Simplified 0+1 and 1+1 pneumococcal vaccine schedules in Ho Chi Minh City, Vietnam: protocol for a randomised controlled trial

Beth Temple, Hau Phuc Tran, Vo Thi Trang Dai, Kathryn Bright, Doan Y Uyen, Anne Balloch, Paul Licciardi, Cattram Duong Nguyen, Catherine Satzke, Heidi Smith-Vaughan, Thuong Vu Nguyen, Kim Mulholland, Beth Temple, Hau Phuc Tran, Vo Thi Trang Dai, Kathryn Bright, Doan Y Uyen, Anne Balloch, Paul Licciardi, Cattram Duong Nguyen, Catherine Satzke, Heidi Smith-Vaughan, Thuong Vu Nguyen, Kim Mulholland

Abstract

Introduction: Reduced-dose schedules offer a more efficient and affordable way to use pneumococcal conjugate vaccines (PCVs). Such schedules rely primarily on the maintenance of herd protection. The Vietnam Pneumococcal Trial II (VPT-II) will evaluate reduced-dose schedules of PCV10 and PCV13 utilising an unvaccinated control group. Schedules will be compared in relation to their effect on nasopharyngeal carriage and immunogenicity.

Methods and analysis: VPT-II is a single-blind open-label randomised controlled trial of 2500 infants in three districts of Ho Chi Minh City, Vietnam. Eligible infants have no clinically significant maternal or perinatal history and are born at or after 36 weeks' gestation. Participants are recruited at 2 months of age and randomly assigned (4:4:4:4:9) using block randomisation, stratified by district, to one of five groups: four intervention groups that receive PCV10 in a 0+1 (at 12 months) or 1+1 (at 2 and 12 months) schedule or PCV13 in the same 0+1 or 1+1 schedule; and a control group (that receives a single dose of PCV10 at 24 months). Participants are followed up to 24 months of age. The primary outcome is vaccine-type pneumococcal carriage at 24 months of age. Secondary outcomes are carriage at 6, 12 and 18 months of age and the comparative immunogenicity of the different schedules in terms of antibody responses, functional antibody responses and memory B cell responses.

Ethics and dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of the Royal Children's Hospital Melbourne and the Vietnam Ministry of Health Ethics Committee. The results, interpretation and conclusions will be presented to parents and guardians, at national and international conferences and published in peer-reviewed open access journals.

Trial registration number: NCT03098628.

Keywords: clinical trials; immunology; microbiology; paediatric infectious disease & immunisation.

Conflict of interest statement

Competing interests: All authors receive salary support from grants from the Bill & Melinda Gates Foundation. KM, CS and CDN are investigators on a collaborative study on PCV impact on adult pneumonia funded by Pfizer.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

References

    1. GBD 2016 Lower Respiratory Infections Collaborators . Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet Infect Dis 2018;18:1191–210. 10.1016/S1473-3099(18)30310-4
    1. Myint TTH, Madhava H, Balmer P, et al. . The impact of 7-valent pneumococcal conjugate vaccine on invasive pneumococcal disease: a literature review. Adv Ther 2013;30:127–51. 10.1007/s12325-013-0007-6
    1. Conklin L, Loo JD, Kirk J, et al. . Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on vaccine-type invasive pneumococcal disease among young children. Pediatr Infect Dis J 2014;33(Suppl 2):S109–18. 10.1097/INF.0000000000000078
    1. Loo JD, Conklin L, Fleming-Dutra KE, et al. . Systematic review of the effect of pneumococcal conjugate vaccine dosing schedules on prevention of pneumonia. Pediatr Infect Dis J 2014;33(Suppl 2):S140–51. 10.1097/INF.0000000000000082
    1. Shiri T, Datta S, Madan J, et al. . Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: a systematic review and meta-analysis. Lancet Glob Health 2017;5:e51–9. 10.1016/S2214-109X(16)30306-0
    1. Pneumococcal conjugate vaccines in infants and children under 5 years of age: WHO position paper - February 2019. Wkly Epidemiol Rec;2019:85–104.
    1. Goldblatt D, Southern J, Andrews NJ, et al. . Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial. Lancet Infect Dis 2018;18:171–9. 10.1016/S1473-3099(17)30654-0
    1. Whitney CG, Pilishvili T, Farley MM, et al. . Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet 2006;368:1495–502. 10.1016/S0140-6736(06)69637-2
    1. Andrews NJ, Waight PA, Burbidge P, et al. . Serotype-Specific effectiveness and correlates of protection for the 13-valent pneumococcal conjugate vaccine: a postlicensure indirect cohort study. Lancet Infect Dis 2014;14:839–46. 10.1016/S1473-3099(14)70822-9
    1. Huebner RE, Mbelle N, Forrest B, et al. . Immunogenicity after one, two or three doses and impact on the antibody response to coadministered antigens of a nonavalent pneumococcal conjugate vaccine in infants of Soweto, South Africa. Pediatr Infect Dis J 2002;21:1004–7. 10.1097/00006454-200211000-00006
    1. Russell FM, Balloch A, Tang MLK, et al. . Immunogenicity following one, two, or three doses of the 7-valent pneumococcal conjugate vaccine. Vaccine 2009;27:5685–91. 10.1016/j.vaccine.2009.06.098
    1. Russell FM, Carapetis JR, Burton RL, et al. . Opsonophagocytic activity following a reduced dose 7-valent pneumococcal conjugate vaccine infant primary series and 23-valent pneumococcal polysaccharide vaccine at 12 months of age. Vaccine 2011;29:535–44. 10.1016/j.vaccine.2010.10.046
    1. Licciardi PV, Temple B, Dai VTT, et al. . Immunogenicity of alternative ten-valent pneumococcal conjugate vaccine schedules in infants in Ho Chi Minh City, Vietnam: results from a single-blind, parallel-group, open-label, randomised, controlled trial. Lancet Infect Dis 2021;21:1415–28. 10.1016/S1473-3099(20)30775-1
    1. Russell FM, Licciardi PV, Balloch A, et al. . Safety and immunogenicity of the 23-valent pneumococcal polysaccharide vaccine at 12 months of age, following one, two, or three doses of the 7-valent pneumococcal conjugate vaccine in infancy. Vaccine 2010;28:3086–94. 10.1016/j.vaccine.2010.02.065
    1. Satzke C, Dunne EM, Choummanivong M, et al. . Pneumococcal carriage in vaccine-eligible children and unvaccinated infants in Lao PDR two years following the introduction of the 13-valent pneumococcal conjugate vaccine. Vaccine 2019;37:296–305. 10.1016/j.vaccine.2018.10.077
    1. Dunne EM, Satzke C, Ratu FT, et al. . Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys. Lancet Glob Health 2018;6:e1375–85. 10.1016/S2214-109X(18)30383-8
    1. Balloch A, Licciardi PV, Leach A, et al. . Results from an inter-laboratory comparison of pneumococcal serotype-specific IgG measurement and critical parameters that affect assay performance. Vaccine 2010;28:1333–40. 10.1016/j.vaccine.2009.11.011
    1. Balloch A, Roalfe L, Ekstrom N, et al. . Interlaboratory comparison of the pneumococcal multiplex Opsonophagocytic assays and their level of agreement for determination of antibody function in pediatric sera. mSphere 2018;3. 10.1128/mSphere.00070-18. [Epub ahead of print: 25 04 2018].
    1. Licciardi PV, Toh ZQ, Clutterbuck EA, et al. . No long-term evidence of hyporesponsiveness after use of pneumococcal conjugate vaccine in children previously immunized with pneumococcal polysaccharide vaccine. J Allergy Clin Immunol 2016;137:e11:1772–9. 10.1016/j.jaci.2015.12.1303
    1. Temple B, Nation ML, Dai VTT, et al. . Effect of a 2+1 schedule of ten-valent versus 13-valent pneumococcal conjugate vaccine on pneumococcal carriage: results from a randomised controlled trial in Vietnam. Vaccine 2021;39:2303–10. 10.1016/j.vaccine.2021.02.043
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. WHO Expert Committee on Biological Standardization . Who technical report series 927. Geneva: World Health Organisation, 2005.
    1. Burton RL, Nahm MH. Development and validation of a fourfold multiplexed opsonization assay (MOPA4) for pneumococcal antibodies. Clin Vaccine Immunol 2006;13:1004–9. 10.1128/CVI.00112-06

Source: PubMed

3
Se inscrever