 18 years of age.
Pneumococcus can commonly be found harmlessly inhabiting the nose where it does not cause any
problem (pneumococcal colonisation). About 10% of adults carry pneumococcus at any one time,
and almost all adults experience an episode of carriage at least once per year. Carriage acts
as a natural vaccine, boosting immunity against pneumococcal infection in adults and
children.
During influenza there is an increase in the burden of pneumococcal pneumonia. We have
studied the effects of pneumococcus for many years and have developed a programme in which we
can nasally inoculate healthy participants with a dose of pneumococcus and achieve a
reproducible carriage rate. The investigators would now like to use this model to investigate
the effects of the nasal influenza vaccine upon pneumococcal carriage and to better
understand how influenza infections lead to increased susceptibility to pneumonia.
Pneumococcal disease in young adults is rare - less than 10 cases per 100,000 people per
year. When pneumococcus does cause problems, usually in young children or elderly people, it
can be very serious as it is responsible for diseases such as pneumonia, sepsis and
meningitis, which kill millions of children around the world each year.
Secondary bacterial infections such as pneumococcal pneumonia are a leading cause of death
during influenza endemics. Individuals recently infected with influenza become more
susceptible to pneumonia, an effect associated with increased density of pneumococcal
carriage in the nose and uncontrolled inflammatory immunological responses. The interaction
of influenza virus and pneumococcus has been known and well documented. Recent works have
shown that the Live Attenuated Influenza Vaccine (LAIV) enhances pneumococcal carriage in
murine models. These results highlighted the potential effect of mass immunization of
children with LAIV on pneumococcal carriage. Increased carriage could lead to increased
pneumococcal disease in LAIV-vaccinated individuals as well as increased bacterial
transmission within the population. LAIV has been licensed for use in children since 2011 in
Europe, and has been increasingly administered in children and adults in the USA. There is an
urgent need for a clinical trial that will determine the effect of LAIV on pneumococcal
carriage dynamics.
The investigators have developed a safe and reproducible experimental human pneumococcal
carriage (EHPC) model. The investigators will use EHPC to define the effect of antecedent and
concurrent LAIV on pneumococcal carriage acquisition, density and duration. The investigators
will perform two double - blinded Randomised Controlled Trials (RCT) to compare LAIV with
Quadrivalent Inactivated Influenza Vaccine (QIV). The investigators will compare clinical
symptoms, pneumococcal carriage density and duration associated with both vaccines
administered antecedent to or concurrently with EHPC inoculation. Changes in the
nasopharyngeal microbiome, inflammatory responses in the nasal mucosal and lung cellular
immunity associated with influenza virus and pneumococcus interaction will be investigated.
This project may provide some reassurance regarding the impact of mass immunization with LAIV
on carriage or, if carriage is increased, will provide knowledge of how a natural carriage
episode might develop into pneumonia in susceptible subjects during pandemic influenza.
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