Zika Virus
Conditions
Brief summary
Zika virus (ZIKV) is an illness people can get from mosquitoes. The infection is generally mild with symptoms that include a fever, rash, red eyes, and joint pain, though most of those infected have no symptoms. Preventing ZIKV is important because if a pregnant person is infected with ZIKV, it can cause birth defects in their unborn child. The goals of this study are to find out if people who have already been infected with one type of ZIKV can get infected with ZIKV a second time, and to test the ability of the TV003 dengue vaccine to prevent people from getting infected with the ZIKV-SJRP challenge virus.
Detailed description
This study is an open label with 2 study arms. Arm 1 will evaluate the protective efficacy of TV003 against ZIKV challenge. Arm 1 will include infectivity controls who will receive PlasmaLyte (the TV003 diluent) and the treatment assignment will be blinded to reduce bias in the assessment of adverse events. The PlasmaLyte recipients will serve as infectivity controls to ensure the potency of the ZIKV challenge. The treatment assignment of the infectivity controls may be unblinded as early as 28 days after receipt of TV003/PlasmaLyte if they are needed for ZIKV-challenge of volunteers in Arm 2 and may be challenged earlier than the TV003 cohort. Arm 2 will evaluate the protective efficacy of previous ZIKV infection against subsequent ZIKV challenge. Both arms will be compared to historical controls who previously received ZIKV infection. Infectivity controls will not be included in the efficacy analysis. This study will include 16 flavivirus-naïve subjects for Arm 1. Twelve subjects will receive the live attenuated dengue vaccine candidate TV003 at Study Day 0 and 4 subjects will receive PlasmaLyte at Study Day 0. These subjects will be randomized in blocks of 4 (3 TV003:1 PlasmaLyte). At Study Day 180, Arm 1 subjects will receive the controlled human infection strain of ZIKV SJRP/2016-184 as a challenge virus. These subjects will include those volunteers who received TV003 and at least 1 of the infectivity controls who received PlasmaLyte. Subjects in Arm 1 will be followed for approximately 52 weeks (approximately 360 days) from the time of vaccination. Ten subjects who had a ZIKV infection, either from a previous ZIKV controlled human infection study where they had received either ZIKV SJRP/2016-184 or ZIKV Nicaragua/2016 or were excluded during screening for previous studies as having ZIKV infection, will be enrolled as a group in Arm 2. Subjects enrolled in Arm 2 will be challenged with the ZIKV SJRP/2016-184 challenge virus separately from TV003 recipients. At least 1 of the PlasmaLyte recipients enrolled in Arm 1 on Day 0 will be included in this group to receive ZIKV SJRP/2016-184 as an infectivity control. Arm 2 subjects will be followed after ZIKV challenge for approximately 26 weeks (approximately 180 days). Subjects will be screened for eligibility up to 60 days prior to vaccination on Study Day 0.
Interventions
BIOLOGICALTetraVax-DV-TV003 (TV003)
0.5 ml of TV003 delivered via subcutaneous injection. TV003 contains 10\^3.3 plaque forming units (PFU)/mL of rDEN1Δ30, 10\^3.3 PFU/mL of rDEN2/4Δ30(ME), 10\^3.3 PFU/mL of rDEN3Δ30/31- 7164 and 10\^3.3 PFU/mL of rDEN4Δ30
BIOLOGICALPlasmalyte
0.5 mL of PlasmaLyte delivered via subcutaneous injection
BIOLOGICALChallenge virus ZIKV-SJRP/2016-184
0.5 ml of ZIKV-SJRP/2016-184 delivered via subcutaneous injection. ZIKV-SJRP/2016-184 contains a dose of 10\^2 plaque-forming units (PFU).
Sponsors
National Institute of Allergy and Infectious Diseases (NIAID)
Johns Hopkins Bloomberg School of Public Health
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
* Adults between 18 and 40 years of age, inclusive. * Good general health as determined by physical examination, laboratory screening, and review of medical history. * Available for the duration of the study, approximately 52 weeks. * Willingness to participate in the study as evidenced by signing the informed consent document. * Must be able to complete the informed consent process and comprehension assessment independently and without assistance. * Subjects assigned male at birth: Willingness to use barrier contraception during cervico-vaginal, anal, and oral intercourse from Study Day 0 through 90 days post ZIKV challenge (in accordance with CDC guidance). * Subjects assigned female at birth: Willingness to use barrier contraception during cervico-vaginal, anal, and oral intercourse from Study Day 0 through 56 days post ZIKV challenge (in accordance with CDC guidance). * Subjects of childbearing potential must be willing to use effective contraception through 56 days post-ZIKV challenge, in accordance with CDC guidance. Reliable methods of contraception include hormonal birth control\* (implantable, hormonal patch, hormonal vaginal ring, oral contraception, Depo-Provera injection, etc.), surgical sterilization (hysterectomy, tubal ligation, or tubal coil at least 3 months prior to inoculation with TV003/PlasmaLyte and/or ZIKV challenge), and intrauterine device. All subjects assigned female at birth will be considered having child-bearing potential except for those with post-menopausal status documented as at least 1 year since last menstrual period, those assigned female at birth who have sex with partners assigned female at birth (exclusively) and have no intention of conceiving a child during the study, and for the vaccination phase of the study only, participants who practice abstinence (≥ 6 months with no sexual contact). Subjects who are not considered to be of childbearing potential will not be required to use contraception other than barrier contraception for the purpose of reducing potential transmission. * Volunteers on hormonal birth control must not be on medications or other agents that decrease the effectiveness of hormonal birth control. Inclusion Criteria for Challenge with ZIKV SJRP/2016-184: * Currently enrolled in the study. * Good general health as determined by physical examination and review of medical history. * Available for the duration of the study, which is approximately 26 weeks after challenge. * If the challenge portion of the study is expected to begin from March 16-October 30, subject is willing to reside in the inpatient unit for 6 days (or longer for safety if necessary) following receipt of ZIKV. * Willingness to participate in the study as evidenced by signing the informed consent document. * Female assigned at birth only: Female assigned at birth subjects of childbearing potential should be willing to use highly effective contraception for the duration of the trial. Reliable methods of contraception include hormonal birth control, surgical sterilization, and intrauterine device. All female assigned at birth subjects will be considered as having childbearing potential in this phase of the study, except for those who have had a hysterectomy, tubal ligation, or tubal coil (at least 3 months prior to vaccination), or who are considered to be post-menopausal, as documented by at least 1 year since last menstrual period. Additional Inclusion Criteria for Arm 2 Subjects with a Previous History of ZIKV Infection Only: -History or serologic evidence of previous ZIKV or identified as an infectivity control.
Exclusion criteria
* Currently pregnant, as determined by positive beta-human choriogonadotropin (b-hCG) test, breast-feeding, planning to become pregnant during the 12-month duration of the study or planning to donate eggs through 56 days post ZIKV challenge. A careful detailed reproductive and contraception use history will be obtained and the subject will be excluded if the history or clinical record raises concerns related to pregnancy prevention. * Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, autoimmune, or renal disease by history, physical examination, and/or laboratory studies. * Behavioral, cognitive, or psychiatric disease that in the opinion of the investigator affects the ability of the subject to understand and cooperate with the requirements of the study protocol. * Evidence of recent opiate use based on urine toxicology screen. * Screening laboratory values of Grade 1 or above for absolute neutrophil count (ANC), ALT, and serum creatinine, as defined in this protocol. * Any other condition that in the opinion of the investigator would jeopardize the safety or rights of a subject participating in the trial or would render the subject unable to comply with the protocol. * Any significant alcohol or drug abuse in the past 12 months which has caused medical, occupational, or family problems, as indicated by subject history. * History of a severe allergic reaction or anaphylaxis. * Severe asthma (emergency room visit or hospitalization within the last 6 months). * HIV infection, by screening and confirmatory assays. * Hepatitis C virus (HCV) infection, by screening and confirmatory assays. * Hepatitis B virus (HBV) infection, by Hepatitis B surface antigen (HBsAg) screening. * History of Guillain-Barré syndrome (GBS). * History of seizure disease or peripheral neuropathy. * History of any neuroinflammatory disorder, i.e., Bell's Palsy, transverse myelitis. * Any known immunodeficiency syndrome, including that caused by malignancy. * Use of anticoagulant medications, (use of antiplatelet medication such as aspirin or non-steroidal anti-inflammatory medication is permitted and will not exclude a subject from enrollment). * Use of corticosteroids (excluding topical, inhaled, or nasal) or immunosuppressive drugs within 28 days prior to or following vaccination. Immunosuppressive dose of corticosteroids is defined as ≥10 mg prednisone equivalent per day for ≥14 days. * Receipt of a live vaccine within 28 days or an inactivated or subprotein vaccine within the 14 days prior to vaccination or anticipated receipt of any vaccine during the 28 days following vaccination with the exception of the inactivated influenza vaccine and COVID 19 vaccines either licensed or under EUA which can be given at any time, however all effort will be made to avoid giving influenza and COVID-19 vaccines within the above windows. * Asplenia. * Receipt of blood products within the past 6 months, including transfusions or immunoglobulin or anticipated receipt of any blood products or immunoglobulin during the 28 days following vaccination. * Anticipated receipt of any investigational agent in the 28 days before or after vaccination. * Subject has definite plans to travel to a ZIKV endemic or dengue endemic area during the study. * Previous hypersensitivity to any study product component. * Refusal to allow storage of specimens for future research. * Subject is a JHU student currently enrolled in a coursework, an internship, or clinical hours where the supervisor or instructor of record is employed by the Center. * Subject is faculty or staff currently employed by the Center. Additional
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of immediate, systemic, and local adverse events (AEs) following vaccination with TV003 | Through 28 days post vaccination | — |
| Frequency of immediate, systemic, and local AEs following inoculation with ZIKV-SJRP/2016-184 | Through 28 days post challenge | — |
| Proportion of subjects who received TV003 who develop clinical signs/symptoms of Zika infection | Through 180 days post challenge | Compared to historical controls |
| Proportion of subjects who were previously infected with ZIKV who develop clinical signs/symptoms of Zika infection | Through 180 days post challenge | Compared to historical controls |
| Incidence, magnitude, and duration of infectious ZIKV-SJRP/2016-184 recovered from serum following administration of ZIKV-SJRP/2016-184 in subjects who received TV003 | Through 180 days post challenge | Compared to historical controls |
| Incidence, magnitude, and duration of infectious ZIKV-SJRP/2016-184 recovered from serum following administration of ZIKV-SJRP/2016-184 in ZIKV-exposed subjects | Through 180 days post challenge | Compared to historical controls |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence, magnitude, and duration of ZIKV viremia induced by administering 10^2 PFU of ZIKV-SJRP/2016-184 in subjects who received TV003 | Through 6 months post challenge | Measured by quantitative polymerase chain reaction (PCR) induced, compared to historical controls. |
| Incidence, magnitude, and duration of ZIKV viremia induced by administering 10^2 PFU of ZIKV-SJRP/2016-184 in previously ZIKV-exposed subjects | Through 6 months post challenge | Measured by quantitative PCR induced, compared to historical controls. |
| Number of TV003 vaccinees infected with DENV-1, DENV-2, DENV-3, and DENV-4 following administration of TV003 | Through 270 days post vaccination | Infection is defined as recovery of vaccine virus from the blood or serum of a subject and/or by seropositivity to DENV measured by quantitative PCR |
| Peak neutralizing antibody titer (NT) to DENV-1, DENV-2, DENV-3, and DENV-4 | Through 90 days post vaccination | Measured by the NT50 at 28, 56, and 90 days after TV003 vaccination. |
| Peak NT to ZIKV-SJRP/2016-184 | Through 90 days post challenge | Measured by NT50 at 0, 28, 56, and 90 days post-administration of ZIKV-SJRP |
| Number of volunteers who become infected following primary ZIKV-SJRP administration | Through 16 days post challenge | — |
| Peak NT50 against ZIKV following TV003 vaccination correlates with protection against ZIKV infection | Through 90 days post challenge | — |
| Evaluate boost in neutralizing antibody titers to DENV-1, DENV-2, DENV-3, and DENV-4 post-ZIKV challenge in subjects who received TV003 | Through 90 days post challenge | Peak NT50 achieved through 90 days post-ZIKV challenge in TV003 recipients. A boost in antibody titer is defined as a ≥ 4-fold rise through 90 days post challenge compared with the titer just prior to ZIKV challenge. |
| Evaluate boost in neutralizing antibody titers to ZIKV post challenge in subjects with previous ZIKV infection | Through 90 days post-ZIKV challenge of previous ZIKV recipients | Peak NT50 achieved through 90 days post-ZIKV challenge. A boost in antibody titer is defined as a ≥ 4-fold rise in peak ZIKV neutralizing antibody titer through 90 days post challenge compared with the ZIKV neutralizing antibody titer in serum collected just prior to ZIKV challenge. |
| Quantity and duration of ZIKV in blood, cervico-vaginal secretions and semen | Through 6 months post challenge | Measured by culture (infectious virus) and by reverse transcriptase - PCR in all participants receiving ZIKV-SJRP/2016-184 |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAnna Durbin, M.D.
Johns Hopkins Bloomberg School of Public Health
Outcome results
None listed