Safety and Immunogenicity of Hecolin® in Healthy Pregnant Women

Hepatitis E Infection Clinical Trial

Official title:

A Phase II, Randomized, Observer-blinded, Placebo Controlled Trial to Evaluate the Safety and Immunogenicity of Hecolin® in Healthy Pregnant Women Between Gestational Age 14-34 Weeks and Non-Pregnant Women of 16-45 Years Old.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05808166
• Other study ID #: IVI_Hecolin_P001
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: June 2024
• Est. completion date: April 2026

Study information

• Verified date: March 2024
• Source: International Vaccine Institute
• Contact: Katerina Rok Song, M.D.
• Phone: +82-2-881-1228
• Email: katerina.song[@]ivi.int
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a phase II randomized, observer-blinded, placebo-controlled study with 3 arms enrolling a total of 2,358 participants. The arms are composed of Arm 1, pregnant participants receiving Hecolin® (N=1,104) with immunogenicity subset (n=150), Arm 2, pregnant participants receiving placebo (N=1,104) with immunogenicity subset (n=150), and Arm 3, non-pregnant participants receiving Hecolin® (N=150) of which all participants in this arm will be included in the immunogenicity subset.

Description:

Hecolin® is licensed in China and Pakistan indicated to be used for prevention of hepatitis E in healthy adult. The primary goal of this clinical trial is to establish the safety and immunogenicity of Hecolin® during pregnancy. As secondary and exploratory objectives, infant immune response through passive immunization of infants achieved through transplacental transfer of maternal IgG antibodies from the pregnant mother who has received Hecolin® in the second or third trimester will be evaluated. Hecolin® follows a 3-dose schedule (0-1-6 months). For Arm 1 and 2, pregnant participants will receive 2 doses of Hecolin® or placebo at a 4 weeks interval and the third dose will be administered postpartum, approximately 20 weeks after the second dose. The neonates from these Arms will be followed for 24 weeks after birth. For Arm 3, non-pregnant participants will receive Hecolin® at 0-1-6 months schedule. After each dose of IP injection to pregnant/non-pregnant participants, immediate AE (30 minutes post injection), solicited AE (7 days post injection), unsolicited AE (28 days post injection) and AESI/SAE (during the whole study period) will be collected. For the immunogenicity subset, the participants' blood will be drawn before and 4 weeks post each dose of IP injection. At delivery, maternal blood will be drawn. Breast milk samples will be taken at delivery, 6 weeks, and 24 weekss after delivery. All infant AESI/SAE will be collected throughout the study period and developmental assessment will be performed at age of 6 weeks, and 24 weeks. Blood will be drawn from infant immunogenicity subset at the same time points, umbilical cord blood (neonate blood will be collected if cord blood is not available for collection) at delivery, venous blood at age of 6 weeks and 24 weeks.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 2358
• Est. completion date: April 2026
• Est. primary completion date: November 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 16 Years to 45 Years

Eligibility

Inclusion Criteria:

In order to be eligible to participate in this study, a pregnant/non-pregnant woman must meet all of the following criteria:

Pregnant women only:

1. Healthy women 16-45 years of age who are between 14 0/7 and 34 6/7 weeks gestation1 on the day of planned vaccination with an uncomplicated, singleton pregnancy, who are at no known increased risk for complications for herself and her infant.

2. Individual willing to provide written informed consent for herself and her infant to participate in the study.

3. Individual who can be followed up during the study period and can comply with the study requirements.

4. Individual and fetus in good health as determined by the outcome of medical history, physical examination, obstetric history, prenatal care (by ultrasound and other prenatal assessment subject to gestational age), vital signs, laboratory evaluations at screening and the clinical judgment of the investigator.

5. Participants who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

Non-pregnant women only:

1. Healthy women 16-45 years of age.

2. Individual willing to provide written informed consent to participate in the study.

3. Individual who can be followed up during the study period and can comply with the study requirements.

4. Individual in good health as determined by the outcome of medical history, physical examination, vital signs, laboratory evaluations at screening and the clinical judgment of the investigator.

5. Individuals who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

6. Females of childbearing potential with negative urinary pregnancy test on the day of screening.

7. Females of childbearing potential who are using an effective birth control method2 for at least 4 weeks before the screening and up to 4 weeks after the last vaccination. Exclusion Criteria: A pregnant/non-pregnant woman who meets any of the following criteria will be excluded from

participation in this study:

1. Has received any hepatitis E vaccine in the past.

2. Febrile illness (axillary temperature = 38.5°C) or acute illness within 3 days prior to the study vaccination.

3. Known history or allergy to study vaccine components and/or excipients or other medications, or any other allergies or medical history deemed by the investigator to increase the risk of an adverse event if they were to participate in the trial (e.g., Guillain-Barre Syndrome).

4. Major congenital abnormalities which in the opinion of investigator may affect the participant's participation in the study.

5. Known history of immune function disorders including immunodeficiency diseases (known HIV infection or other immune function disorders) and lupus.

6. Chronic use of systemic steroids (>2 mg/kg/day or >20 mg/day prednisone equivalent for periods exceeding 10 days), cytotoxic or other immunosuppressive drugs within past 6 weeks.

7. Any abnormality or chronic disease which in the opinion of the investigator might be detrimental for the safety of the participant and interfere with the assessment of the study objectives.

8. Behavioral or cognitive impairment, or chronic substance abuse, or psychiatric disease or neural disorders, that, in the opinion of the investigator, could interfere with the participant's ability to participate in the trial.

9. History of splenectomy.

10. Past history of thrombocytopenia and/or thrombosis, myocarditis or pericarditis or any other significant cardiac condition.

11. With a known bleeding diathesis, or any condition that may be associated with a prolonged bleeding time resulting in contraindication for IM injections/blood extractions. (Those who receive low dose aspirin (less than 100mg/day) are not excluded)

12. Receipt of blood or blood-derived products in the past 3 months.

13. Receipt of other vaccines from 4 weeks prior to test vaccination or planned to receive any vaccine within 4 weeks of last dose of study vaccine

14. As per Investigator's medical judgement, an individual could be excluded from the study in spite of meeting all inclusion/exclusion criteria mentioned above.

15. Concomitantly enrolled or scheduled to be enrolled in another trial.

16. Research staff involved with the clinical study or family/household members of research staff.

17. Body mass index (BMI) of = 40, at the time of the screening visit.

Pregnant women only:

1. Plans to terminate her pregnancy. Pregnancy complications (in the current pregnancy) such as preterm labor, gestational diabetes, hypertension (blood pressure (BP) > 140/90 in the presence of proteinuria or BP > 150/100 with or without proteinuria), or currently on an antihypertensive therapy, or pre-eclampsia, or evidence of intrauterine growth restriction.

3. Prior stillbirth or neonatal death, or multiple (= 3) spontaneous abortions. 4. Prior preterm delivery = 34 weeks gestation or having ongoing intervention (medical/surgical) in current pregnancy to prevent preterm birth.

5. Previous infant with a known genetic disorder or major congenital anomaly. 6. History of major gynecologic or major abdominal surgery (previous Caesarean section is not an exclusion) 7. Current pregnancy results from in vitro fertilization (IVF). 8. Current pregnancy results from rape or incest. 9. Plans to release the neonate for adoption or the neonate to be a ward of the state.

10. Greater than 5 prior deliveries

Non-pregnant women only:

1. Pregnant or plan to be pregnant during the study period.

Related Conditions & MeSH terms

• Hepatitis
• Hepatitis E
• Hepatitis E Infection

Intervention

Biological:
• Hecolin® (Recombinant Hepatitis E Vaccine (Escherichia coli)).
Hecolin® will be administered 2 doses administered 4 weeks apart during pregnancy and 1 dose administered after delivery at least 20 weeks following the second dose for the pregnant participants (arm 1), and 0, 1 and 6 months for the non-pregnant participant (arm 3).

Other:
• Isotonic Sodium Chloride injection
Placebo will be administered 2 doses administered 4 weeks apart during pregnancy and 1 dose administered after delivery at least 20 weeks following the second dose for the pregnant participants (arm 2)

Locations

Country	Name	City	State
Pakistan	The Aga Khan University	Karachi	Sindh

Sponsors (4)

Lead Sponsor	Collaborator
International Vaccine Institute	Bill and Melinda Gates Foundation, Open Philanthropy, Thrasher Research Fund

Country where clinical trial is conducted

Pakistan, 

References & Publications (46)

Aggarwal R. Clinical presentation of hepatitis E. Virus Res. 2011 Oct;161(1):15-22. doi: 10.1016/j.virusres.2011.03.017. Epub 2011 Mar 31. — View Citation

Aye TT, Uchida T, Ma XZ, Iida F, Shikata T, Zhuang H, Win KM. Complete nucleotide sequence of a hepatitis E virus isolated from the Xinjiang epidemic (1986-1988) of China. Nucleic Acids Res. 1992 Jul 11;20(13):3512. doi: 10.1093/nar/20.13.3512. No abstrac — View Citation

Bendall R, Ellis V, Ijaz S, Ali R, Dalton H. A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries. J Med Virol. 2010 May;82(5):799-805. doi: 10.1002/jmv.21656. — View Citation

Beniwal M, Kumar A, Kar P, Jilani N, Sharma JB. Prevalence and severity of acute viral hepatitis and fulminant hepatitis during pregnancy: a prospective study from north India. Indian J Med Microbiol. 2003 Jul-Sep;21(3):184-5. — View Citation

Berglov A, Hallager S, Weis N. Hepatitis E during pregnancy: Maternal and foetal case-fatality rates and adverse outcomes-A systematic review. J Viral Hepat. 2019 Nov;26(11):1240-1248. doi: 10.1111/jvh.13129. Epub 2019 Jun 14. — View Citation

Bigna JJ, Modiyinji AF, Nansseu JR, Amougou MA, Nola M, Kenmoe S, Temfack E, Njouom R. Burden of hepatitis E virus infection in pregnancy and maternofoetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020 Jul 28;20(1):426. d — View Citation

Bonhoeffer J, Kochhar S, Hirschfeld S, Heath PT, Jones CE, Bauwens J, Honrado A, Heininger U, Munoz FM, Eckert L, Steinhoff M, Black S, Padula M, Sturkenboom M, Buttery J, Pless R, Zuber P; GAIA project participants. Global alignment of immunization safet — View Citation

Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepatogastroenterol. 2016 Jan-Jun;6(1):70-81. doi: 10.5005/jp-journals-10018-1172. Epub 2016 Jul 9. — View Citation

Fulton TR, Narayanan D, Bonhoeffer J, Ortiz JR, Lambach P, Omer SB. A systematic review of adverse events following immunization during pregnancy and the newborn period. Vaccine. 2015 Nov 25;33(47):6453-65. doi: 10.1016/j.vaccine.2015.08.043. Epub 2015 Se — View Citation

Gouilly J, Chen Q, Siewiera J, Cartron G, Levy C, Dubois M, Al-Daccak R, Izopet J, Jabrane-Ferrat N, El Costa H. Genotype specific pathogenicity of hepatitis E virus at the human maternal-fetal interface. Nat Commun. 2018 Nov 12;9(1):4748. doi: 10.1038/s4 — View Citation

Gurley ES, Halder AK, Streatfield PK, Sazzad HM, Huda TM, Hossain MJ, Luby SP. Estimating the burden of maternal and neonatal deaths associated with jaundice in Bangladesh: possible role of hepatitis E infection. Am J Public Health. 2012 Dec;102(12):2248- — View Citation

Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, Peppelenbosch MP, Pan Q. The global burden of hepatitis E outbreaks: a systematic review. Liver Int. 2017 Jan;37(1):19-31. doi: 10.1111/liv.13237. Epub 2016 Sep 9. — View Citation

Holla RP, Ahmad I, Ahmad Z, Jameel S. Molecular virology of hepatitis E virus. Semin Liver Dis. 2013 Feb;33(1):3-14. doi: 10.1055/s-0033-1338110. Epub 2013 Apr 5. — View Citation

Iqbal M, Ahmed A, Qamar A, Dixon K, Duncan JF, Islam NU, Rauf A, Bryan JP, Malik IA, Legters LJ. An outbreak of enterically transmitted non-A, non-B hepatitis in Pakistan. Am J Trop Med Hyg. 1989 Apr;40(4):438-43. doi: 10.4269/ajtmh.1989.40.438. — View Citation

Jilani N, Das BC, Husain SA, Baweja UK, Chattopadhya D, Gupta RK, Sardana S, Kar P. Hepatitis E virus infection and fulminant hepatic failure during pregnancy. J Gastroenterol Hepatol. 2007 May;22(5):676-82. doi: 10.1111/j.1440-1746.2007.04913.x. — View Citation

Jin H, Zhao Y, Zhang X, Wang B, Liu P. Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis. Epidemiol Infect. 2016 Jul;144(10):2098-106. doi: 10.1017/S0950268816000418. Epub 2016 Mar 4. — View Citation

Jones CE, Munoz FM, Kochhar S, Vergnano S, Cutland CL, Steinhoff M, Black S, Heininger U, Bonhoeffer J, Heath PT. Guidance for the collection of case report form variables to assess safety in clinical trials of vaccines in pregnancy. Vaccine. 2016 Dec 1;3 — View Citation

Kamar N, Lhomme S, Abravanel F, Cointault O, Esposito L, Cardeau-Desangles I, Del Bello A, Dorr G, Lavayssiere L, Nogier MB, Guitard J, Ribes D, Goin AL, Broue P, Metsu D, Saune K, Rostaing L, Izopet J. An Early Viral Response Predicts the Virological Res — View Citation

Khuroo MS, Kamili S, Khuroo MS. Clinical course and duration of viremia in vertically transmitted hepatitis E virus (HEV) infection in babies born to HEV-infected mothers. J Viral Hepat. 2009 Jul;16(7):519-23. doi: 10.1111/j.1365-2893.2009.01101.x. Epub 2 — View Citation

Khuroo MS, Kamili S. Aetiology, clinical course and outcome of sporadic acute viral hepatitis in pregnancy. J Viral Hepat. 2003 Jan;10(1):61-9. doi: 10.1046/j.1365-2893.2003.00398.x. — View Citation

Khuroo MS. Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India. Viruses. 2021 Jul 9;13(7):1329. doi: 10.3390/v13071329. — View Citation

Krain LJ, Atwell JE, Nelson KE, Labrique AB. Fetal and neonatal health consequences of vertically transmitted hepatitis E virus infection. Am J Trop Med Hyg. 2014 Feb;90(2):365-70. doi: 10.4269/ajtmh.13-0265. Epub 2014 Jan 13. — View Citation

Kumar RM, Uduman S, Rana S, Kochiyil JK, Usmani A, Thomas L. Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates. Eur J Obstet Gynecol Reprod Biol. 2001 Dec 10;100(1):9-15. doi: 10.1016/s — View Citation

Labrique AB, Sikder SS, Krain LJ, West KP Jr, Christian P, Rashid M, Nelson KE. Hepatitis E, a vaccine-preventable cause of maternal deaths. Emerg Infect Dis. 2012 Sep;18(9):1401-4. doi: 10.3201/eid1809.120241. — View Citation

Li SW, Zhang J, He ZQ, Gu Y, Liu RS, Lin J, Chen YX, Ng MH, Xia NS. Mutational analysis of essential interactions involved in the assembly of hepatitis E virus capsid. J Biol Chem. 2005 Feb 4;280(5):3400-6. doi: 10.1074/jbc.M410361200. Epub 2004 Nov 22. — View Citation

Li SW, Zhang J, Li YM, Ou SH, Huang GY, He ZQ, Ge SX, Xian YL, Pang SQ, Ng MH, Xia NS. A bacterially expressed particulate hepatitis E vaccine: antigenicity, immunogenicity and protectivity on primates. Vaccine. 2005 Apr 22;23(22):2893-901. doi: 10.1016/j — View Citation

Madhi SA, Polack FP, Piedra PA, Munoz FM, Trenholme AA, Simoes EAF, Swamy GK, Agrawal S, Ahmed K, August A, Baqui AH, Calvert A, Chen J, Cho I, Cotton MF, Cutland CL, Englund JA, Fix A, Gonik B, Hammitt L, Heath PT, de Jesus JN, Jones CE, Khalil A, Kimber — View Citation

Medhat A, el-Sharkawy MM, Shaaban MM, Makhlouf MM, Ghaneima SE. Acute viral hepatitis in pregnancy. Int J Gynaecol Obstet. 1993 Jan;40(1):25-31. doi: 10.1016/0020-7292(93)90768-r. — View Citation

Mori Y, Matsuura Y. Structure of hepatitis E viral particle. Virus Res. 2011 Oct;161(1):59-64. doi: 10.1016/j.virusres.2011.03.015. Epub 2011 Apr 1. — View Citation

Nelson KE, Heaney CD, Labrique AB, Kmush BL, Krain LJ. Hepatitis E: prevention and treatment. Curr Opin Infect Dis. 2016 Oct;29(5):478-85. doi: 10.1097/QCO.0000000000000294. — View Citation

Pathirana J, Munoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, Pool V, Pourmalek F, Varricchio F, Kochhar S, Cutland CL; Brighton Collaboration Neonatal Death Working Group. Neonatal death: Case definit — View Citation

Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007 Jul 3;147(1):28-33. doi: 10.7326/0003-4819-147-1-200707030-00005. — View Citation

Puri M, Patra S, Singh P, Malhotra N, Trivedi SS, Sharma S, Kumar A, Sarin SK. Factors influencing occurrence of postpartum haemorrhage in pregnant women with hepatitis E infection and deranged coagulation profile. Obstet Med. 2011 Sep;4(3):108-12. doi: 1 — View Citation

Qiao YL, Wu T, Li RC, Hu YM, Wei LH, Li CG, Chen W, Huang SJ, Zhao FH, Li MQ, Pan QJ, Zhang X, Li Q, Hong Y, Zhao C, Zhang WH, Li YP, Chu K, Li M, Jiang YF, Li J, Zhao H, Lin ZJ, Cui XL, Liu WY, Li CH, Guo DP, Ke LD, Wu X, Tang J, Gao GQ, Li BY, Zhao B, Z — View Citation

Ratho RK, Thakur V, Arya S, Singh MP, Suri V, Das A. Placenta as a site of HEV replication and inflammatory cytokines modulating the immunopathogenesis of HEV in pregnant women. J Med Virol. 2022 Jul;94(7):3457-3463. doi: 10.1002/jmv.27699. Epub 2022 Mar — View Citation

Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012 Apr;55(4):988-97. doi: 10.1002/hep.25505. — View Citation

Scott RM, Kmush BL, Norkye K, Hada M, Shrestha MP, Vaughn DW, Myint KSA, Endy TP, Shrestha SK, Innis BL. Historical Analysis of the Risk of Hepatitis E and Its Complications in Pregnant Women in Nepal, 1996-1998. Am J Trop Med Hyg. 2021 Jun 14;105(2):440- — View Citation

Sharma S, Kumar A, Kar P, Agarwal S, Ramji S, Husain SA, Prasad S, Sharma S. Risk factors for vertical transmission of hepatitis E virus infection. J Viral Hepat. 2017 Nov;24(11):1067-1075. doi: 10.1111/jvh.12730. Epub 2017 Jul 12. — View Citation

Stout MJ, Busam R, Macones GA, Tuuli MG. Spontaneous and indicated preterm birth subtypes: interobserver agreement and accuracy of classification. Am J Obstet Gynecol. 2014 Nov;211(5):530.e1-4. doi: 10.1016/j.ajog.2014.05.023. Epub 2014 May 17. — View Citation

Tavares Da Silva F, Gonik B, McMillan M, Keech C, Dellicour S, Bhange S, Tila M, Harper DM, Woods C, Kawai AT, Kochhar S, Munoz FM; Brighton Collaboration Stillbirth Working Group. Stillbirth: Case definition and guidelines for data collection, analysis, — View Citation

Wei M, Zhang X, Yu H, Tang ZM, Wang K, Li Z, Zheng Z, Li S, Zhang J, Xia N, Zhao Q. Bacteria expressed hepatitis E virus capsid proteins maintain virion-like epitopes. Vaccine. 2014 May 19;32(24):2859-65. doi: 10.1016/j.vaccine.2014.02.025. Epub 2014 Mar — View Citation

Wu T, Zhu FC, Huang SJ, Zhang XF, Wang ZZ, Zhang J, Xia NS. Safety of the hepatitis E vaccine for pregnant women: a preliminary analysis. Hepatology. 2012 Jun;55(6):2038. doi: 10.1002/hep.25522. No abstract available. — View Citation

Zaman K, Dudman S, Stene-Johansen K, Qadri F, Yunus M, Sandbu S, Gurley ES, Overbo J, Julin CH, Dembinski JL, Nahar Q, Rahman A, Bhuiyan TR, Rahman M, Haque W, Khan J, Aziz A, Khanam M, Streatfield PK, Clemens JD. HEV study protocol : design of a cluster- — View Citation

Zhang J, Liu CB, Li RC, Li YM, Zheng YJ, Li YP, Luo D, Pan BB, Nong Y, Ge SX, Xiong JH, Shih JW, Ng MH, Xia NS. Randomized-controlled phase II clinical trial of a bacterially expressed recombinant hepatitis E vaccine. Vaccine. 2009 Mar 13;27(12):1869-74. — View Citation

Zhang J, Zhang XF, Huang SJ, Wu T, Hu YM, Wang ZZ, Wang H, Jiang HM, Wang YJ, Yan Q, Guo M, Liu XH, Li JX, Yang CL, Tang Q, Jiang RJ, Pan HR, Li YM, Shih JW, Ng MH, Zhu FC, Xia NS. Long-term efficacy of a hepatitis E vaccine. N Engl J Med. 2015 Mar 5;372( — View Citation

Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ, Wang H, Yang CL, Jiang HM, Cai JP, Wang YJ, Ai X, Hu YM, Tang Q, Yao X, Yan Q, Xian YL, Wu T, Li YM, Miao J, Ng MH, Shih JW, Xia NS. Efficacy and safety of a recombinant hepatitis E vaccine in healthy — View Citation

* Note: There are 46 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Proportion of vaginal delivery, elective cesarian section and emergency cesarian section in pregnant participants.		throughout the study
Other	Immunogenicity in neonate/infant participants	GMC of anti-HEV IgG in neonates/infants at delivery and age of 6 weeks and 6 months.; Anti-HEV IgG Subclass	at delivery, infant age of 6 weeks and 6 months
Other	Immunogenicity in maternal blood and umbilical cord at delivery	GMC of anti-HEV IgG in maternal blood and umbilical cord at the time of delivery; Anti-HEV IgG Subclass	at time of delivery
Other	Immunogenicity in breastmilk	GMC of anti-HEV IgG in breastmilk at delivery and postpartum 6 weeks and 6 months.; Anti-HEV IgG Subclass	at delivery, 6 weeks and 6 months post partum
Other	Counts and proportion of laboratory confirmed Hepatitis E among pregnant recipients of Hecolin® and placebo and their infants during pregnancy and 6 months after birth.		throughout the study period, approximately 24 months
Other	Safety in seropositive and seronegative pregnant participants at baseline	Proportion of pregnancy-related AESI from the vaccination throughout the entire study in pregnant participants by serostatus.; Proportion of SAE from the vaccination throughout the entire study in pregnant by serostatus.	throughout the study period, approximately 24 months
Other	Immunogenicity in seropositive and seronegative pregnant and non-pregnant participants	GMC of anti-HEV IgG at 4 weeks post third dose of Hecolin® (2 doses in pregnancy and 1 dose after delivery) in pregnant and non-pregnant participants depending on serostatus.	4 weeks post third dose of vaccination.
Primary	Proportion of pregnancy-related AESI and SAE from vaccination in pregnant participant.	Proportion of pregnancy-related AESI from the vaccination throughout the entire study in pregnant participants.; Proportion of SAE from the vaccination throughout the entire study in pregnant participants.	Throughout the study period, approximately 24 months.
Primary	Immunogenicity in pregnant and non-pregnant participants	GMC of anti-HEV IgG at 4 weeks post second dose of Hecolin® administered 4 weeks apart in pregnant women and non-pregnant women.	4 weeks post second dose of Hecolin®
Secondary	Proportion of AESIs and SAE in neonate/infant participants.	Proportion of neonatal/infant AESIs.; Proportion of SAE through the 6 months of life in neonate/infant.	6 months of life in neonate/infant
Secondary	Proportion of immediate adverse events in pregnant and non-pregnant participants	Proportion of immediate adverse events within 30 minutes post each dose of vaccination in pregnant and non-pregnant participants.	Within 30 minutes post each dose of vaccination.
Secondary	Proportion of Solicited local and system adverse events in pregnant and non-pregnant participants	Proportion of solicited local and systemic adverse events within 7 days post each dose of vaccination in pregnant and non-pregnant participants.	Within 7 days post each dose of vaccination.
Secondary	Proportion of unsolicited adverse events in pregnant and non-pregnant participants	Proportion of unsolicited adverse events within 28 days post each dose of vaccination in pregnant and non-pregnant participants.	Within 28 days post each dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post second dose of Hecolin® administered 4 weeks apart in pregnant and non-pregnant participants.	4 weeks post second dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	GMC of anti-HEV IgG at 4 weeks post third dose of Hecolin® (2 doses in pregnancy and 1 dose after delivery) in pregnant and non-pregnant participants.	4 weeks post third dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post third dose of Hecolin® (2 doses in pregnancy and 1 dose after delivery) in pregnant and non-pregnant participants.	4 weeks post third dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	GMC of anti-HEV IgG at 4 weeks post first dose of Hecolin® in pregnant and non-pregnant participants.	4 weeks post first dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post first dose of Hecolin® in pregnant and non-pregnant participants.	4 weeks post first dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	GMC of anti-HEV IgG at 4 weeks post second dose of Hecolin® in pregnant participants of GA 14-27 weeks (second trimester) and 28-34 weeks (third trimester) and non-pregnant participants as measured by anti HEV IgG ELISA.	4 weeks post second dose of vaccination.
Secondary	Immunogenicity in pregnant and non-pregnant participants	SCR (antibody response greater than four times or more increase of anti-HEV IgG in paired sera) at 4 weeks post second dose of Hecolin® in pregnant participants of GA 14-27 weeks (second trimester) and 28-34 weeks (third trimester) and non-pregnant participants.	4 weeks post second dose of vaccination.