Immunogenicity and Safety of Vaccinations in Immunocompromised Persons

February 24, 2016 updated by: University of Zurich

A Prospective Cohort Study in 6 Swiss Rheumatology Centres and 4 Travel Clinics on the Immunogenicity and Safety of Tetanus and Hepatitis A Vaccine in Patients With Rheumatoid Arthritis, Axial Spondyloarthritis and Vasculitis and Healthy Controls

Backgound and relevance of the project:

Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at increased risk of contracting infections. The increased risk can be attributed to the immunological disorder itself, as well as to the immunosuppressive treatment. Vaccination against many infections is recommended in this patient group. However, the immunogenicity of vaccines may be reduced and may also be influenced by the administered treatment. Potential reactivation of the underlying disease triggered by vaccination is another important concern.

From the patients' and public health perspectives, an important task of physicians is giving advice on vaccines. Completing this task is often difficult, because data on the immunogenicity and safety of vaccines in these patient groups are scarce, especially with regard to treatment with new immunosuppressive medications, such as biological agents. Lastly and importantly, due to new therapeutic options, health among AIIRD patients has considerably improved and an increasing number of patients undertake overseas travel activities requiring additional vaccinations. In this context, reliable advice with regard to vaccinations is almost impossible, because for most travel vaccinations the immunogenicity and safety profile is unknown.

Research addressing the immunogenicity and safety of vaccines in different autoimmune inflammatory diseases treated with different immunosuppressive medications is urgently needed to allow giving evidence based vaccine advice.

In this observational study the immunogenicity and safety of tetanus booster and hepatitis A vaccinations will be assessed in AIIRD patients. The immune response will be evaluated as a function of the underlying disease and the possible influence of commonly used immunosuppressive drugs on the immune response will be studied.

Rationale for studying tetanus booster and hepatitis A vaccine Tetanus vaccination is one of the most frequently recommended vaccinations, and the effect of a booster vaccination can be addressed. Hepatitis A vaccine is the most widely used travel vaccine. Despite their importance, only very limited data are available for tetanus and hepatitis A vaccine in this patient group. By focusing on these vaccines the study will lead the way to the evaluation of further vaccines.

The purpose of this study is to determine whether tetanus and hepatitis A vaccinations are as immunogenic and safe in AIIRD patients as in healthy controls.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The study will be placed in 6 rheumatology clinics in Switzerland and in 4 travel medicine clinics. Consecutive subjects with rheumatoid arthritis, spondylarthritis (ankylosing spondylitis), vasculitis (ANCA associated vasculitis and Behçet's disease) and healthy controls will be recruited.

Study Type

Observational

Enrollment (Actual)

645

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Switzerland
      • Bern, Switzerland, 3010
        • University of Bern, Inselspital, Division of Infectious Diseases and Travel Medicine
      • Bern, Switzerland, 3010
        • University of Bern, Inselspital, Division of Rheumatology
      • Geneva, Switzerland, 1211
        • University of Geneva, University Hospitals, Division of Rheumatology
      • Geneva, Switzerland, 1211
        • University of Geneva, University Hospitals, Service de Médecine Tropicale et Humanitaire
      • St. Gallen, Switzerland, 9007
        • Cantonal Hospital St. Gallen, Division of Rheumatology
      • Zürich, Switzerland, 8001
        • University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Divison of Infectious Diseases
      • Zürich, Switzerland, 8091
        • University of Zurich, University Hopsital, Divison of Rheumatology
    • Aargau
      • Aarau, Aargau, Switzerland, 5001
        • Cantonal Hospital Aarau, Division of Rheumatology
    • Basel Town
      • Basel, Basel Town, Switzerland, 4031
        • University Hospital of Basel, Rheumatology Division
      • Basel, Basel Town, Switzerland, 4051
        • Swiss Tropical and Public Health Institute

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

The cohort will be selected from patients with rheumatic diseases under treatment at 6 rheumatology outpatient clinics in Switzerland (University of Basel, University of Bern, University of Geneva, University of Zurich, Cantonal Hospital Aarau, Cantonal Hospital St. Gallen)

Description

Inclusion Criteria:

  • Indication for hepatitis A and/or tetanus vaccination according to Swiss Federal Office of Public Health recommendations
  • Male and female rheumatic patients with rheumatoid arthritis or axial spondyloarthritis (ankylosing spondylitis, axial psoriatic arthritis, axial undifferentiated spondyloarthritis, enteropahtic arthritis) or peripheral psoriatic arthritis or vasculitis (Behçet's disease or ANCA-associated vasculitis) or male and female healthy participants ≥ 18 years
  • Signed Informed Consent after being informed

Exclusion Criteria:

  • Known hypersensitivity to a vaccine ingredient
  • Estimated patient survival below 1 year
  • Active malignant or active infectious disease
  • Drug/alcohol abuse
  • Insufficient understanding of local language

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Healthy controls
If a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 319 healthy controls will be enrolled and will receive hepatitis A and/or tetanus vaccination
Biological: Hepatitis A vaccine and tetanus vaccine
Hepatitis A and/or tetanus vaccination will be given to participants in all group on day 0. All monovalent active hepatitis A vaccinations and all vaccines containing tetanus toxoid available in Switzerland may be used in the study
Other Names:
  • Boostrix
  • Epaxal
  • Havrix 1440
  • Td-Pur
  • BoostrixPolio
  • Revaxis
Patients with rheumatoid arthritis
If a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with rheumatoid arthritis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Biological: Hepatitis A vaccine and tetanus vaccine
Hepatitis A and/or tetanus vaccination will be given to participants in all group on day 0. All monovalent active hepatitis A vaccinations and all vaccines containing tetanus toxoid available in Switzerland may be used in the study
Other Names:
  • Boostrix
  • Epaxal
  • Havrix 1440
  • Td-Pur
  • BoostrixPolio
  • Revaxis
Patients with axial spondylarthritis
If a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with axial spondylarthritis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Biological: Hepatitis A vaccine and tetanus vaccine
Hepatitis A and/or tetanus vaccination will be given to participants in all group on day 0. All monovalent active hepatitis A vaccinations and all vaccines containing tetanus toxoid available in Switzerland may be used in the study
Other Names:
  • Boostrix
  • Epaxal
  • Havrix 1440
  • Td-Pur
  • BoostrixPolio
  • Revaxis
Patients with vasculitis
If a vaccination is indicated according to the recommendations by the Swiss Federal Office of Public Health: 142 patients with vasculitis will be enrolled and will receive hepatitis A and/or tetanus vaccination.
Biological: Hepatitis A vaccine and tetanus vaccine
Hepatitis A and/or tetanus vaccination will be given to participants in all group on day 0. All monovalent active hepatitis A vaccinations and all vaccines containing tetanus toxoid available in Switzerland may be used in the study
Other Names:
  • Boostrix
  • Epaxal
  • Havrix 1440
  • Td-Pur
  • BoostrixPolio
  • Revaxis

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Immunogenicity of hepatitis A and tetanus vaccination in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls
Time Frame: Change from Baseline in geometric mean antibody titre and seroprotection at 4 weeks and at 12 weeks
comparison of the geometric mean antibody titre and percentage of seroprotected individuals after tetanus and hepatitis A vaccination between each disease group and healthy controls
Change from Baseline in geometric mean antibody titre and seroprotection at 4 weeks and at 12 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety of tetanus and hepatitis A vaccines in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls
Time Frame: Activation of rheumatic disease will be assessed for 1 week after vaccine administration and at 4 and 12 weeks compared to baseline

Number of patients with any worsening or reactivation of the rheumatic disease after vaccine administration

Number of participants with adverse vaccine reactions (local and systemic reactions) in patients with rheumatoid arthritis, axial spondyloarthritis and vasculitis and in healthy controls
Activation of rheumatic disease will be assessed for 1 week after vaccine administration and at 4 and 12 weeks compared to baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Zurich

Collaborators

University Hospital, Geneva
University of Bern
Swiss Tropical & Public Health Institute
University of Basel
Cantonal Hospital of St. Gallen
Cantonal Hospital of Aarau, Switzerland

Investigators

  • Principal Investigator: Christoph Hatz, Professor, University of Zurich, Epidemiology, Biostatistics and Prevention Institute

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

October 1, 2013

Primary Completion (ACTUAL)

December 1, 2015

Study Completion (ACTUAL)

February 1, 2016

Study Registration Dates

First Submitted

August 22, 2013

First Submitted That Met QC Criteria

September 19, 2013

First Posted (ESTIMATE)

September 20, 2013

Study Record Updates

Last Update Posted (ESTIMATE)

February 25, 2016

Last Update Submitted That Met QC Criteria

February 24, 2016

Last Verified

February 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CS_2013_01

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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