Safety and Immunogenicity of Recombinant Hepatitis B Vaccine Sci-B-Vac® Compared to Engerix-B®

Sponsor
VBI Vaccines Inc. (Industry)
Overall Status
Completed
CT.gov ID
NCT04209400
Collaborator
(none)
100
1
2
12.1
8.3

Study Details

Study Description

Brief Summary

This study was a comparative, randomized, double-blind clinical study of the efficacy and safety of Sci-B-Vac® (10 μg dose) and the Engerix-B® (20 μg dose) vaccines in two parallel groups of hepatitis B-naive healthy adult subjects in Russia.

Condition or Disease Intervention/Treatment Phase
  • Biological: Sci-B-Vac®
  • Biological: Engerix-B®
Phase 3

Detailed Description

This study was a comparative randomized double-blind clinical study of the efficacy and safety of Sci-B-Vac® (10 μg dose) and the Engerix-B® (20 μg dose) vaccines in hepatitis B-naive healthy adult subjects (n = 100). The study was conducted at 3 study sites in the Russian Federation. Subjects who passed the screening successfully were randomized into two groups, Sci-B-Vac® (10 μg dose) and Engerix-B® (20 μg dose), in a 1:1 ratio. Subjects were vaccinated three times at days 1, 28, and 180 of the study.

Statistical Methods: Evaluation and comparison of immunogenicity were conducted at baseline, day 28, day 90 (60 days after the second vaccination), day 180 (prior to administering the third vaccine, 90 days after the second vaccination), and day 210 (30 days after the third vaccination) of the study.

The primary outcome was the seroconversion rate (proportion of subjects with anti-HBs levels ≥ 2.1 mIU/mL) after the third vaccination at day 210. The non-inferiority margin was set at 4%. The percentage of subjects who achieved seroconversion was analyzed using the Chi-square test for proportions along with the McNemar's test for repeated measurements in each group. The non-inferiority hypotheses were confirmed if the lower range of the confidence interval was at least -4%. The secondary endpoint was SPR (≥10 mIU/ml), measured at days 1, 28, 90, 180 and 210.

Demographic data, initial parameters, safety parameters, tolerance of the experimental vaccine, and other study parameters were analyzed using descriptive statistics (mean value, standard deviation, median, minimum and maximum values, range, quartiles, the number of valid cases-for quantitative variables; absolute number, proportion, allocation-for qualitative variables). A comparative assessment of the detection rate for different parameters in the two comparison groups was conducted using the Student's t-test; differences were considered statistically significant at a significance level of 5%. The assay used to measure anti-HBs concentrations had an upper limit of 1000 mIU/mL.

Study Design

Study Type:
Interventional
Actual Enrollment :
100 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose:
Prevention
Official Title:
A Comparative Randomized Double-Blind Study of Safety and Immunogenicity of Recombinant Hepatitis B Vaccine Sci-B-Vac® in Adult Study Subjects
Actual Study Start Date :
Apr 18, 2014
Actual Primary Completion Date :
Apr 20, 2015
Actual Study Completion Date :
Apr 20, 2015

Arms and Interventions

Arm Intervention/Treatment
Experimental: Sci-B-Vac®

The 3-antigen HepB vaccine, Sci-B-Vac® contains three recombinant proteins of HBV viral envelope: small S, medium pre-S2, and large pre-S1 surface antigens. Sci-B-Vac® was supplied in 1.0 ml vials.

Biological: Sci-B-Vac®
Sci-B-Vac® vaccine-10 μg of HBsAg, intramuscular injection of 10 μg/ml

Active Comparator: Engerix-B®

The single-antigen HepB vaccine, Engerix-B® (GSK), contains the small S recombinant protein. Engerix-B® was supplied in 1.0 ml vials.

Biological: Engerix-B®
Engerix-B® vaccine-20 μg of HBsAg, intramuscular injection of 20 μg/ml

Outcome Measures

Primary Outcome Measures

  1. Seroconversion Rate [Day 210]

    Percentage of subjects with an anti-HBs antibody level ≥ 2.1 mIU/mL 30 days after the last of three vaccinations. Seroconversion is defined as the development of a detectable anti-HBs antibody level above an established threshold of 2.1 mIU/mL.

Secondary Outcome Measures

  1. Seroprotection Rate [Days 1, 28, 90, 180, 210]

    Percentage of subjects with an anti-HBs antibody level ≥ 10 mIU/mL prior to vaccination, 28 days after the first vaccination, 60 and 150 days after the second vaccination and 30 days after the third vaccination. The development of an anti-HBs antibody level of at least 10 mIU/mL is an established surrogate of seroprotection and correlate of protective immunity against HBV.

  2. Seroconversion Rate [Days 1, 28, 90, 180]

    Percentage of subjects with an anti-HBs antibody level ≥ 2.1 mIU/mL prior to vaccination, 28 days after the first vaccination and 60 and 150 days after the second vaccination. Seroconversion is defined as the development of a detectable anti-HBs antibody level above an established threshold of 2.1 mIU/mL.

  3. Geometric Mean Concentrations (GMC) of HBs Antibodies [Days 1, 28, 90, 180, and 210]

    Geometric mean concentration of anti-HBs antibody in mIU/mL 28 days after the first vaccination, 60 and 150 days after the second vaccination, and 30 days after the third vaccination.

Other Outcome Measures

  1. Adverse Events: Local Reactions at the Injection Site- Incidence of Redness [Day 1, Day 2, and Day 28]

    Incidence of mild erythema at the injection site 1, 2 and 28 days after the first vaccination.

  2. Adverse Events: Local Reactions at the Injection Site - Incidence of Itch [Days 1-5, Days 28-32, Day 90, Days 180-185, Day 210]

    Incidence of itchiness at the injection site at any point throughout the trial. Itchiness was assessed for 5 days following vaccinations on Days 1, 28, and 180 and also assessed on Day 90 and Day 210.

  3. Adverse Events: Local Reactions at the Injection Site - Incidence of Pain [Days 1, 28, 180]

    Incidence of pain at the injection site on the day of vaccination. Vaccination was performed on Day 1, Day 28, and Day 180.

  4. Adverse Events: Local Reactions at the Injection Site - Intensity of Pain [Days 1, 28, 180]

    Pain was evaluated 30 minutes after each vaccination by the subject using the visual analogue scale. A higher score indicates greater pain intensity.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years to 45 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
Yes
Inclusion Criteria:
  1. Availability of written Informed Consent to participate in the study from the subject.

  2. Male or female between 18 and 45 years old without previous contact with hepatitis B virus (HBV).

  3. Good health condition based on full physical examination.

  4. Normal values of laboratory biochemical blood tests.

  5. Seronegative with respect to anti-HBs (surface) antibodies, anti-HBc (core) antibodies, and HBs Antigen (HBsAg) on screening.

  6. Not pregnant and not breast-feeding.

  7. For men and women of reproductive age: consent for use of an effective contraception method, for example, an intrauterine device, oral contraceptive, hypodermic implant or double barrier method (a condom with contraceptive sponge or contraceptive suppository) throughout the entire study.

Exclusion Criteria:
  1. Congenital or inherited immunodeficiency disorder in family history.

  2. Information of a serious blood disorder, cardiac disorder, or tumour.

  3. Current use of any medication that could alter immune reactivity.

  4. Infection with HBV at the present time or in the past, confirmed by HBV markers test.

  5. Anaphylaxis or severe allergy, or atopy, history of alcoholism or drug abuse.

  6. Pregnancy and breast-feeding.

Contacts and Locations

Locations

Site City State Country Postal Code
1 Saint Petersburg State Budgetary Healthcare Institution Saint Petersburg Mirgorodskaya Russian Federation 191167

Sponsors and Collaborators

  • VBI Vaccines Inc.

Investigators

  • Principal Investigator: Elena Esaulenko, Saint Petersburg State Paediatric Medical University

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

Publications

None provided.
Responsible Party:
VBI Vaccines Inc.
ClinicalTrials.gov Identifier:
NCT04209400
Other Study ID Numbers:
  • 38-13-040 RUS
First Posted:
Dec 24, 2019
Last Update Posted:
Jul 25, 2022
Last Verified:
Mar 1, 2022
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by VBI Vaccines Inc.
Additional relevant MeSH terms:

Study Results

Participant Flow

Recruitment Details
Pre-assignment Detail
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, IM injection at Days 1, 28 and 180 Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, IM injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Period Title: Overall Study
STARTED 50 50
COMPLETED 50 49
NOT COMPLETED 0 1

Baseline Characteristics

Arm/Group Title Sci-B-Vac® Engerix-B® Total
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, IM injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, IM injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Total of all reporting groups
Overall Participants 50 50 100
Age (Count of Participants)
<=18 years
0
0%
0
0%
0
0%
Between 18 and 65 years
50
100%
50
100%
100
100%
>=65 years
0
0%
0
0%
0
0%
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]
28.38
(7.72)
30.56
(8.13)
29.47
(7.96)
Sex: Female, Male (Count of Participants)
Female
32
64%
29
58%
61
61%
Male
18
36%
21
42%
39
39%
Race/Ethnicity, Customized (Count of Participants)
Caucasian-Russians
50
100%
50
100%
100
100%
Region of Enrollment (Count of Participants)
Russia
50
100%
50
100%
100
100%

Outcome Measures

1. Primary Outcome
Title Seroconversion Rate
Description Percentage of subjects with an anti-HBs antibody level ≥ 2.1 mIU/mL 30 days after the last of three vaccinations. Seroconversion is defined as the development of a detectable anti-HBs antibody level above an established threshold of 2.1 mIU/mL.
Time Frame Day 210

Outcome Measure Data

Analysis Population Description
The primary analysis was performed on the intent-to-treat (ITT) set, which included all participants randomized. Analysis of the study parameters for vaccine immunogenicity was performed for all subjects included in the vaccine groups who received at least one injection, if at least one assessment after the start of the vaccination was available.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 47 47
Count of Participants [Participants]
47
94%
46
92%
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Sci-B-Vac®, Engerix-B®
Comments The null hypothesis is that the vaccines equally affect the achievement of seroconversion level.
Type of Statistical Test Non-Inferiority
Comments P < 0.05 is considered a statistically significant difference in seroconversion between the two groups.
Statistical Test of Hypothesis p-Value 1
Comments
Method Chi-squared
Comments
2. Secondary Outcome
Title Seroprotection Rate
Description Percentage of subjects with an anti-HBs antibody level ≥ 10 mIU/mL prior to vaccination, 28 days after the first vaccination, 60 and 150 days after the second vaccination and 30 days after the third vaccination. The development of an anti-HBs antibody level of at least 10 mIU/mL is an established surrogate of seroprotection and correlate of protective immunity against HBV.
Time Frame Days 1, 28, 90, 180, 210

Outcome Measure Data

Analysis Population Description
The analysis was performed on the intent-to-treat (ITT) set, which included all participants randomized. Analysis of the study parameters for vaccine immunogenicity was performed for all subjects included in the vaccine groups who received at least one injection, if at least one assessment after the start of the vaccination was available.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 1
0
0%
0
0%
Day 28
30
60%
24
48%
Day 90
47
94%
41
82%
Day 180
47
94%
42
84%
3. Secondary Outcome
Title Seroconversion Rate
Description Percentage of subjects with an anti-HBs antibody level ≥ 2.1 mIU/mL prior to vaccination, 28 days after the first vaccination and 60 and 150 days after the second vaccination. Seroconversion is defined as the development of a detectable anti-HBs antibody level above an established threshold of 2.1 mIU/mL.
Time Frame Days 1, 28, 90, 180

Outcome Measure Data

Analysis Population Description
The analysis was performed on the intent-to-treat (ITT) set, which included all participants randomized. Analysis of the study parameters for vaccine immunogenicity was performed for all subjects included in the vaccine groups who received at least one injection, if at least one assessment after the start of the vaccination was available.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 1
0
0%
0
0%
Day 28
46
92%
36
72%
Day 90
48
96%
45
90%
Day 180
47
94%
45
90%
4. Secondary Outcome
Title Geometric Mean Concentrations (GMC) of HBs Antibodies
Description Geometric mean concentration of anti-HBs antibody in mIU/mL 28 days after the first vaccination, 60 and 150 days after the second vaccination, and 30 days after the third vaccination.
Time Frame Days 1, 28, 90, 180, and 210

Outcome Measure Data

Analysis Population Description
The analysis was performed on the intent-to-treat (ITT) set, which included all participants randomized. Analysis of the study parameters for vaccine immunogenicity was performed for all subjects included in the vaccine groups who received at least one injection, if at least one assessment after the start of the vaccination was available.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 90
618.3
(404.2)
378.7
(417.9)
Day 180
757.7
(378.0)
441.3
(437.6)
Day 210
891.4
(253.7)
787.0
(351.9)
5. Other Pre-specified Outcome
Title Adverse Events: Local Reactions at the Injection Site- Incidence of Redness
Description Incidence of mild erythema at the injection site 1, 2 and 28 days after the first vaccination.
Time Frame Day 1, Day 2, and Day 28

Outcome Measure Data

Analysis Population Description
The analysis of safety and tolerability was conducted in the population of subjects included in the study meeting the inclusion criteria while complying with the exclusion criteria, who received at least one dose of the experimental vaccine.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 1
8
16%
4
8%
Day 2
2
4%
1
2%
Day 28
3
6%
0
0%
6. Other Pre-specified Outcome
Title Adverse Events: Local Reactions at the Injection Site - Incidence of Itch
Description Incidence of itchiness at the injection site at any point throughout the trial. Itchiness was assessed for 5 days following vaccinations on Days 1, 28, and 180 and also assessed on Day 90 and Day 210.
Time Frame Days 1-5, Days 28-32, Day 90, Days 180-185, Day 210

Outcome Measure Data

Analysis Population Description
The analysis of safety and tolerability was conducted in the population of subjects included in the study meeting the inclusion criteria while complying with the exclusion criteria, who received at least one dose of the experimental vaccine.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Count of Participants [Participants]
1
2%
0
0%
7. Other Pre-specified Outcome
Title Adverse Events: Local Reactions at the Injection Site - Incidence of Pain
Description Incidence of pain at the injection site on the day of vaccination. Vaccination was performed on Day 1, Day 28, and Day 180.
Time Frame Days 1, 28, 180

Outcome Measure Data

Analysis Population Description
The analysis of safety and tolerability was conducted in the population of subjects included in the study meeting the inclusion criteria while complying with the exclusion criteria, who received at least one dose of the experimental vaccine.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 1
7
14%
8
16%
Day 28
8
16%
7
14%
Day 180
7
14%
11
22%
8. Other Pre-specified Outcome
Title Adverse Events: Local Reactions at the Injection Site - Intensity of Pain
Description Pain was evaluated 30 minutes after each vaccination by the subject using the visual analogue scale. A higher score indicates greater pain intensity.
Time Frame Days 1, 28, 180

Outcome Measure Data

Analysis Population Description
The analysis of safety and tolerability was conducted in the population of subjects included in the study meeting the inclusion criteria while complying with the exclusion criteria, who received at least one dose of the experimental vaccine.
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
Measure Participants 50 49
Day 1 : Pains score 1
43
86%
41
82%
Day 1 : Pain score 2
5
10%
6
12%
Day 1 : Pain score 3
2
4%
2
4%
Day 28 : Pain score 1
42
84%
41
82%
Day 28 : Pain score 2
7
14%
6
12%
Day 28 : Pain score 3
1
2%
1
2%
Day 180 : Pain score 1
40
80%
36
72%
Day 180 : Pain score 2
7
14%
9
18%
Day 180 : Pain score 3
0
0%
2
4%

Adverse Events

Time Frame Through study completion, approximately 7 months.
Adverse Event Reporting Description An AE is any unfavourable sign (including abnormal lab results), symptom, or disease that are time-associated with vaccine use, regardless whether or not they are viewed as having been caused by medicinal products, and whether they are mild or serious. Intensity of the adverse events were defined as Mild: Adverse event that is easily tolerated. Moderate: AEs causing discomfort sufficient for impairment of everyday activity. Severe: Adverse event preventing normal everyday activity
Arm/Group Title Sci-B-Vac® Engerix-B®
Arm/Group Description Sci-B-Vac® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 10ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination Engerix-B® (hepatitis B vaccine) Hepatitis B Vaccination, Solution, 20ug, intramuscular (IM) injection at Days 0, 28, and 180. Hepatitis B Vaccination: Prophylactic Hepatitis B Vaccination
All Cause Mortality
Sci-B-Vac® Engerix-B®
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/50 (0%) 0/49 (0%)
Serious Adverse Events
Sci-B-Vac® Engerix-B®
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 0/50 (0%) 0/49 (0%)
Other (Not Including Serious) Adverse Events
Sci-B-Vac® Engerix-B®
Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 2/50 (4%) 7/49 (14.3%)
Gastrointestinal disorders
nausea 0/50 (0%) 0 1/49 (2%) 2
General disorders
Hyperthermia 0/50 (0%) 0 1/49 (2%) 1
Hepatobiliary disorders
steatohepatitis 0/50 (0%) 0 1/49 (2%) 1
Infections and infestations
acute respiratory viral infection 0/50 (0%) 0 1/49 (2%) 3
rotavirus infection 0/50 (0%) 0 1/49 (2%) 1
Musculoskeletal and connective tissue disorders
weakness 0/50 (0%) 0 1/49 (2%) 1
Nervous system disorders
drowsiness 2/50 (4%) 3 2/49 (4.1%) 2
metallic taste 0/50 (0%) 0 1/49 (2%) 2

Limitations/Caveats

Final CSR does not follow ICH guidelines and the original document in Russian was translated into English for the purpose of writing the manuscript and completing the documentation in clinicaltrials.gov

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

Name/Title Dr Francisco Diaz-Mitoma
Organization VBI Vaccines Inc.
Phone 613-297-3304
Email fdiazmitoma@vbivaccines.com
Responsible Party:
VBI Vaccines Inc.
ClinicalTrials.gov Identifier:
NCT04209400
Other Study ID Numbers:
  • 38-13-040 RUS
First Posted:
Dec 24, 2019
Last Update Posted:
Jul 25, 2022
Last Verified:
Mar 1, 2022