Immunogenicity and Safety PCV-20 of the Vaccine Administered During an Acute Febrile Illness in Adults (PREV-HOSPIT)

Immunogenicity and Safety of the 20-Valent Pneumococcal Conjugate Vaccine (PCV-20) Administered During an Acute Febrile Illness in Adults: a Multicentric Randomized Non-inferiority Trial

Streptococcus pneumoniae is responsible for serious infections associated to numerous hospitalizations and high rate of mortality. The incidence and therefore the burden of pneumococcal infections have been significantly reduced thanks to the use of pneumococcal conjugate vaccines (PCVs). PCVs were shown to be effective against vaccine-type serotypes causing both non-invasive and invasive pneumococcal diseases (IPD) in children and adults. PCVs use in children was shown to have an impact on IPD incidence among adults due to herd immunity and on antimicrobial resistance. To increase the protection of at-risk patients against IPD, the 20-valent PCV (PCV-20) is recently recommended in adults, after a period where PCV-13 followed by pneumococcal polysaccharide vaccine 23 valent (PPV-23) was recommended. PCV-20 effectiveness against IPD and against pneumonia was inferred from immunobridging with PCV-13. Indeed PCV-13 was shown effective to reduce the incidence of low respiratory tract infections and IPD (bacteraemia and meningitis) in 65-years-old-adults and older. Currently immunization against S. pneumoniae is recommended with PCV-20 for adult patients at-risk for IPD such as immunocompromised (=high-risk patients) and in immunocompetent people with underlying chronic conditions (cardiovascular, liver, pulmonary, kidney diseases and diabetes mellitus) (=medium risk patients). However, vaccine coverage against IPD in adults remains low globally, and does not exceed 5 % in France. Reducing missed opportunities of vaccination for S. pneumoniae is crucial.

Study Overview

• Status: Recruiting
• Conditions: Pneumococcal Infections; Acute Febrile Illness
• Intervention / Treatment: Biological: Early intervention; Biological: Delayed intervention

Detailed Description

Patients at-risk of IPD are very frequently hospitalized for acute febrile illnesses. More than 50 % of the IPD at-risk patients hospitalized for an IPD or a pneumonia have been admitted to the hospital during the past 5 years without receiving a pneumococcal vaccination. Hospitalization appears to be therefore an opportunity to provide vaccines. However, physicians usually consider that vaccines should be postponed during an acute febrile illness including if non-severe. This consideration of not vaccinating during an acute febrile illness is however not evidence-based. This is associated to concerns about a potential risk of an impaired response to the vaccine and safety. In children, data about vaccination during a febrile illness have shown no safety nor efficacy concerns. In most countries, recommendations regarding this particular point are unclear.

In fine, vaccination is then rarely provided during the hospital stay as well as after discharge including in the USA, a country where it is recommended to vaccinate whatever the body temperature is and during hospitalization. Reluctance to immunize adults in this situation is probably due to the absence of evidence showing that it is as effective and safe as vaccinating patients without an acute or febrile illness.

To reduce the number of missed opportunities to immunize adults against S. pneumoniae, investigators aim to demonstrate that the administration of PCV-20 during an acute non-severe febrile illness is non-inferior than the administration one month after fever resolution in terms of immunogenicity (assessed by vaccine types (VT) Immunoglobulin G (IgG) concentrations and at least 2-fold change increase), and that it is as safe.

• Study Type: Interventional
• Enrollment (Estimated): 1052
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Elisabeth BOTELHO-NEVERS, MD PhD; Phone Number: +33 (0)477829234; Email: Elisabeth.Botelho-Nevers@chu-st-etienne.fr

Study Locations

• France
  • Annecy, France, 74000
    • Not yet recruiting
    • Centre hospitalier
    • Contact: JANSSEN CECILE, MD; Phone Number: +33 450636602; Email: cjanssen@ch-annecygenevois.fr
  • Besançon, France, 25000
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: KEVIN BOUILLER, MD; Phone Number: +33 (0)3 81 66 81 66; Email: kevin.bouiller@chu-besancon.fr
  • Bordeaux, France, 33000
    • Not yet recruiting
    • Centre hospitalier
    • Contact: CHARLES CAZANAVE, PHD; Phone Number: (0)556795536; Email: charles.cazanave@chu-bordeaux.fr
  • Brest, France, 29609
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: ROZENN LE BERRE, PHD; Phone Number: +33 (0)298347336; Email: rozenn.leberre@chu-brest.fr
  • Brest, France, 29609
    • Not yet recruiting
    • Centre hospitalier
    • Contact: SYLVAIN JAFFUEL, MD; Phone Number: (0)298347213; Email: sylvain.jaffuel@chu-brest.fr
  • Chambéry, France, 73011
    • Not yet recruiting
    • Centre Hospitalier General Metropole Savoie
    • Contact: EMMANUEL FORESTIER, MD; Phone Number: +33 (0)479965172; Email: emmanuel.forestier@ch-metropole-savoie.fr
  • Créteil, France, 94000
    • Not yet recruiting
    • Centre Hospitalier de Creteil
    • Contact: ANTOINE FROISSART, MD; Phone Number: +33 (0)157022783; Email: antoine.froissart@chicreteil.fr
  • Dijon, France, 21000
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: LIONEL PIROTH, PHD; Phone Number: +33 (0)380293305; Email: lionel.piroth@chu-dijon.fr
  • Grenoble, France, 38043
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: OLIVIER EPAULARD, PHD; Phone Number: +33 (0)476765291; Email: oepaulard@chu-grenoble.fr
  • La Roche-sur-Yon, France, 85925
    • Not yet recruiting
    • Centre hospitalier
    • Contact: THOMAS GUIMARD, MD; Phone Number: (0)251446385; Email: thomas.guimard@ght85.fr
  • Le Mans, France, 72000
    • Not yet recruiting
    • Centre Hospitalier Général
    • Contact: SOPHIE BLANCHI, MD; Phone Number: +33 (0)2434343; Email: sblanchi@ch-lemans.fr
  • Le Puy-en-Velay, France, 43000
    • Not yet recruiting
    • Centre hospitalier
    • Contact: CYRILLE CORNILLE, MD; Phone Number: +33 (0)4 71 04 32 10; Email: cyrille.cornille@ch-lepuy.fr
  • Lille, France, 59037
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: KARINE FAURE, PHD; Phone Number: (0)320445743; Email: karine.faure@chu-lille.fr
  • Lyon, France, 69004
    • Not yet recruiting
    • Hospices Civils de Lyon
    • Contact: ANNE CONRAD, MD; Phone Number: +33 (0)472071107; Email: anne.conrad@chu-lyon.fr
  • Montpellier, France, 34295
    • Not yet recruiting
    • Centre Hospitalier Régional Universitaire
    • Contact: CORRINE MERLE DE BOEVER, MD; Phone Number: +33 (0)467337211; Email: c-merle_de_boever@chu-montpellier.fr
  • Nancy, France, 54511
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: BENJAMIN LEFEVRE, PHD; Phone Number: +33 (0)383157654; Email: b.lefevre@chru-nancy.fr
  • Nantes, France, 44093
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: ANNE-SOPHIE LECOMPTE, MD; Phone Number: +33 (0)240083112; Email: annesophie.lecompte@chu-nantes.fr
  • Nice, France, 06202
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: ELISA DEMONCHY, MD; Phone Number: +33 (0)686778358; Email: demonchy.e@chu-nice.fr
  • Nîmes, France, 30029
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: PAUL LOUBET, PHD; Phone Number: +33 (0)466684149; Email: paul.loubet@chu-nimes.fr
  • Paris, France, 75012
    • Not yet recruiting
    • Centre Hospitalier Bichat
    • Contact: XAVIER LESCURE, PHD; Phone Number: +33 (0)140256994; Email: xavier.lescure@inserm.fr
  • Paris, France, 75679
    • Not yet recruiting
    • Assistance Publique Hopitaux de Paris
    • Contact: ODILE LAUNAY, PHD; Phone Number: +33 (0)158412858; Email: odile.launay@aphp.fr
  • Rennes, France, 35000
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: LEA PICARD, MD; Phone Number: +33 (0)3329928; Email: lea.picard@chu-rennes.fr
  • Rouen, France, 76000
    • Not yet recruiting
    • Centre Hospitalier Universitaire
    • Contact: MANUEL ETIENNE, PHD; Phone Number: +33 (0)232888739; Email: manuel.etienne@chu-rouen.fr
  • France
    • Saint-Etienne, France, France, 42055
      • Recruiting
      • CHU de Saint-Etienne
      • Principal Investigator: Elisabeth BOTELHO-NEVERS, MD PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria :

• History of body temperature ≥ 38°C measured at least twice prior to randomization (Randomization must be performed as soon as possible on a febrile patient or 72 hours after apyrexia at the latest)

• Having at least one comorbidity that defines patients as medium or high risk for pneumococcal invasive infection:

  • Medium risk: Cyanogenic congenital heart disease; chronic heart failure; chronic respiratory failure; chronic obstructive pulmonary disease; emphysema; severe asthma under chronic treatment; chronic renal failure; chronic liver disease; diabetes mellitus treated; Osteo-meningeal leak or cochlear implant; Age > 65 years old.
  • High risk : Hypo or asplenic people; hereditary immunodeficiency syndromes; people living with HIV; solid organ transplanted; People under immunosuppressors (corticosteroids, biotherapy) for an auto-immune or an inflammatory chronic disease; patients with nephrotic syndrome
• Hospitalization for > 24 hours long
• Social security affiliation
• Signed informed consent

Exclusion criteria :

• Patient unable to give informed consent
• Curators, wardship
• History of previous vaccination with PCV-7 or PCV-13 or PCV-20
• History of PPV-23 in the previous year
• Patient having received another vaccination within one month prior to inclusion or planning another vaccination in the month after inclusion except for Influenza vaccine.
• Patient with history of bone marrow transplantation
• Patient with haematological malignancies
• Patient under chemotherapy for solid tumor or with a history of chemotherapy in the past three months
• Patient treated with Rituximab currently or in the past 6 months
• Patient with Sequential Organ Failure Assessment (qSOFA ) score ≥ 2 at randomization (acute severe febrile illness)
• Patient hospitalized in an Intensive Care Unit
• Pregnancy
• Breastfeeding woman
• Recipients of polyclonal gammaglobulins in the past three months
• Inability to follow the protocol
• Bleeding disorder contra-indicating intramuscular injection according to the investigator
• History of allergy to PCV-20 or vaccine-related components.
• S. pneumoniae infection with laboratory confirmation (blood culture, culture from a sterile site, urinary or Cerebrospinal fluid antigens, sputum culture with > 10^7 colony forming unit (CFU)/mL) being the cause of the current hospitalization

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Early vaccination; The patient will receive unique dose of the PCV-20 vaccine as soon as possible and until 72h after apyrexia. The "Prevenar 20" will be used	Biological: Early intervention; In this arm, patient will receive unique dose of the PCV-20 vaccine (Prevnar 20) as soon as possible and until 72h after apyrexia. The "Prevenar 20" will be used Prevenar 20 will be injected by intramuscular route. The preferred site of injection is the deltoid muscle of the upper arm in adults.
Active Comparator: Delayed vaccination; From 15 days and until 58 days after fever resolution (i.e after the first day with a body temperature < 37.5°C without paracetamol use in the 6 previous hours) (whether or not the patient has been discharged) in the absence of fever, the patient will receive PCV-20 vaccination The "Prevenar 20" will be used	Biological: Delayed intervention; In this arm, from 15 days and until 58 days after fever resolution (i.e after the first day with a body temperature < 37.5°C without paracetamol use in the 6 previous hours) (whether or not the patient has been discharged) in the absence of fever, the patient will receive unique dose of the PCV-20 vaccine (Prevnar 20). The "Prevenar 20" will be used Prevenar 20 will be injected by intramuscular route. The preferred site of injection is the deltoid muscle of the upper arm in adults.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of immune "good responders" to PCV-20 in both arms	Good responders is defined as - a seroconversion (a 2-fold increase in VT IgG after vaccination), for ≥10 vaccine serotypes (VT) among the 13 tested on 20 in ELISA, AND an immune protective response defined as ELISA IgG > 1,3 μg/mL in ≥ 10 out 13 VT. OR - -a seroconversion (a 4-fold increase in VT IgG after vaccination), for ≥10 vaccine serotypes (VT) among the 13 tested on 20 in ELISA, AND an immune protective response defined as ELISA IgG < 1,3 μg/mL in ≥ 10 out 13 VT.	1 month post vaccination

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety endpoints in both arms in the month following vaccination : adverse events	Number, type and severity of solicited (in the 7 days following vaccination) and unsolicited (in the month following vaccination) adverse events	1 month post vaccination
Frequency of local reactions	Local reactions will be defined as : pain, redness, and swelling at the study vaccine injection site and limitation of arm movement	1 month post vaccination
Frequency of systemic events related to the vaccination	Onset or worsening of fever, diarrhoea, chills, fatigue, headache, vomiting, decreased appetite, rash, muscle pain, joint pain). An independent blinded central adjudication committee will define the onset or worsening of symptoms and will review all systemic events.	1 month post vaccination
Proportion of immune good responders serotype by serotype	"Good responders" being defined above (primary end-point) A blood sample for immunologic analysis will be performed	1 month post vaccination
opsonophagocytic activity (OPA) IgG titers for serotype by serotype	A blood sample for immunologic analysis will be performed. ELISA method will be used for immunologic analysis.	1 month post vaccination
Proportion of the participants immune "good responders" to PCV-20 in both arms.	"Good responders" being defined above (primary end-point) A blood sample for immunologic analysis will be performed. ELISA method will be used for immunologic analysis.	1 year post vaccination
Number of low respiratory tract infections events	Data about occurrence of respiratory infections will be recorded.	1 year post vaccination
Number of confirmed S.pneumoniae infections	Data about pneumococcal infection will be recorded.	1 year post vaccination
Analyze the gut microbiota on the immune response	Analyze the gut microbiota on the immune response in both arm ( during an acute febrile illness or 15-58 days after resolution of the acute febrile illness) A stool sample is taken before vaccination	1 year post vaccination
Reactogenic inflammatory response after vaccination	Fold change kinetics (transcriptomics) (before and at 24 hours after vaccination) of vaccine-induced gene signatures in peripheral blood mononuclear cells and serum cytokine levels at baseline and 24 hours after vaccination in both arms.	1 month post vaccination
Frequency of specific PCV-20 interferon-gamma (IFNg) secreting CD4 or CD8 T cells	Blood sample will be collected 1 month post-vaccination.	1 month post vaccination
Frequency of specific PCV-20 IFNg secreting CD4 or CD8 T cells	Blood sample will be collected 1 year post-vaccination.	1 year post vaccination
Proportion of volunteers with circulatory immunoglobulin A (IgA)	Blood sample will be collected 1 month post-vaccination.	1 month post vaccination

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Saint Etienne
• Collaborators: Ministry of Health, France; IREIVAC/COVIREIVAC Network
• Investigators: Principal Investigator: Elisabeth BOTELHO-NEVERS, MD PhD, CHU Saint-Etienne

Study record dates

Study Major Dates

• Study Start (Actual): December 17, 2025
• Primary Completion (Estimated): October 1, 2028
• Study Completion (Estimated): October 1, 2028

Study Registration Dates

• First Submitted: February 7, 2025
• First Submitted That Met QC Criteria: February 7, 2025
• First Posted (Actual): February 12, 2025

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: infections; vaccin; pneumococcal; Acute febrile illness; Prevenar 20; PCV-20; PCV-21
• Additional Relevant MeSH Terms: Gram-Positive Bacterial Infections; Bacterial Infections; Bacterial Infections and Mycoses; Streptococcal Infections; Infections; Pneumococcal Infections; Health Services; Health Care Facilities Workforce and Services; Child Health Services; Community Health Services; Preventive Health Services; Early Intervention, Educational
• Other Study ID Numbers: 19PH225; 2024-517411-73-00 (Ctis)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No