Smallpox
Conditions
Keywords
Smallpox, vaccine, IMVAMUNE, Stratis, parent protocol
Brief summary
Imvamune (licensed name of MVA being developed as a smallpox vaccine) has been tested in over 2,000 individuals and is on path for licensure. This study will be a Phase II to evaluate three different immunization schedules and two different modes of delivery. The study will look at condensed schedules. Study will randomize subjects to one of four arms.
Detailed description
This is a Phase II, randomized, open-label immunogenicity and safety study of different immunization schedules and delivery systems (syringe and needle vs. the Stratis™) in healthy, vaccinia-naïve adults 18 years to 40 years of age, inclusive. Approximately 352 subjects will be enrolled and randomized to one of four study arms. Study Arm A (N=88) will receive a two dose regimen of IMVAMUNE® (1x10\^8 TCID50/0.5 mL per dose) via the SC route using a syringe and needle on Day 1 and 29. Study Arm B (N=88) will receive a two dose regimen of IMVAMUNE® (1x10\^8 TCID50/0.5 mL per dose) via the SC route using a syringe and needle on Day 1 and 15. Study Arm C (N=88) will receive a two dose regimen of IMVAMUNE® (1x10\^8 TCID50/0.5 mL) via the SC route using a syringe and needle on Day 1 and 22. Study Arm D (N=88) will receive a two dose regimen of IMVAMUNE® (1x10\^8 TCID50/0.5 mL) via the SC route using the Stratis™ on Day 1 and 29. Immunogenicity assessments will be performed using ELISA and PRNT. Safety assessments will be done via solicited injection site and systemic reactions. Unsolicited AEs will be collected until 28 days post last injection and SAEs for the duration of the subjects' study participation. Safety laboratory assessments will be performed at baseline and 14 days after each vaccination. Primary outcome measures: For each subject, the peak PRNT will be defined as the highest titer among all available measurements post second vaccination; Occurrence of solicited local injection site reactions in subjects receiving vaccine via the Stratis™ compared to syringe and needle administration as collected on the memory aid and by in clinic assessment. Parent protocol to sub-study 13-0027.
Interventions
BIOLOGICALMVA Smallpox Vaccine
Subjects receive two dose regimen of IMVAMUNE® (1x10\^8 TCID50/0.5 mL per dose) via the SC route using either a syringe and needle or the Stratis™ system. Arm A receives doses via syringe and needle on days 1 and 29; Arm B receives doses via syringe and needle on days 1 and 15, Arm C receives doses via syringe and needle on days 1 and 22, Arm D receives doses via Stratis on days 1 and 29.
Sponsors
National Institute of Allergy and Infectious Diseases (NIAID)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
1. 18 to 40 years of age, inclusive. 2. Read, signed, and dated informed consent document. 3. Available for follow-up for the planned duration of the study (six months after last immunization). 4. Acceptable medical history by screening evaluation and limited physical assessment. 5. If the subject is female and of childbearing potential, negative serum or urine pregnancy test at screening and within 24 hours prior to vaccination. 6. If the subject is female and of childbearing potential\*, she agrees to practice abstinence\*\* or use acceptable contraception\*\*\* through 56 days after the last vaccination in order to avoid pregnancy: \* a woman is considered of childbearing potential unless post-menopausal (\>/= 1 year without menses) or surgically sterilized (tubal ligation, bilateral oophorectomy, or hysterectomy) \*\*No sexual intercourse with men (vaginal penetration by a penis, coitus) \*\*\*Acceptable contraception methods are restricted to effective devices (IUDs, NuvaRing®) or licensed hormonal products with use of method for a minimum of 30 days prior to vaccination, condoms with spermicidal agents, monogamous relationship with a vasectomized partner who has been vasectomized for 6 months or more prior to study entry, or successful Essure placement with documented confirmation test at least 3 months after the procedure, and any other FDA-approved contraceptive method 7. Negative test for HIV. 8. Alanine Aminotransferase (ALT) \<1.25 times the central lab upper limit of normal. 9. Negative hepatitis B surface antigen and negative antibody to hepatitis C virus. 10. Negative urine glucose and negative or trace urine protein by dipstick or urinalysis. 11. Adequate renal function (defined as a serum creatinine not exceeding the central lab's upper limit of normal). 12. Electrocardiogram (ECG) with no clinically significant abnormalities\* \* e.g., complete left or right bundle branch block, incomplete left bundle branch block or sustained ventricular arrhythmia, or two PVC's in a row, or ST elevation consistent with ischemia) 13. Acceptable hematology parameters: * Hemoglobin (Hgb) equal or above the lower limit of central lab normal (sex-specific); * White Blood Cell (WBC) \> 3,800 and \< 10,900/mm\^3; * Platelets \>/=120,000/mm\^3 14. Body mass index \>/=18.5-\< 35. 15. Be able to understand and comply with planned study procedures.
Exclusion criteria
1. History of immunodeficiency. 2. Typical vaccinia scar. 3. Known or suspected history of smallpox vaccination including MVA alone or as a vector, as well as other investigational smallpox vaccines. 4. Military service prior to 1991 or after January 2003. 5. Known or suspected significant underlying illness including, but not limited to, clinically significant liver disease, diabetes mellitus, or moderate to severe kidney impairment. 6. Malignancy (not including squamous cell skin cancer or basal cell skin cancer unless at the vaccination site) or history of skin cancer at the vaccination site. 7. Active autoimmune disease. Persons with vitiligo or thyroid disease (e.g., taking thyroid hormone replacement) are not excluded. 8. History of myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, or other heart condition under the care of a doctor\* \*Subjects with a not clinically relevant heart murmur, i.e., without any pathological ECG/arrhythmias or under treatment are not excluded. 9. Systolic blood pressure \>/= 150mmHg or diastolic blood pressure \>/= 100mmHg. 10. Ten percent or greater risk of developing a myocardial infarction or coronary death within the next 10 years using the National Cholesterol Education Program's (NCEP) risk assessment tool\* \*NOTE that this criterion applies only to subjects 20 years of age and older AND only if at least one of the following apply: * have smoked a cigarette in the past month, and/or * have hypertension (defined as systolic blood pressure \>140 mm Hg) or are on antihypertensive medication, and/or * have a family history of coronary heart disease in male first-degree relative (father or brother) \<55 years of age or a female first-degree relative (mother or sister) \<65 years of age URL for NCEP risk assessment tool: http://cvdrisk.nhlbi.nih.gov/calculator.asp (if a subject has an HDL of greater than 100mg/dl please enter 100 in the tool) 11. High-dose corticosteroid use for greater than 2 weeks duration within three months prior to vaccination or current use of immunosuppressive medication: * \>5 mg prednisone or equivalent is considered high dose and immunosuppressive * Corticosteroid nasal sprays for allergic rhinitis are permissible * Persons who are using a topical steroid for mild uncomplicated dermatitis such as poison ivy or contact dermatitis may be enrolled the day after their therapy is completed * Inhaled steroids for asthma are not permissible * Oral/parenteral corticosteroids given for non-chronic conditions not expected to recur are permissible if the length of therapy was \</= 14 days with completion at least 30 days prior to enrollment. 12. Medical or psychiatric condition or occupational responsibilities that preclude subject compliance with the protocol. 13. Any history of illegal injection drug use. 14. Receipt or planned receipt of inactivated vaccine from 14 days prior to the first vaccination through 14 days post second vaccination. 15. Receipt or planned receipt of any other live attenuated vaccine within 30 days prior to the first vaccination through 30 days post second vaccination. 16. Use of any other experimental agent within 30 days prior to vaccination and for the duration of the subject's participation in the study. 17. Receipt of blood products or immunoglobulin, including Rhogam, within six months prior to vaccination. 18. Donation of a unit of blood within 56 days prior to vaccination or planned donation prior to 28-days following the last vaccination. 19. Pregnant or breastfeeding women. 20. Active exfoliative skin disorders/conditions, current varicella zoster virus infection, or any acute skin disorders of large magnitude, e.g., laceration requiring sutures, burn greater than 2×2 cm. 21. Any condition that, in the opinion of the investigator, might interfere with assessing the study objectives. 22. Known allergy to egg, aminoglycoside (including gentamicin) or chicken. 23. Study personnel. 24. Allergic reaction to any vaccine.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination | Day 7 through Day 31 after 2nd vaccination | Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of plaque reduction neutralization titers. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers. |
| Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | 15 days after each vaccination | Participants maintained a memory aid to record daily the occurrence of local injection site reactions for 15 days after vaccination based on their interference with daily activities (pain and itchiness at injection site, underarm pain and swelling) or based on a quantitative measurement of the reaction (redness, swelling). In the subjective grading scale, severe reactions prevented daily activities, moderate reactions interfered with but did not prevent daily activities, and mild reactions were present but did not interfere with daily activities. For the quantitative scale, severe reactions greater than 30 millimeters (mm), moderate reactions were 15-30mm, and mild reactions were 1-15mm. Participants are counted by the maximum severity on any of the 15 days, and for this outcome measure, only those reporting moderate or severe events are counted. Formal comparisons by Fisher's Exact test were conducted for Arm D (Stratis, Day 1,29) compared to A |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Geometric Mean Peak ELISA Titer After Second Vaccination | Day 7 through 31 after the 2nd vaccination | Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of antibody titers by ELISA. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers. |
| Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE | Day 1 after the first vaccination through 180 days after the 2nd vaccination. | Serious adverse events included any untoward medical occurrence that resulted in death; was life threatening; was a persistent/significant disability/incapacity; required inpatient hospitalization or prolongation thereof; was a congenital anomaly/birth defect; or may have jeopardized the participant, or required intervention to prevent one of the outcomes. Association with IMVAMUNE was determined by the investigator and defined as Related, meaning a reasonable possibility that the study product caused the adverse event. Reasonable possibility was defined as there being evidence to suggest a causal relationship between the study product and the adverse event. |
Countries
United States
Participant flow
Recruitment details
Participants were healthy adult males and females recruited from existing volunteer populations and from the communities at large around the clinical sites. Participants were enrolled between 17JUN2013 and 23SEP2014.
Participants by arm
| Arm | Count |
|---|---|
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle IMVAMUNE 1x10\^8 TCID50/0.5 mL subcutaneously (SC) via syringe and needle on Days 1 and 29. | 115 |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle IMVAMUNE 1x10\^8 TCID50/0.5 mL SC) via syringe and needle on Days 1 and 15. | 96 |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle IMVAMUNE 1x10\^8 TCID50/0.5 mL subcutaneously (SC) via syringe and needle on Days 1 and 22. | 104 |
| Arm D: IMVAMUNE Days 1+29, Stratis IMVAMUNE® 1x10\^8 TCID50/0.5 mL subcutaneously (SC) via Stratis™ auto injector on Days 1 and 29. | 120 |
| Total | 435 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 0 | 4 | 2 |
| Overall Study | Lost to Follow-up | 0 | 2 | 0 | 4 |
| Overall Study | Physician Decision | 0 | 1 | 0 | 1 |
| Overall Study | Protocol Violation | 1 | 0 | 0 | 0 |
| Overall Study | Temporary study halt to vaccinations | 11 | 2 | 5 | 13 |
| Overall Study | Withdrawal by Subject | 1 | 2 | 2 | 3 |
Baseline characteristics
| Characteristic | Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Arm D: IMVAMUNE Days 1+29, Stratis | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 115 Participants | 96 Participants | 104 Participants | 120 Participants | 435 Participants |
| Age, Continuous | 27.2 years STANDARD_DEVIATION 5.6 | 27.1 years STANDARD_DEVIATION 5.4 | 27.2 years STANDARD_DEVIATION 5 | 27.9 years STANDARD_DEVIATION 5.2 | 27.4 years STANDARD_DEVIATION 5.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants | 4 Participants | 12 Participants | 7 Participants | 33 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 104 Participants | 92 Participants | 92 Participants | 113 Participants | 401 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 7 Participants | 3 Participants | 7 Participants | 12 Participants | 29 Participants |
| Race (NIH/OMB) Black or African American | 20 Participants | 15 Participants | 17 Participants | 18 Participants | 70 Participants |
| Race (NIH/OMB) More than one race | 6 Participants | 8 Participants | 4 Participants | 4 Participants | 22 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 81 Participants | 70 Participants | 74 Participants | 86 Participants | 311 Participants |
| Region of Enrollment United States | 115 participants | 96 participants | 104 participants | 120 participants | 435 participants |
| Sex: Female, Male Female | 61 Participants | 49 Participants | 59 Participants | 60 Participants | 229 Participants |
| Sex: Female, Male Male | 54 Participants | 47 Participants | 45 Participants | 60 Participants | 206 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 114 / 116 | 94 / 96 | 103 / 103 | 119 / 120 |
| serious Total, serious adverse events | 2 / 116 | 1 / 96 | 1 / 103 | 1 / 120 |
Outcome results
Primary
Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination
Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of plaque reduction neutralization titers. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers.
Time frame: Day 7 through Day 31 after 2nd vaccination
Population: The modified ATP population was defined as all participants who received both vaccinations in window, excluding those who did not have a complete dose delivered or received non-study vaccinations. Only measurements (blood draws) between Days 7-31 were considered and subjects had to have at least two measurements in that range to be included.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination | 138.0 titers |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination | 55.1 titers |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination | 75.9 titers |
| Arm D: IMVAMUNE Days 1+29, Stratis | Geometric Mean Peak Plaque Reduction Neutralization Titer (PRNT) After Second Vaccination | 103.5 titers |
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm B)) ≥ 1 or GMT(Arm A)/GMT (Arm B) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm B)) \< 1 or GMT(Arm A)/GMT(Arm B) \< 2.~Sample Size: The SD for log2 PRNT based on a prior study was\~1.9. The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used. Power=80%98.33% CI: [0.72, 1.93]
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm C)) ≥ 1 or GMT(Arm A)/GMT (Arm C) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm C)) \< 1 or GMT(Arm A)/GMT(Arm C) \< 2.~Sample Size: The SD for log2 PRNT based on a prior study was\~1.9. The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used. Power=80%98.33% CI: [0.26, 1.47]
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm D)) ≥ 1 or GMT(Arm A)/GMT (Arm D) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm D)) \< 1 or GMT(Arm A)/GMT(Arm D) \< 2.~Sample Size: The SD for log2 PRNT based on a prior study was\~1.9. The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used. Power=80%98.33% CI: [-0.17, 1.0007]
Primary
Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration
Participants maintained a memory aid to record daily the occurrence of local injection site reactions for 15 days after vaccination based on their interference with daily activities (pain and itchiness at injection site, underarm pain and swelling) or based on a quantitative measurement of the reaction (redness, swelling). In the subjective grading scale, severe reactions prevented daily activities, moderate reactions interfered with but did not prevent daily activities, and mild reactions were present but did not interfere with daily activities. For the quantitative scale, severe reactions greater than 30 millimeters (mm), moderate reactions were 15-30mm, and mild reactions were 1-15mm. Participants are counted by the maximum severity on any of the 15 days, and for this outcome measure, only those reporting moderate or severe events are counted. Formal comparisons by Fisher's Exact test were conducted for Arm D (Stratis, Day 1,29) compared to A
Time frame: 15 days after each vaccination
Population: All subjects receiving at least one vaccination are included in the analysis population 'as treated', so one subject randomized to Arm C vaccinated out of window, equivalent to the schedule for Arm A, was analyzed for this outcome measure as Arm A.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Pain at Injection Site | 28 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Swelling at Injection Site | 52 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Redness at Injection Site | 54 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Itchiness at Injection Site | 6 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Any Solicited Local Symptom | 73 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Pain | 4 percentage of participants |
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Swelling | 2 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Swelling at Injection Site | 47 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Swelling | 2 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Pain | 4 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Redness at Injection Site | 52 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Any Solicited Local Symptom | 69 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Itchiness at Injection Site | 10 percentage of participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Pain at Injection Site | 36 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Swelling | 2 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Pain at Injection Site | 26 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Itchiness at Injection Site | 17 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Pain | 3 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Redness at Injection Site | 60 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Swelling at Injection Site | 52 percentage of participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Any Solicited Local Symptom | 77 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Pain | 5 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Any Solicited Local Symptom | 90 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Swelling at Injection Site | 70 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Itchiness at Injection Site | 12 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Pain at Injection Site | 33 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Redness at Injection Site | 79 percentage of participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Percentage of Participants Reporting Moderate or Severe Solicited Local Injection Site Reactions After Receiving Vaccine Via the Stratis™ Compared to Syringe and Needle Administration | Underarm Swelling | 1 percentage of participants |
Comparison: Hypothesis:~H0: Pr('Pain at Injection Site ' Arm A) = Pr('Pain at Injection Site ' Arm D) H1: Pr('Pain at Injection Site ' Arm A) not = Pr('Pain at Injection Site ' Arm D)p-value: 0.4782Fisher Exact
Comparison: Hypothesis:~H0: Pr('Itchiness at Injection Site' Arm A) = Pr('Itchiness at Injection Site' Arm D) H1: Pr('Itchiness at Injection Site' Arm A) not = Pr('Itchiness at Injection Site' Arm D)p-value: 0.1704Fisher Exact
Comparison: Hypothesis:~H0: Pr('Underarm pain' Arm A) = Pr('Underarm pain' Arm D) H1: Pr('Underarm pain' Arm A) not = Pr('Underarm pain' Arm D)p-value: 1Fisher Exact
Comparison: Hypothesis:~H0: Pr('Underarm swelling' Arm A) = Pr('Underarm swelling' Arm D) H1: Pr('Underarm swelling' Arm A) not = Pr('Underarm swelling' Arm D)p-value: 0.6171Fisher Exact
Comparison: Hypothesis:~H0: Pr('Redness at Injection Site' Arm A) = Pr('Redness at Injection Site' Arm D) H1: Pr('Redness at Injection Site' Arm A) not = Pr('Redness at Injection Site' Arm D)p-value: <0.0001Fisher Exact
Comparison: Hypothesis:~H0: Pr('Swelling at Injection Site' Arm A) = Pr('Swelling at Injection Site' Arm D) H1: Pr('Swelling at Injection Site' Arm A) not = Pr('Swelling at Injection Site' Arm D)p-value: 0.005Fisher Exact
Comparison: Hypothesis:~H0: Pr('Any Solicited Local Reaction' Arm A) = Pr('Any Solicited Local Reaction' Arm D) H1: Pr('Any Solicited Local Reaction' Arm A) not = Pr('Any Solicited Local Reaction' Arm D)p-value: 0.0012Fisher Exact
Secondary
Geometric Mean Peak ELISA Titer After Second Vaccination
Blood was collected from all participants at 8, 15, 22 and 29 days after receipt of the second vaccination for assessment of antibody titers by ELISA. The peak titer for each participant was defined as the highest titer among all available measurements post second vaccination. The geometric mean for each group was then assessed from individual participants' peak titers.
Time frame: Day 7 through 31 after the 2nd vaccination
Population: The modified ATP population was defined as all participants who received both vaccinations in window, excluding those who did not have a complete dose delivered or received non-study vaccinations. Only measurements (blood draws) between Days 7-31 were considered and subjects had to have at least two measurements in that range to be included.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Geometric Mean Peak ELISA Titer After Second Vaccination | 1259.8 titers |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Geometric Mean Peak ELISA Titer After Second Vaccination | 741.4 titers |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Geometric Mean Peak ELISA Titer After Second Vaccination | 1021.0 titers |
| Arm D: IMVAMUNE Days 1+29, Stratis | Geometric Mean Peak ELISA Titer After Second Vaccination | 1351.8 titers |
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm B)) ≥ 1 or GMT(Arm A)/GMT (Arm B) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm B)) \< 1 or GMT(Arm A)/GMT(Arm B) \< 2.~The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used.98.33% CI: [0.37, 1.15]
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm C)) ≥ 1 or GMT(Arm A)/GMT (Arm C) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm C)) \< 1 or GMT(Arm A)/GMT(Arm C) \< 2.~The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used.98.33% CI: [-0.06, 0.67]
Comparison: Hypotheses: H0: log2(GMT(Arm A))-log2 (GMT(Arm D)) ≥ 1 or GMT(Arm A)/GMT (Arm D) ≥2 H1: log2(GMT(Arm A))-log2(GMT(Arm D)) \< 1 or GMT(Arm A)/GMT(Arm D) \< 2.~The margin of non-inferiority was specified as a 2-fold difference on the original scale (1 on the log2 scale). The objective included three non-inferiority evaluations (A vs. B, A vs. C, A vs. D). Thus, a Bonferroni-corrected alpha of 2.5% / 3 = 0.833% was used.98.33% CI: [-0.5, 0.3]
Secondary
Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE
Serious adverse events included any untoward medical occurrence that resulted in death; was life threatening; was a persistent/significant disability/incapacity; required inpatient hospitalization or prolongation thereof; was a congenital anomaly/birth defect; or may have jeopardized the participant, or required intervention to prevent one of the outcomes. Association with IMVAMUNE was determined by the investigator and defined as Related, meaning a reasonable possibility that the study product caused the adverse event. Reasonable possibility was defined as there being evidence to suggest a causal relationship between the study product and the adverse event.
Time frame: Day 1 after the first vaccination through 180 days after the 2nd vaccination.
Population: All subjects receiving at least one vaccination are included in the analysis population 'as treated', so one subject randomized to Arm C vaccinated out of window, equivalent to the schedule for Arm A, was analyzed for this outcome measure as Arm A.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A: IMVAMUNE Days 1+29, Syringe and Needle | Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE | 1 participants |
| Arm B: IMVAMUNE Days 1+15, Syringe and Needle | Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE | 0 participants |
| Arm C: IMVAMUNE Days 1+22, Syringe and Needle | Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE | 1 participants |
| Arm D: IMVAMUNE Days 1+29, Stratis | Number of Subjects Experiencing Serious Adverse Events (SAEs) Associated With IMVAMUNE | 0 participants |