Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03930017
Other study ID # R01ES026973
Secondary ID
Status Completed
Phase
First received
Last updated
Start date October 14, 2018
Est. completion date January 6, 2020

Study information

Verified date January 2023
Source Johns Hopkins Bloomberg School of Public Health
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

As the global availability of vaccines increases, and reaches areas disproportionately affected by arsenic and malnutrition, resolving questions about potential environmental and biologic barriers to maternal immunization has become increasingly urgent. It is not known whether arsenic, a known developmental toxicant, can alter maternal immune responses to vaccination and whether exposure to arsenic during pregnancy can impair the transfer of maternal vaccine-induced antibody to the newborn. Moreover, factors known to affect arsenic metabolism and toxicity outcomes, particularly micronutrients critical in one-carbon metabolism, have not been evaluated in studies of arsenic immunotoxicity and vaccine-induced protection in mothers and their newborns. The objective in this study is to investigate whether maternal arsenic exposure and one-carbon metabolism micronutrient deficiencies alter maternal and newborn measures of vaccine-induced protection, respiratory morbidity, and systemic immune function following influenza vaccination during pregnancy.


Description:

The objective in this study is to investigate whether maternal arsenic exposure and one-carbon metabolism micronutrient deficiencies alter maternal and newborn measures of vaccine-induced protection, respiratory morbidity, and systemic immune function following influenza vaccination during pregnancy. The hypothesis is that maternal arsenic exposure and one-carbon metabolism micronutrient deficiencies alter maternal and newborn influenza antibody titer and avidity, respiratory infection morbidity, and markers of systemic immune function following maternal influenza vaccination during pregnancy. This study leverages a comprehensive pregnancy surveillance system at the JiVitA Maternal and Child Health and Nutrition Research Project site in Bangladesh (hereafter JiVitA) to pursue the following three aims: Aim 1. Establish whether arsenic exposure during pregnancy alters maternal and newborn influenza antibody titer and avidity following maternal influenza vaccination. Aim 2. Determine whether markers of systemic immune function mediate the association between arsenic exposure and respiratory illness in pregnant women and their newborns. Aim 3. Assess whether arsenic exposure and one-carbon metabolism micronutrient deficiencies during pregnancy have a joint effect on markers of systemic immune function and respiratory illness in mothers and their newborns. This study will yield three expected outcomes. First, it will fill critical knowledge gaps about whether arsenic exposure and one-carbon metabolism micronutrient deficiencies alter immune responses to a vaccination with known benefits for mothers and their newborns. Second, it will increase understanding of arsenic-associated respiratory morbidity and specific immune function pathways between arsenic exposure and respiratory morbidity in mothers and their newborns. Finally, as the global availability of vaccines increases, improving knowledge of potential environmental and biologic barriers to maternal and newborn vaccine-induced protection could lead to improved vaccine regimens (targeted vaccination campaigns, higher vaccine doses, and/or additional booster immunizations) to restore vaccine-induced protection in arsenic-exposed and malnutrition-affected populations of pregnant women and newborns worldwide.


Recruitment information / eligibility

Status Completed
Enrollment 784
Est. completion date January 6, 2020
Est. primary completion date January 6, 2020
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 13 Years to 45 Years
Eligibility Inclusion Criteria: Women who: - are within 13-16 weeks of gestational age (GA) of pregnancy; - are between 13 and 45 years of age; - are married; - provide informed consent for herself and assent for her unborn child; - agree to receive the seasonal influenza vaccine (VAXIGRIP® TETRA seasonal quadrivalent inactivated influenza vaccine, Sanofi Pasteur) upon study enrollment. Exclusion Criteria: Women who: - have pre-existing immune-related health condition (e.g., immunodeficiency, lupus, chronic infection, or cancer); - previous or current use of immune-altering drug/therapy (e.g., steroids); - have already received influenza vaccination for the current season.

Study Design


Intervention

Biological:
Seasonal influenza vaccine - VAXIGRIP TETRA influenza vaccine (quadrivalent, split virion, inactivated)
Influenza virus (quadrivalent, split virion, inactivated) of the strains that comply with the World Health Organization (WHO) recommendations (Northern Hemisphere) and European Union (EU) decision for the 2018/2019 season. The quadrivalent vaccine is propagated in fertilised hens' eggs from healthy chicken flocks.

Locations

Country Name City State
Bangladesh JiVitA Maternal and Child Health and Nutrition Research Program Gaibandha

Sponsors (7)

Lead Sponsor Collaborator
Johns Hopkins Bloomberg School of Public Health Columbia University, Institute of Epidemiology, Disease Control and Research, Johns Hopkins Bangladesh - The JiVitA Project Site, Sanofi Pasteur, a Sanofi Company, UNC Gillings School of Global Public Health, University of Graz

Country where clinical trial is conducted

Bangladesh, 

References & Publications (2)

Attreed SE, Navas-Acien A, Heaney CD. Arsenic and Immune Response to Infection During Pregnancy and Early Life. Curr Environ Health Rep. 2017 Jun;4(2):229-243. doi: 10.1007/s40572-017-0141-4. — View Citation

Heaney CD, Kmush B, Navas-Acien A, Francesconi K, Gossler W, Schulze K, Fairweather D, Mehra S, Nelson KE, Klein SL, Li W, Ali H, Shaikh S, Merrill RD, Wu L, West KP Jr, Christian P, Labrique AB. Arsenic exposure and hepatitis E virus infection during pregnancy. Environ Res. 2015 Oct;142:273-80. doi: 10.1016/j.envres.2015.07.004. Epub 2015 Jul 15. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Other Gestational age (GA) at birth Calculated from known last menstrual period to the week of birth. Within 72 hours of birth
Other Newborn anthropometry weight Weight (grams) Within 72 hours of birth
Other Newborn anthropometry length Length (cm) Within 72 hours of birth
Other Newborn anthropometry head, chest, middle-upper arm circumference head, chest, and middle-upper arm circumference (cm) Within 72 hours of birth
Other Change in micronutrient deficiency status Micronutrient deficiency status will be assessed for micronutrients critical for one-carbon metabolism (folate, vitamin B12 [cobalamin]) and vitamin D and zinc. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Other Change in cytokines Cytokines and chemokines will be measured in plasma or serum, including interleukin 1 beta (IL-1ß), interleukin 2 (IL-2), tumor necrosis factor alpha (TNF-a), interferon gamma (IFN-?). Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Other Change in peripheral blood lymphocyte numbers Peripheral blood lymphocytes cluster of differentiation (CD) 4+ (CD4+) T cell and cluster of differentiation (CD) (CD8+) T cell will be measured. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Other Change in peripheral blood lymphocyte function Functional responses of peripheral blood lymphocytes cluster of differentiation (CD) 4+ (CD4+) T cell and cluster of differentiation (CD) (CD8+) T cell will be measured. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Other Change in total circulating immunoglobulin (Ig) levels, including IgG (IgG 1-4 subclasses), IgA, IgM, IgE Total circulating immunoglobulin (Ig) levels, including immunoglobulin G (IgG) 1-4 subclasses, immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin E (IgE) will be measured in plasma or serum Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Other Occurrence of WHO Definition of Diarrhea Occurrence of participant self-report of watery stools, 3 or more times a day within previous 7 days From date of enrollment visit until date of 3 months postpartum visit, assessed at weekly intervals
Primary Change in influenza hemagglutination-inhibition (HI) antibody titer Influenza hemagglutination-inhibition (HI) antibody titer will be measured in participant's serum. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Primary Mean percent influenza virus antibody avidity The accumulated strength of multiple affinities of individual non-covalent binding interactions of influenza-specific antibodies, including avidity of antibodies to seasonal inactivated influenza virus (IIV) strains included in the formulation in Sanofi Pasteur's 2018-2019 seasonal VAXIGRIP® TETRA vaccine. Measured at baseline, 28 days post vaccination, birth, and 3 months post-partum
Primary Seroconversion rate The proportion of pregnant women demonstrating seroconversion Defined as a post-vaccination HI titer of =40 given a pre-vaccination titer =10 or, alternatively, a =4-fold increase in HI titer between pre-vaccination and post-vaccination sera if the pre-vaccination titer was >10.
Primary Change in geometric mean HI antibody titer (GMT) GMT HI antibody titers will be transformed to binary logarithms, and original values will be divided by 4 (undetectable titer) to set the starting point of the log scale to zero prior to transformation. We will calculate average log2 GMT antibody titers. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Primary Geometric mean ratio of infant:mother HI titer Ratio of infant to mother HI titer as a measure of transplacental transfer of influenza antibody. Birth and 3 months post-partum
Primary Change in influenza virus neutralizing antibody titer Virus neutralization is measured as a titer calculated based on the highest serum dilution that eliminates virus. Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Primary Change in anti-influenza virus total immunoglobulin G (IgG) enzyme immunoassay Total IgG antibodies to influenza virus as measured in serum or plasma by enzyme immunoassay Comparing baseline to 28 days post vaccination, birth, and 3 months post-partum
Secondary Maternal influenza-like illness (ILI) Defined as at least one symptom-free day prior to onset of fever >37.8°C and cough or sore throat. From date of enrollment visit until date of 3 months postpartum visit, assessed at weekly intervals
Secondary Infant influenza-like illness (ILI) Defined as at least one symptom-free day prior to onset of fever >37.8°C and cough. From date of birth visit until date of 3 months postpartum visit, assessed at weekly intervals
Secondary Laboratory-confirmed influenza (LCI) Influenza A and/or B virus real-time (RT)-quantitative polymerase chain reaction (qPCR) positive nasal swab from a participant reporting ILI at a weekly mobile phone positive follow-up. From date of enrollment visit until date of 3 months postpartum visit, assessed at weekly intervals
Secondary Acute respiratory illness (ARI) Defined as: cough; rapid breathing or grunting or wheezing, excluding asthma; blood in sputum; ear discharge; low fever; and/or headache. A stand-alone outcome of ARI plus fever will be defined as the above symptoms plus high fever >37.8°celsius (C). From date of enrollment visit until date of 3 months postpartum visit, assessed at weekly intervals
See also
  Status Clinical Trial Phase
Completed NCT05523089 - The Effectiveness of CD388 to Prevent Flu in an Influenza Challenge Model in Healthy Adults Phase 2
Completed NCT05009251 - Using Explainable AI Risk Predictions to Nudge Influenza Vaccine Uptake N/A
Completed NCT03282240 - Safety and Immunogenicity of High-Dose Quadrivalent Influenza Vaccine in Participants ≥65 Years in the US Phase 3
Completed NCT00968539 - Study to Evaluate the Immunogenicity & Safety of an Investigational Influenza Vaccine (H1N1) in Adults Phase 3
Completed NCT00971425 - Evaluation of the Immune Response and the Safety of a Pandemic Influenza Candidate Vaccine (H1N1) Phase 3
Completed NCT00968526 - Study to Evaluate Immunogenicity and Safety of an Investigational Influenza Vaccine (H1N1) in Adults Phase 3
Completed NCT05525494 - Patient Portal Flu Vaccine Reminders (5) N/A
Completed NCT04074928 - Safety and Immunogenicity Study of QIVc in Healthy Pediatric Subjects Phase 3
Completed NCT04695717 - This Study Was Conducted to Evaluate the Safety and Immunogenicity of IVACFLU-S Produced in Children From 6 Months to Under 18 Years Old and the Elderly Over 60 Years Old in Vietnam Phase 3
Completed NCT05012163 - Lottery Incentive Nudges to Increase Influenza Vaccinations N/A
Completed NCT04109222 - Collection of Serum Samples From Children and Older Adults Receiving the 2019-2020 Formulations of Fluzone® Quadrivalent and Fluzone® High-Dose Influenza Vaccines, Respectively Phase 4
Completed NCT03888989 - Response to Influenza Vaccine During Pregnancy Phase 1
Completed NCT02587221 - Clinical Study to Evaluate the Efficacy, Safety and Immunogenicity of an MF59-Adjuvanted Quadrivalent Influenza Vaccine Compared to Non-influenza Vaccine Comparator in Adults ≥ 65 Years of Age Phase 3
Completed NCT03453801 - The Role of CD4+ Memory Phenotype, Memory, and Effector T Cells in Vaccination and Infection Phase 1
Completed NCT01440387 - A Study of Immunogenicity and Safety of GSK Biologicals' Influenza Vaccine FLU-Q-QIV in Adults Aged 18 Years and Older Phase 3
Terminated NCT01195779 - Trial to Evaluate Safety and Immunogenicity of GSK Biologicals' Influenza Vaccine GSK2584786A in Healthy Children Phase 2
Completed NCT03321968 - Lot-to-lot Consistency of a Plant-Derived Quadrivalent Virus-Like Particles Influenza Vaccine in Healthy Adults Phase 3
Completed NCT00972517 - Study to Evaluate the Immunogenicity and Safety of an Investigational Influenza Vaccine (H1N1) in Children Phase 3
Completed NCT04570904 - Broadening Our Understanding of Early Versus Late Influenza Vaccine Effectiveness
Recruiting NCT03331991 - Prevention of Influenza and Other Wintertime Respiratory Viruses Among Healthcare Professionals in Israel N/A