A Randomised Controlled Trial in HIV-1 Exposed Ugandan Infants to Estimate Additional Benefits (Non-specific Effects) of BCG
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 4,500
- 试验地点
- 1
- 主要终点
- Severe illness
研究概览
简要总结
BCG vaccination may have non-specific effects (NSE) i.e., additional benefits on childhood morbidity and mortality that are separate the vaccine's effect on the incidence of disseminated tuberculosis. Though the available literature is mostly from observational study designs, and is fraught with controversy, BCG vaccination at birth, in a high risk population of HIV exposed children, may protect infants against serious infections other than TB. Yet, other studies indicate that giving BCG later in infancy, when the immune system is more mature, may offer even greater protection. The appropriate timing of BCG vaccination could therefore be up for revision. This study will therefore compare BCG vaccination at birth with BCG vaccination at 14 weeks of age in HIV exposed (HE) babies.
Methods: This is an individually randomized clinical trial in 4,500 HIV exposed infants. The intervention is an intra-dermal administration of 0.05 ml of BCG vaccine within 24 hours of birth while the comparator will be an intra-dermal administration of 0.05ml of BCG vaccine at 14 weeks of age.
The main study outcomes include:
- Severe illness in the first 14 weeks of life,
- Innate and adaptive immune responses to mycobacterial, non-mycobacterial antigens and TLR-agonists
- Severe illness in the first 14-52 weeks and 0-52 weeks of life.
The study will be carried in two health centers and one district hospital in Uganda.
Implications: A well-timed BCG vaccination could have important additional benefits in HE infants. This trial could inform the development of programmatically appropriate timing of BCG vaccination for HE infants.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- — 至 1 Day（Child）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •A baby born at a participating study clinic will be included if s/he:
- •has a mother with a positive HIV test (ELISA or rapid test)
- •is receiving peri-exposure prophylaxis as part of the standard/national guidelines in Uganda
- •has a mother that is of legal age for participation in clinical research studies in Uganda or is an emancipated minor
- •has a mother/caregiver that resides within the study area, is not intending to move out of the area in the next 4 months and is likely to be traceable for up to 12 months
- •has a mother/caregiver that gives informed consent to random assignment to either of the two trial arms
- •has a mother that has received antiretroviral therapy (ART) for at least 4 weeks
排除标准
- •A new-born child will be excluded if she/he has:
- •an identified serious congenital malformation(s)
- •severe illness requiring hospitalization
- •a birth weight < 2.0 kg
- •a mother participating in another clinical trial on the day of enrolment or a mother who will participate in another clinical trial within the next month.
- •a mother or other household member with symptoms and signs of tuberculosis on the day of enrolment
- •a severely ill mother with (a) condition(s) requiring hospitalization
- •a baby with an Apgar score at 5 minutes <7
- •a twin or triplet
研究组 & 干预措施
Intervention arm: BCG at birth
Infants randomized to this arm will receive an intra-dermal administration of 0.05 ml of BCG vaccine within 24h of birth
干预措施: BCG at birth (Biological)
结局指标
主要结局
Severe illness
时间窗: The first 14 weeks of life
Among children \<2 months of age, severe illness (other than TB) will be defined as an acute illness that is associated with any of the following danger signs observed or verified by a clinician: inability to feed or vomiting of everything and unable to keep anything down, lethargy or unconsciousness, severe lower chest in-drawing, axillary temperature of ≥38.0 deg C or \<35.5 deg C, grunting, cyanosis, convulsions or a history of convulsions (except epilepsy), and/or requires hospitalization and/or results in death. Among children ≥2 months of age, severe illness (other than TB) will be defined as an acute illness that is associated with at least one of the following danger signs observed by a clinician: inability to drink or breastfeed lethargy or unconsciousness, vomiting of all feeds, convulsions or a history of convulsions (except epilepsy), and/or requires hospitalization and/or results in death. Events resulting from violent injury or burns are not considered severe illness.
Innate and adaptive immune responses against mycobacterial and non-mycobacterial antigens.
时间窗: 14 weeks post BCG vaccination
The following immunological outcomes will be measured in a sub-sample of 180 infants: Innate immune responses (IL-6, TNF, IL-10, IL-1b) against TLR-agonists and adaptive immune responses (IFNy, IL-17, IL-10 and IL-22) against mycobacterial (ESAT-6/CFT10 and PPD) and non-mycobacterial antigens (C.albicans, S. aureus and SARS-CoV-2 spike peptides).
次要结局
- Severe illness from 48 h after randomization to 14 weeks of life(48 hours to 14 weeks of life)
- Adverse events(First 52 weeks of life)
- Severe illness until 6 weeks of age(6 weeks)
- Infant death(First year of life)
- BCG scar at 52 weeks of age(First year of life)
- Severe illness until 14 weeks of age within strata of presence or absence of maternal BCG scar(14 weeks)
- Severe illness in weeks 0-52 and 14-52 of life(First 0-52 and 14-52 weeks of life)
- Growth up to 52 weeks of life(First year of life)