Pneumococci and Hib Vaccination After Neurotrauma or Neurosurgery

June 19, 2016 updated by: Uppsala University

Pneumococci and Hib Vaccination Early and Late After Neurotrauma or Neurosurgery

The purpose of this study is to determine wether skull trauma or neurosurgery affect the immune response to two vaccine types.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

There is a risk of meningitis after neurotrauma and different actions have been taken to reduce this risk. Prophylactic antibiotics are often administered, although at present there is little evidence to support such a regimen. Increasing problems with antibiotic resistance heightens the need for pertinent use of antibiotics.

Even if most of these infections occur early in the course, the risk appears to persist for many years and almost half of the posttraumatic meningitis cases occur after one month. Streptococcus pneumoniae is the most common causative agent and pneumococcal vaccination after neurotrauma is now recommended in several national guidelines. There are, however, no recommendations of when to administer the vaccine. In clinical practice, vaccination is most often performed several weeks after the trauma. Because the risk of meningitis is at the highest shortly after the trauma, vaccination within days would be preferable. Until recently, pneumococcal polysaccharide vaccine (PPSV) was the most common recommendation. During recent years pneumococcal conjugate vaccines (PCV) have been introduced, offering long-term protection and is now recommended in the USA.

Trauma, as well as surgery, activate the innate immune system resulting in, among other things, decreased T-cell function. Patients with injuries of the central nervous system (CNS) may show signs of a specific CNS-injury-induced immune deficiency syndrome (CIDS), which is also characterized by impaired T-cell activity. Accordingly, it can be speculated that ongoing anti-inflammatory response after trauma, here referred to as trauma-induced immune deficiency syndrome (TIDS), and CIDS by impaired T-cell function could negatively affect the response to vaccines, especially to T-cell dependent conjugate vaccines. In the present thesis, focus will be the impact of TIDS and CIDS on the response to T-cell dependent and T-cell independent vaccines.

Methods

Vaccination A conjugate vaccine against Haemophilus influenzae type b (Hib) was chosen as the T-cell-dependent antigen. All patients received a single subcutaneous injection of 0.5 ml Act-HIB® (Sanofi Pasteur MSD, Lyon, France) in the upper right arm. A 0.5 ml dose of this vaccine contains 10 μg of Hib polysaccharide conjugated to 24 micrograms of tetanus protein.

All patients also received, at the same time, a single subcutaneous injection of 0.5 ml Pneumovax® (Sanofi Pasteur MSD AB, Lyon, France) (PPSV23) containing 25 μg of purified capsular polysaccharide from each of the 23 serotypes (1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F) in the upper left arm.

Patients in the NT and NS groups were vaccinated within 10 days after trauma or surgery. Control patients were vaccinated, according to the local routine for pneumococcal vaccination, at least three weeks after trauma or surgery.

Adverse reactions to the vaccine were recorded in the case report form.

Sera collection and analysis Pre-vaccination sera were collected just before vaccination and post-vaccination sera were obtained three and six weeks after vaccination. Samples were stored at -70oC pending analysis. The laboratory was blinded with respect to group assignment of the patients.

IgG antibody concentrations to Hib polysaccharide were determined by enzyme immunoassay which is an established and accredited methodology.

An anti-Hib polysaccharide antibody concentration of 0.15 -1.0 μg/ml has been associated with long-term protection against invasive Hib infection after vaccination of children with Hib polysaccharide vaccine. Based on previous experience in children, a post-vaccination concentration of 10 μg/ml, 10 times the upper supposed protective concentration, was chosen as the target level for a good response to the vaccination in this study.

Serotype-specific anti-polysaccharide binding IgG antibody levels to serotypes 4, 6B, 9V, 14, 18C, 19F and 23F were determined by enzyme immunoassay which is an established and accredited methodology.

A serotype-specific IgG >0.35 μg/ml has been defined as the correlate of protection for invasive disease in infant recipients of (PCV). The true correlate of protection for adults after vaccination with PPSV23 is not known. The value of 1.0 μg/ml was chosen as the target level for a good response to the vaccination in this study.

Study Type

Interventional

Enrollment (Actual)

85

Phase

  • Phase 2

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

17 years and older (ADULT, OLDER_ADULT, CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Basilar skull fracture or transsphenoidal pituitary gland surgery
  • Own or presumed consent (by next of kin of unconscious)

Exclusion criteria

  • None

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

  • Primary Purpose: PREVENTION
  • Allocation: NON_RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
ACTIVE_COMPARATOR: Neurotrauma
Patients with basilar skull fracture with or without known cerebrospinal fluid leakage were enrolled in the neurotrauma (NT) group. All patients were vaccinated with two vaccines at the same time, 0,5 ml PPSV23 and 0,5 ml Act-HIB which is a conjugate vaccine against H. influenzae type b.The vaccines were administered by subcutaneous injections within 10 days from trauma.
described in "Arm description"
Other Names:
  • PPSV23=Pneumovax,
ACTIVE_COMPARATOR: Neurosurgery
Patients scheduled for elective, transsphenoidal pituitary gland surgery were assigned to the neurosurgery (NS) group. All patients were vaccinated with two vaccines at the same time, 0,5 ml PPSV23 and 0,5 ml Act-HIB which is a conjugate vaccine against H. influenzae type b.The vaccines were administered by subcutaneous injections within 10 days from surgery.
described in "Arm description"
Other Names:
  • PPSV23=Pneumovax,
ACTIVE_COMPARATOR: Control
All control patients had undergone neurotrauma with or without basilar skull fracture, or had neurosurgery, at least three weeks earlier. All patients were vaccinated with two vaccines at the same time, 0,5 ml PPSV23 and 0,5 ml Act-HIB which is a conjugate vaccine against H. influenzae type b. They were vaccinated at least three weeks after trauma or surgery. The vaccines were administered by subcutaneous injections.
described in "Arm description"
Other Names:
  • PPSV23=Pneumovax,

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Change from baseline of IgG anti-Hib (ug/ml)
Time Frame: baseline and 3 weeks
baseline and 3 weeks
Change from baseline of IgG anti-Hib (ug/ml)
Time Frame: baseline and 6 weeks
baseline and 6 weeks
Change from baseline of specific IgG against pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F (ug/ml)
Time Frame: baseline and 3 weeks
baseline and 3 weeks
Change from baseline of specific IgG against pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F (ug/ml)
Time Frame: baseline and 6 weeks
baseline and 6 weeks

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Jan Sjölin, Professor, Uppsala University

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.

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

January 1, 2001

Primary Completion (ACTUAL)

January 1, 2008

Study Completion (ACTUAL)

January 1, 2010

Study Registration Dates

First Submitted

May 30, 2016

First Submitted That Met QC Criteria

June 15, 2016

First Posted (ESTIMATE)

June 20, 2016

Study Record Updates

Last Update Posted (ESTIMATE)

June 21, 2016

Last Update Submitted That Met QC Criteria

June 19, 2016

Last Verified

June 1, 2016

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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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