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This is an open-label, randomized, exploratory study to evaluate the human immune response to reduced subcutaneous (SQ) dosing of Yellow Fever vaccine compared to the standard FDA approved subcutaneous vaccination dose. The current dose of the US FDA licensed Yellow Fever vaccine is approximately 55,000 plaque-forming unit(s) (PFU) in 0.5 mL administered SQ. Using the licensed dosage as standard, investigators are evaluating reduced doses of 1/5th (0.10 mL) and 1/10th (0.05 mL) standard Yellow Fever vaccine (YF-VAX).
Up to 150 individuals will be screened in order to randomize 90 eligible individuals to one of three groups: Group 1- YF-VAX® standard dose 0.5 mL SQ = 30 subjects; Group 2-0.10 mL (1/5th) SQ = 30 subjects; Group 3-0.05 mL (1/10th) SQ = 30 subjects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard Dose (Group 1) | Active Comparator | Yellow Fever vaccine standard dose, 0.5mL. |
|
| Fractional dose (Group 2) | Experimental | Yellow Fever vaccine 1/5th standard dose, 0.1mL. |
|
| Fractional dose (Group 3) | Experimental | Yellow Fever vaccine 1/10th standard dose, 0.05mL. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Yellow Fever Vaccine | Biological | Administered subcutaneously once. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Adverse Events | Rate of Adverse Events of fractional doses vs standard dose of YF-VAX. | Up to 28 days post vaccination |
| Neutralizing Antibody Response | For each group determine the PRNT50 neutralizing antibody response rate at the primary data point at post-vaccination day 28. | The primary data point is day 28 post-vaccination. |
| Measure | Description | Time Frame |
|---|---|---|
| Viremia | Compare the rate of viremia by Reverse Transcription Polymerase Chain Reaction (RT-PCR) [copies/mL] of fractional doses vs standard dose. | First 14 days following vaccination. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Phillip R Pittman, M.D., M.P.H. | US Army Medical Research Institute of Infectious Diseases | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| United States Army Medical Research Institute of Infectious Diseases | Frederick | Maryland | 21702 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27400066 | Background | Vasconcelos PF, Monath TP. Yellow Fever Remains a Potential Threat to Public Health. Vector Borne Zoonotic Dis. 2016 Aug;16(8):566-7. doi: 10.1089/vbz.2016.2031. Epub 2016 Jul 11. | |
| 27116054 | Background | Monath TP, Woodall JP, Gubler DJ, Yuill TM, Mackenzie JS, Martins RM, Reiter P, Heymann DL. Yellow fever vaccine supply: a possible solution. Lancet. 2016 Apr 16;387(10028):1599-600. doi: 10.1016/S0140-6736(16)30195-7. Epub 2016 Apr 14. No abstract available. |
| Label | URL |
|---|---|
| Addressing a Yellow Fever Vaccine Shortage | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Standard Dose (Group 1) | Yellow Fever vaccine standard dose, 0.5mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| FG001 | Fractional Dose (Group 2) | Yellow Fever vaccine 1/5th standard dose, 0.1mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| FG002 | Fractional Dose (Group 3) | Yellow Fever vaccine 1/10th standard dose, 0.05mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Analysis population included all subjects that signed consent & were randomized to a study group. Two targeted populations were defined for this study as outlined below. 1. Safety will be analyzed for all subjects who receive an injection of vaccine regardless of adherence to the protocol (intent to treat). 2. Subjects who receive vaccine & had titers drawn in compliance to protocol were included in the per protocol analysis set & used for immunogenicity and exploratory analysis (per protocol).
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| ID | Title | Description |
|---|---|---|
| BG000 | Standard Dose (Group 1) | Yellow Fever vaccine standard dose, 0.5mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| BG001 | Fractional Dose (Group 2) | Yellow Fever vaccine 1/5th standard dose, 0.1mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Adverse Events | Rate of Adverse Events of fractional doses vs standard dose of YF-VAX. | All participants who received a single dose of vaccine. | Posted | Count of Participants | Participants | Up to 28 days post vaccination |
|
Adverse Events collected Up to one year following vaccination.
Solicited and non-Solicited adverse events collected.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Standard Dose (Group 1) | Yellow Fever vaccine standard dose, 0.5mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Broken Jaw | Musculoskeletal and connective tissue disorders | Systematic Assessment | Two-night hospitalization which requires listing as SAE(not study related). |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Injection Site Pain | General disorders | Systematic Assessment |
This was a pilot study to establish proof of concept.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Phillip R. Pittman, M.D., MPH | USAMRIID | 301-619-2997 | phillip.r.pittman.civ@health.mil |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 14, 2023 | May 29, 2024 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Sep 2, 2021 | Mar 14, 2022 | ICF_000.pdf |
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| ID | Term |
|---|---|
| D022341 | Yellow Fever Vaccine |
| ID | Term |
|---|---|
| D014765 | Viral Vaccines |
| D014612 | Vaccines |
| D001688 | Biological Products |
| D045424 | Complex Mixtures |
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|
| 27479749 | Background | Calisher CH, Woodall JP. Yellow Fever-More a Policy and Planning Problem than a Biological One. Emerg Infect Dis. 2016 Oct;22(10):1859-60. doi: 10.3201/eid2210.160875. Epub 2016 Oct 15. No abstract available. |
| 27609407 | Background | Elachola H, Ditekemena J, Zhuo J, Gozzer E, Marchesini P, Rahman M, Sow S, Kattan RF, Memish ZA. Yellow fever outbreaks, vaccine shortages and the Hajj and Olympics: call for global vigilance. Lancet. 2016 Sep 17;388(10050):1155. doi: 10.1016/S0140-6736(16)31546-X. Epub 2016 Sep 5. No abstract available. |
| 18431480 | Background | Roukens AH, Vossen AC, Bredenbeek PJ, van Dissel JT, Visser LG. Intradermally administered yellow fever vaccine at reduced dose induces a protective immune response: a randomized controlled non-inferiority trial. PLoS One. 2008 Apr 23;3(4):e1993. doi: 10.1371/journal.pone.0001993. |
| 24331381 | Background | Slifka MK, Leung DY, Hammarlund E, Raue HP, Simpson EL, Tofte S, Baig-Lewis S, David G, Lynn H, Woolson R, Hata T, Milgrom H, Hanifin J. Transcutaneous yellow fever vaccination of subjects with or without atopic dermatitis. J Allergy Clin Immunol. 2014 Feb;133(2):439-47. doi: 10.1016/j.jaci.2013.10.037. Epub 2013 Dec 10. |
| 25022840 | Background | Campi-Azevedo AC, de Almeida Estevam P, Coelho-Dos-Reis JG, Peruhype-Magalhaes V, Villela-Rezende G, Quaresma PF, Maia Mde L, Farias RH, Camacho LA, Freire Mda S, Galler R, Yamamura AM, Almeida LF, Lima SM, Nogueira RM, Silva Sa GR, Hokama DA, de Carvalho R, Freire RA, Filho EP, Leal Mda L, Homma A, Teixeira-Carvalho A, Martins RM, Martins-Filho OA. Subdoses of 17DD yellow fever vaccine elicit equivalent virological/immunological kinetics timeline. BMC Infect Dis. 2014 Jul 15;14:391. doi: 10.1186/1471-2334-14-391. |
| 27837923 | Background | Wu JT, Peak CM, Leung GM, Lipsitch M. Fractional dosing of yellow fever vaccine to extend supply: a modelling study. Lancet. 2016 Dec 10;388(10062):2904-2911. doi: 10.1016/S0140-6736(16)31838-4. Epub 2016 Nov 10. |
| 27837922 | Background | Visser LG, Roukens AH. Modelling a way out of yellow fever. Lancet. 2016 Dec 10;388(10062):2847-2848. doi: 10.1016/S0140-6736(16)31330-7. Epub 2016 Nov 10. No abstract available. |
| 29443626 | Background | Casey RM, Harris JB, Ahuka-Mundeke S, Dixon MG, Kizito GM, Nsele PM, Umutesi G, Laven J, Kosoy O, Paluku G, Gueye AS, Hyde TB, Ewetola R, Sheria GKM, Muyembe-Tamfum JJ, Staples JE. Immunogenicity of Fractional-Dose Vaccine during a Yellow Fever Outbreak - Final Report. N Engl J Med. 2019 Aug 1;381(5):444-454. doi: 10.1056/NEJMoa1710430. Epub 2018 Feb 14. |
| 23364472 | Background | Martins RM, Maia Mde L, Farias RH, Camacho LA, Freire MS, Galler R, Yamamura AM, Almeida LF, Lima SM, Nogueira RM, Sa GR, Hokama DA, de Carvalho R, Freire RA, Pereira Filho E, Leal Mda L, Homma A. 17DD yellow fever vaccine: a double blind, randomized clinical trial of immunogenicity and safety on a dose-response study. Hum Vaccin Immunother. 2013 Apr;9(4):879-88. doi: 10.4161/hv.22982. Epub 2013 Jan 30. |
| 28643507 | Background | Yellow fever vaccine: WHO position on the use of fractional doses - June 2017. Wkly Epidemiol Rec. 2017 Jun 23;92(25):345-50. No abstract available. English, French. |
| 30937437 | Background | Roukens AHE, Visser LG. Fractional-dose yellow fever vaccination: an expert review. J Travel Med. 2019 Sep 2;26(6):taz024. doi: 10.1093/jtm/taz024. |
| 16494976 | Background | Hepburn MJ, Kortepeter MG, Pittman PR, Boudreau EF, Mangiafico JA, Buck PA, Norris SL, Anderson EL. Neutralizing antibody response to booster vaccination with the 17d yellow fever vaccine. Vaccine. 2006 Apr 5;24(15):2843-9. doi: 10.1016/j.vaccine.2005.12.055. Epub 2006 Jan 18. |
| 37843124 | Background | Hotez PJ, LaBeaud AD. Yellow Jack's Potential Return to the American South. N Engl J Med. 2023 Oct 19;389(16):1445-1447. doi: 10.1056/NEJMp2308420. Epub 2023 Oct 14. No abstract available. |
| 38023411 | Background | Hansen CA, Staples JE, Barrett ADT. Fractional Dosing of Yellow Fever Live Attenuated 17D Vaccine: A Perspective. Infect Drug Resist. 2023 Nov 8;16:7141-7154. doi: 10.2147/IDR.S370013. eCollection 2023. |
| BG002 | Fractional Dose (Group 3) | Yellow Fever vaccine 1/10th standard dose, 0.05mL. Yellow Fever Vaccine: Administered subcutaneously once. |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | Years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
|
| Fractional Dose (Group 3) |
Yellow Fever vaccine 1/10th standard dose, 0.05mL. Yellow Fever Vaccine: Administered subcutaneously once. |
|
|
| Primary | Neutralizing Antibody Response | For each group determine the PRNT50 neutralizing antibody response rate at the primary data point at post-vaccination day 28. | All participants who received a single dose of vaccine and complied with day 28 study visit. | Posted | Count of Participants | Participants | The primary data point is day 28 post-vaccination. |
|
|
|
| Secondary | Viremia | Compare the rate of viremia by Reverse Transcription Polymerase Chain Reaction (RT-PCR) [copies/mL] of fractional doses vs standard dose. | Posted | Count of Participants | Participants | First 14 days following vaccination. |
|
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| 0 |
| 29 |
| 1 |
| 29 |
| 15 |
| 29 |
| EG001 | Fractional Dose (Group 2) | Yellow Fever vaccine 1/5th standard dose, 0.1mL. Yellow Fever Vaccine: Administered subcutaneously once. | 0 | 30 | 0 | 30 | 11 | 30 |
| EG002 | Fractional Dose (Group 3) | Yellow Fever vaccine 1/10th standard dose, 0.05mL. Yellow Fever Vaccine: Administered subcutaneously once. | 0 | 29 | 0 | 29 | 7 | 29 |
|
| Headache | Nervous system disorders | Systematic Assessment |
|
| Nasal Congestion | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Bruise (vaccination site) | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| Erythema at Injection Site | Skin and subcutaneous tissue disorders | Systematic Assessment |
|
| Induration (vaccination site) | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| White Blood Cell Decreased | Blood and lymphatic system disorders | Systematic Assessment |
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| Neutrophil Count Decreased | Blood and lymphatic system disorders | Systematic Assessment |
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| Body Aches | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Bruise: Blood Draw Site | Blood and lymphatic system disorders | Systematic Assessment |
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