Rotavirus Gastroenteritis
Conditions
Brief summary
This study will assess the efficacy, safety, and immunogenicity of a 3-dose regimen of RotaTeq™ (V260) in healthy Chinese infants. Approximately 4040 participants at least 6 weeks and up to 12 weeks of age at the time of the first vaccination with V260 or placebo will be enrolled and randomized (1:1) to receive either V260 or placebo. Participants will also receive the routine China Expanded Program on Immunization (EPI) vaccines (oral poliovirus vaccine \[OPV\] and diphtheria, tetanus, and acellular pertussis vaccine \[DTaP\]) either staggered or concomitantly with V260 or placebo. All participants will be followed for efficacy and safety. Immune responses to OPV and DTaP will be evaluated in a subset of participants. The primary hypothesis of the study states that V260 will be efficacious in preventing any severity of rotavirus gastroenteritis as compared with placebo.
Interventions
V260 (RotaTeq™; live, oral, pentavalent rotavirus vaccine)
Placebo control
Oral poliovirus vaccine administered according to the standard of care
Diphtheria, Tetanus, Acellular Pertussis vaccine administered according to the standard of care
Sponsors
Study design
Eligibility
Inclusion criteria
* Healthy infants at least 6 weeks (42 days) and up to 12 weeks (84 days) of age at the time of the first study vaccination * Parent/legal guardian agrees to participate by giving written informed consent and is willing and able to comply with study requirements
Exclusion criteria
* History of congenital abdominal disorders, prior rotavirus gastroenteritis, chronic diarrhea, failure to thrive, or abdominal surgery * History of intussusception * Impairment of immunological function, including Severe Combined Immunodeficiency (SCID) * Acute disease, severe chronic disease, or chronic disease during the acute period * Uncontrolled epilepsy, encephalopathy, seizure, or other progressive neurological disease * Hypersensitivity to any component of the rotavirus vaccine, OPV, or DTaP * Prior receipt of any rotavirus vaccine * Fever, with an axillary temperature \>=37.5 °C (or equivalent) within 24 hours before study vaccination (study vaccination can be deferred until complete resolution of febrile illness) * Clinical evidence of active gastrointestinal illness * Received intramuscular, oral, or intravenous corticosteroid treatment since birth (topical, ophthalmic, and inhaled steroids are permitted) * Resides in a household with an immunocompromised person * Receipt of a blood transfusion or blood products, including immunoglobulins * Participation in another interventional study within 14 days before the first study vaccination or during the study * Receipt of an investigational or non-registered product other than the study vaccine within 30 days before the first study vaccination or during the study * For participants in immunogenicity arms: inability to obtain a blood specimen at randomization visit (note: the visit may be rescheduled so that a baseline specimen may be obtained); history of polio, diphtheria, tetanus, or pertussis disease; previous vaccination against diphtheria, tetanus, pertussis, or poliomyelitis * Any condition which, in the opinion of the investigator, may interfere with the evaluation of the study objectives
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Any Severity of Rotavirus Gastroenteritis | From 14 days after the third dose of V260 or placebo through the first rotavirus season (up to 15 months) | The number of participants with rotavirus gastroenteritis (RVGE) caused by naturally-occurring wild-type rotavirus (regardless of serotype or disease severity) was assessed. The case definition of RVGE included 1) 3 or more watery or looser-than-normal stools within a 24-hour period and/or forceful vomiting, and 2) naturally-occurring wild-type rotavirus must be detected in a stool specimen taken within 7 days after the onset of symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Vomiting or Diarrhea | Up to 30 days after any dose of V260 or Placebo | Episodes of vomiting and diarrhea were noted by the guardian and recorded on the Vaccination Record Card during Day 1 to Day 14 after each dose of vaccination. Vomiting and diarrhea reported by the guardian were also collected as an adverse event during Day 15 to Day 30 after any dose of vaccination. The percentage of participants with an episode or an adverse event of vomiting or diarrhea was assessed. |
| Percentage of Participants With Intussusception | Up to 15 months | Episodes of intussusception were collected from the time of written consent until the end of study. The percentage of participants with an episode of intussusception was assessed. |
| Number of Participants With Severe Rotavirus Gastroenteritis | From 14 days after the third dose of V260 or placebo through the first rotavirus season (up to 15 months) | The number of participants with severe rotavirus gastroenteritis (RVGE) caused by naturally-occurring wild-type rotavirus (regardless of serotype or disease severity) was assessed. The case definition of RVGE included 1) 3 or more watery or looser-than-normal stools within a 24-hour period and/or forceful vomiting, and 2) naturally-occurring wild-type rotavirus must be detected in a stool specimen taken within 7 days after the onset of symptoms. Severe RVGE was defined as \>=11 on the Vesikari Scoring System, a composite of the seven parameters related to symptoms and treatment with an overall range from 0 to 20. |
| Percentage of Participants With Elevated Temperature | Up to 30 days after any dose of V260 or Placebo | Elevated temperature (temperature \>=37.5°C axillary or equivalent) was noted by the guardian and recorded on the Vaccination Report Card during Day 1 to Day 14 after each dose of vaccination. Elevated temperature reported by the guardian was also collected as an adverse event (pyrexia) during Day 15 to Day 30 after each dose of vaccination. The percentage of participants with axillary temperature \>=37.5 °C or an adverse event of pyrexia was assessed. |
| Percentage of Participants With Any Adverse Event | Up to 30 days after any dose of V260 or Placebo | An adverse event is defined as any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. An adverse event can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product or protocol-specified procedure, whether or not considered related to the medicinal product or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the use of the sponsor's product, is also an adverse event. |
| Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Baseline and between 28 and 51 days after the third DTaP vaccination | The percentage of participants seropositive to diphtheria, pertussis, or tetanus antigens was assessed. Seropositive was defined as the following: 1) anti-diphtheria antibody titers \>=0.1 International Units (IU)/mL, 2) anti-tetanus antibody titers \>=0.1 IU/mL, 3) antipertussis toxin antibody titers \>=20 Enzyme-linked Immunosorbent Assay (ELISA) Units (EU)/mL, 4) anti-pertussis filamentous hemagglutinin (FHA) antibody titers \>=20 EU/mL. This outcome was evaluated only in participants receiving concomitant administration of V260 and EPI. |
| Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Baseline and between 28 and 56 days after the third OPV vaccination | The percentage of participants who achieved seroprotection against poliovirus Type 1, 2, or 3 was assessed. Seroprotection was defined as a neutralizing antibody titer \>=1:8. This outcome was evaluated only in participants receiving concomitant administration of V260 and OPV. |
Participant flow
Recruitment details
A total of 4173 participants were screened, 4040 were randomized, and 4037 received at least one dose of study vaccination.
Participants by arm
| Arm | Count |
|---|---|
| V260 With Staggered EPI V260 administered as a 2 mL oral solution at age \
2, 3, and 4 months, and staggered EPI as follows: OPV administered as a 1 g oral solution at age \
2.5, 3.5, and 4.5 months, and DTaP administered as a 0.5 mL intramuscular injection at age \
3.5, 4.5, and 5.5 months. | 1,620 |
| Placebo With Staggered EPI Placebo administered as a 2 mL oral solution at age \
2, 3, and 4 months, and staggered EPI as follows: OPV administered as a 1 g oral solution at age \
2.5, 3.5, and 4.5 months, and DTaP administered as a 0.5 mL intramuscular injection at age \
3.5, 4.5, and 5.5 months. | 1,620 |
| V260 With Concomitant EPI V260 administered as a 2 mL oral solution at age \
2, 3, and 4 months, and concomitant EPI as follows: OPV administered as a 1 g oral solution at age \
2, 3, and 4 months, and DTaP administered as a 0.5 mL intramuscular injection at age \
3, 4, and 5 months. | 400 |
| Placebo With Concomitant EPI Placebo administered as a 2 mL oral solution at age \
2, 3, and 4 months, and concomitant EPI as follows: OPV administered as a 1 g oral solution at age \
2, 3, and 4 months, and DTaP administered as a 0.5 mL intramuscular injection at age \
3, 4, and 5 months. | 400 |
| Total | 4,040 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 19 | 13 | 1 | 0 |
| Overall Study | Death | 0 | 0 | 0 | 1 |
| Overall Study | Incomplete EPI by database lock | 2 | 0 | 0 | 0 |
| Overall Study | Lost to Follow-up | 0 | 0 | 1 | 0 |
| Overall Study | Moved | 10 | 11 | 1 | 0 |
| Overall Study | Protocol Violation | 1 | 0 | 0 | 0 |
| Overall Study | Withdrawn by parent/guardian | 46 | 41 | 9 | 8 |
Baseline characteristics
| Characteristic | V260 With Staggered EPI | Placebo With Staggered EPI | V260 With Concomitant EPI | Placebo With Concomitant EPI | Total |
|---|---|---|---|---|---|
| Age, Continuous | 57.5 Days STANDARD_DEVIATION 10 | 57.2 Days STANDARD_DEVIATION 9.7 | 68.3 Days STANDARD_DEVIATION 5.7 | 68.5 Days STANDARD_DEVIATION 5.7 | 59.5 Days STANDARD_DEVIATION 10.2 |
| Sex: Female, Male Female | 806 Participants | 775 Participants | 185 Participants | 183 Participants | 1949 Participants |
| Sex: Female, Male Male | 814 Participants | 845 Participants | 215 Participants | 217 Participants | 2091 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 938 / 2,015 | 931 / 2,019 |
| serious Total, serious adverse events | 339 / 2,015 | 338 / 2,019 |
Outcome results
Number of Participants With Any Severity of Rotavirus Gastroenteritis
The number of participants with rotavirus gastroenteritis (RVGE) caused by naturally-occurring wild-type rotavirus (regardless of serotype or disease severity) was assessed. The case definition of RVGE included 1) 3 or more watery or looser-than-normal stools within a 24-hour period and/or forceful vomiting, and 2) naturally-occurring wild-type rotavirus must be detected in a stool specimen taken within 7 days after the onset of symptoms.
Time frame: From 14 days after the third dose of V260 or placebo through the first rotavirus season (up to 15 months)
Population: Participants who were vaccinated in either the staggered EPI or concomitant EPI groups, were not protocol violators, and were classified as evaluable for RVGE according to the per-protocol case definition.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| V260 With Staggered or Concomitant EPI | Number of Participants With Any Severity of Rotavirus Gastroenteritis | 34 Participants |
| Placebo With Staggered or Concomitant EPI | Number of Participants With Any Severity of Rotavirus Gastroenteritis | 109 Participants |
Number of Participants With Severe Rotavirus Gastroenteritis
The number of participants with severe rotavirus gastroenteritis (RVGE) caused by naturally-occurring wild-type rotavirus (regardless of serotype or disease severity) was assessed. The case definition of RVGE included 1) 3 or more watery or looser-than-normal stools within a 24-hour period and/or forceful vomiting, and 2) naturally-occurring wild-type rotavirus must be detected in a stool specimen taken within 7 days after the onset of symptoms. Severe RVGE was defined as \>=11 on the Vesikari Scoring System, a composite of the seven parameters related to symptoms and treatment with an overall range from 0 to 20.
Time frame: From 14 days after the third dose of V260 or placebo through the first rotavirus season (up to 15 months)
Population: Participants who were vaccinated in either the staggered EPI or concomitant EPI groups, were not protocol violators, and were classified as evaluable for RVGE according to the per-protocol case definition.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| V260 With Staggered or Concomitant EPI | Number of Participants With Severe Rotavirus Gastroenteritis | 11 Participants |
| Placebo With Staggered or Concomitant EPI | Number of Participants With Severe Rotavirus Gastroenteritis | 52 Participants |
Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens
The percentage of participants seropositive to diphtheria, pertussis, or tetanus antigens was assessed. Seropositive was defined as the following: 1) anti-diphtheria antibody titers \>=0.1 International Units (IU)/mL, 2) anti-tetanus antibody titers \>=0.1 IU/mL, 3) antipertussis toxin antibody titers \>=20 Enzyme-linked Immunosorbent Assay (ELISA) Units (EU)/mL, 4) anti-pertussis filamentous hemagglutinin (FHA) antibody titers \>=20 EU/mL. This outcome was evaluated only in participants receiving concomitant administration of V260 and EPI.
Time frame: Baseline and between 28 and 51 days after the third DTaP vaccination
Population: Participants in the concomitant EPI groups who receive their scheduled doses of DTaP without intervening disease specific to the antigen before the blood sample collection postdose 3, adhere to the guidelines for administration of vaccine, and have valid values available for analysis within specified day ranges.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Diphtheria: Baseline, n=181, 186 | 3.31 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Diphtheria: Post DTaP #3, n=187, 194 | 99.47 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis FHA: Baseline, n=181, 186 | 0.00 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis FHA: Post DTaP #3, n=187, 194 | 44.92 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis Toxin: Baseline, n=181, 186 | 1.66 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis Toxin, Post DTaP #3, n=187, 194 | 95.19 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Tetanus: Baseline, n=181, 186 | 12.15 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Tetanus: Post DTaP #3, n=187, 194 | 100.00 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Tetanus: Post DTaP #3, n=187, 194 | 100.00 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Diphtheria: Baseline, n=181, 186 | 2.69 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis Toxin: Baseline, n=181, 186 | 1.08 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Diphtheria: Post DTaP #3, n=187, 194 | 99.48 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Tetanus: Baseline, n=181, 186 | 12.37 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis FHA: Baseline, n=181, 186 | 0.00 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis Toxin, Post DTaP #3, n=187, 194 | 94.33 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Seropositive to Diphtheria, Pertussis, or Tetanus Antigens | Pertussis FHA: Post DTaP #3, n=187, 194 | 43.81 Percentage of participants |
Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3
The percentage of participants who achieved seroprotection against poliovirus Type 1, 2, or 3 was assessed. Seroprotection was defined as a neutralizing antibody titer \>=1:8. This outcome was evaluated only in participants receiving concomitant administration of V260 and OPV.
Time frame: Baseline and between 28 and 56 days after the third OPV vaccination
Population: Participants in the concomitant EPI groups who receive their scheduled doses of OPV without intervening disease specific to the antigen before the blood sample collection postdose 3, adhere to the guidelines for administration of vaccine, and have valid values available for analysis within specified day ranges.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 1: Baseline, n=186, 190 | 44.09 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 1: Post OPV #3, n=187, 192 | 98.93 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 2: Baseline, n=186, 190 | 44.09 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 2: Post OPV #3, n=187, 192 | 100.00 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 3: Baseline, n=186, 190 | 25.27 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 3: Post OPV #3, n=187, 192 | 98.93 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 3: Baseline, n=186, 190 | 21.05 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 1: Baseline, n=186, 190 | 38.95 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 2: Post OPV #3, n=187, 192 | 100.00 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 1: Post OPV #3, n=187, 192 | 100.00 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 3: Post OPV #3, n=187, 192 | 98.96 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants Who Achieved Seroprotection Against Poliovirus Type 1, 2, or 3 | Poliovirus Type 2: Baseline, n=186, 190 | 41.58 Percentage of participants |
Percentage of Participants With Any Adverse Event
An adverse event is defined as any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. An adverse event can therefore be any unfavourable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product or protocol-specified procedure, whether or not considered related to the medicinal product or protocol-specified procedure. Any worsening of a preexisting condition that is temporally associated with the use of the sponsor's product, is also an adverse event.
Time frame: Up to 30 days after any dose of V260 or Placebo
Population: All Subjects as Treated with safety follow-up
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants With Any Adverse Event | 53.5 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants With Any Adverse Event | 53.3 Percentage of participants |
Percentage of Participants With Elevated Temperature
Elevated temperature (temperature \>=37.5°C axillary or equivalent) was noted by the guardian and recorded on the Vaccination Report Card during Day 1 to Day 14 after each dose of vaccination. Elevated temperature reported by the guardian was also collected as an adverse event (pyrexia) during Day 15 to Day 30 after each dose of vaccination. The percentage of participants with axillary temperature \>=37.5 °C or an adverse event of pyrexia was assessed.
Time frame: Up to 30 days after any dose of V260 or Placebo
Population: All Subjects as Treated with follow-up specific to the endpoint
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants With Elevated Temperature | 21.84 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants With Elevated Temperature | 22.83 Percentage of participants |
Percentage of Participants With Intussusception
Episodes of intussusception were collected from the time of written consent until the end of study. The percentage of participants with an episode of intussusception was assessed.
Time frame: Up to 15 months
Population: All Subjects as Treated with safety follow-up
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants With Intussusception | 0.10 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants With Intussusception | 0.00 Percentage of participants |
Percentage of Participants With Vomiting or Diarrhea
Episodes of vomiting and diarrhea were noted by the guardian and recorded on the Vaccination Record Card during Day 1 to Day 14 after each dose of vaccination. Vomiting and diarrhea reported by the guardian were also collected as an adverse event during Day 15 to Day 30 after any dose of vaccination. The percentage of participants with an episode or an adverse event of vomiting or diarrhea was assessed.
Time frame: Up to 30 days after any dose of V260 or Placebo
Population: All Subjects as Treated with safety follow-up
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| V260 With Staggered or Concomitant EPI | Percentage of Participants With Vomiting or Diarrhea | Vomiting | 2.68 Percentage of participants |
| V260 With Staggered or Concomitant EPI | Percentage of Participants With Vomiting or Diarrhea | Diarrhea | 20.15 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants With Vomiting or Diarrhea | Vomiting | 3.52 Percentage of participants |
| Placebo With Staggered or Concomitant EPI | Percentage of Participants With Vomiting or Diarrhea | Diarrhea | 20.11 Percentage of participants |