Trial of Antibody Responses by Vitamin Supplementation

Sponsor

St. Jude Children's Research Hospital (Other)

Overall Status

Active, not recruiting

CT.gov ID

NCT03859687

Collaborator

The Gerber Foundation (Other)

Enrollment

Location

Arms

53.8

Anticipated Duration (Months)

1.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Streptococcus pneumoniae, commonly called pneumococcus, can cause a wide range of diseases in children from mild ear infections to deadly pneumonia or meningitis. Vaccination is currently the single best way to protect children. Nutrition, especially the amount of vitamin A, may play a role in how well your body responds to infection or a vaccine. We call this an immune response. This research will look to see if children who take a vitamin with their vaccine have a better immune response than children who do not take a vitamin with their vaccine.

Primary Objective

To evaluate the influence of vitamin A supplementation on Prevnar vaccine immunogenicity based on changes in antibody scores in a commercial ELISA at Day 21 (after a booster vaccine dose) compared to pre-vaccine values.

Secondary Objectives

To evaluate the relationship between baseline vitamin levels and pneumococcal or hepatitis A vaccine antibody responses (based on in commercial ELISAs) at Days 0 and 21.
To evaluate the influence of vitamin A supplementation on hepatitis vaccine immunogenicity based on changes in antibody scores in a commercial ELISA at Day 21 compared to pre-vaccine values.
To evaluate relationships between total serum antibodies (based on individual IgM, IgG1, IgG2, IgG3, IgG4, and IgA scores in a Luminex assay) at Day 0 and changes between Days 0 and 21 with baseline (Day 0) vitamin levels in young children, and with vitamin A supplementation.

Condition or Disease	Intervention/Treatment	Phase
Healthy Participants	Biological: Vitamin A supplementation Biological: No vitamin A supplementation	Phase 1

Detailed Description

Children between the ages of 1 and 4 years old (inclusive) will be enrolled. All will receive PCV and hepatitis A vaccination. Those randomized to the treatment arm will receive 10,000 IU orally at the time of vaccination, while those randomized to the control arm will only receive vaccines. Vitamin levels and antibody responses towards the vaccines will be measured at screening, Day 0 (vaccination day) and Day +21. Children will be randomized using a stratified permuted block method.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

80 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Prevention

Official Title:

A Randomized Controlled Trial of Antibody Responses by Vitamin Supplementation at the Time of Pneumococcus Vaccination in Children

Actual Study Start Date :

Aug 19, 2019

Anticipated Primary Completion Date :

Oct 1, 2022

Anticipated Study Completion Date :

Feb 12, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Intervention group PCV (Prevnar-13 Vaccine) and the hepatitis A vaccine (Havrix Vaccine) plus a liquid oral vitamin A supplementation	Biological: Vitamin A supplementation liquid oral vitamin A supplementation
Experimental: Control group PCV (Prevnar-13 Vaccine) and the hepatitis A vaccine (Havrix Vaccine) only, 'No vitamin A supplementation'	Biological: No vitamin A supplementation No vitamin A supplementation

Arm

Intervention/Treatment

Experimental: Intervention group

PCV (Prevnar-13 Vaccine) and the hepatitis A vaccine (Havrix Vaccine) plus a liquid oral vitamin A supplementation

Biological: Vitamin A supplementation

liquid oral vitamin A supplementation

Experimental: Control group

PCV (Prevnar-13 Vaccine) and the hepatitis A vaccine (Havrix Vaccine) only, 'No vitamin A supplementation'

Biological: No vitamin A supplementation

No vitamin A supplementation

Outcome Measures

Primary Outcome Measures

Seroconversion rate in two arms [Measured at Day 21]
The seroconversion rate, defined as the proportion of 4X increases or conversion from undetectable to detectable response in vaccine-specific antibody after vaccinations (Day 21) versus the baseline (Day 0) antibody level in intervention and control groups will be estimated and 95% confidence interval will be described for both groups. The 95% confidence interval will serve as a measure of precision of the seroconversion rate estimate. Chi-square test will be performed to make the comparison between two arms.
Sera titer ratio [Measured at Day 21]
Titer ratios will be summarized with descriptive statistics. Two-sample tests (t-test or Wilcoxon rank-sum test) will be applied whenever appropriate

Secondary Outcome Measures

Spearman's correlation coefficient of vaccine antibody responses at days 0 with baseline vitamin levels for each arm. [Measured at Day 21]
Spearman's correlation coefficient.
Spearman's correlation coefficient of vaccine antibody responses at days 21 with baseline vitamin levels for each arm. [Measured at Day 21]
Spearman's correlation coefficient.
Proportion of subjects showing 4X increases or conversion from undetectable to detectable response in B cell responses after vaccinations for both groups, and by VA/VD stratum. [Measured at Day 21]
The proportion difference with 95% confidence interval will be reported via Chi-square test or Fisher's test.
Correlation of immunoglobulin M (IgM) antibody (measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 1 (IgG1) antibody (measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 2 (IgG2) antibody (measured by Luminex assay [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 3 (IgG3) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 4 (IgG4)antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin A (IgA) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient
Correlation of immunoglobulin M (IgM) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 2 (IgG2) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 3 (IgG3) antibody (measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin G subclass 4 (IgG4) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.
Correlation of immunoglobulin A (IgA) antibody(measured by Luminex assay) [Measured at Day 21]
Correlation will be expressed as Spearman's correlation coefficient.

Eligibility Criteria

Criteria

Ages Eligible for Study:

1 Year to 4 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Between 1 and 4 years old (inclusive) at the time of enrollment
Fully weaned from breast-feeding or formula-feeding for at least 4 weeks prior to vaccination date (Day 0).
Received at least 2 doses of Prevnar-13 vaccination
Parent or legal guardian willing and able to provide informed consent.

Exclusion Criteria:

Current use of investigational or immunosuppressive drugs (e.g., steroids) at the time of enrollment
Parent/guardian planning to continue (or initiate) the administration of daily vitamin A, vitamin D, or multivitamin to the child during the study period.
Evidence of developmental delay or evolving neurological disorders at screening.
Current use of antibiotics or antivirals at enrollment.
Currently receiving cancer related treatment.
History of heart, kidney, or chronic respiratory condition (e.g., asthma) conditions.
History of diabetes.
Acute febrile illness [e.g., >100.0F (37.8oC) oral] illness within 3 days prior to enrollment.
Received a previous PCV13 vaccine within 2 months of the enrollment date (Day 0).
Received hepatitis A vaccine previously.
Ever had a life-threatening allergic reaction to a dose of PCV13 vaccine, to an earlier pneumococcal vaccine called PCV7, or to any vaccine containing diptheria toxoid (for example, DTaP).