Official Title
A Phase 2b Multicenter Randomized, Placebo-Controlled, Double-Blind, Study to Evaluate the Safety, Immunogenicity and Efficacy of R21/Matrix-M Malaria Vaccine in African Infants With Different Immunization Schedules
Brief Summary

The aim of this study is to identify an optimal infant vaccine schedule for a malariavaccine which is better aligned with the timing of other vaccine interventions.

Detailed Description

The R21/Matrix-M (R21/MM) vaccine has been recommended by the World Health Organization
(WHO) to prevent clinical malaria in young children living in moderate to high
transmission areas of Sub-Saharan Africa. R21/MM is based on the circumsporozoite protein
(CSP) targeting the pre-erythrocytic stage of Plasmodium falciparum. R21/MM elicits high
levels of antibodies against the central repeat (Asn-Ala-Asn-Pro [NANP]) of the
circumsporozoite protein (CSP) which has been shown to correlate with protection.
Currently, R21/MM is recommended to be delivered to young children starting at 5-6 months
of age with 3 doses given at monthly intervals, however, there are no existing Essential
Programme on Immunization (EPI) vaccine visits scheduled at these ages.

We plan to evaluate, using the R21/MM malaria vaccine as a model system, how age at first
vaccine dose and time intervals between doses modify the immunogenicity of the vaccine
and the ensuant efficacy in protecting infants against clinical Plasmodium falciparum
malaria.

Healthy male or female infants 6 to 7 weeks of age will be randomized to one of three
different immunization schedule cohorts: a) a "compressed" conventional schedule at
6-10-14 weeks of age; b) a "relaxed" schedule at 2-4-6 months of age; c) a "relaxed"
schedule at 3-6-9 months of age. Participants in each immunization schedule cohort will
be randomized in a ratio of 3:1 to receive 4 doses of either R21/MM or placebo with a 4th
dose to be administered at 15 months of age.

Infants randomized to the respective immunization schedule categories will receive
co-administered routine EPI vaccines. The study will include the provision of a three
dose R21/MM compressed schedule to all participants randomized to the placebo arms upon
completion of the study at Month 27 of life.

Not yet recruiting
Malaria Vaccines

Biological: R21 Matrix-M (R21/MM) Malaria Vaccine

Administered by intramuscular injection. Each 0.5 mL dose contains R21 Malaria Antigen (5
mcg) and Matrix-M1 (Adjuvant) (50 mcg).

Biological: Placebo

Administered by intramuscular injection. Each dose (0.5 mL) contains Normal saline
(0.9%).

Biological: Hexavalent Vaccine

Administered by intramuscular injection. Each dose of 0.5 mL contains:

- Diphtheria Toxoid > 30 IU

- Tetanus Toxoid > 40 IU

- B. pertussis (whole cell) > 4 IU

- Hepatitis B surface antigen (HBsAg) (recombinant DNA) 15 mcg

- Inactivated polio vaccine (Salk strains grown on vero cells): Type - 1 (Mahoney
strain) 40 D antigen units (DU); Type - 2 (MEF-1 strain) 8 DU; Type - 3 (Saukett
strain) 32 DU

- Haemophilus influenzae Type b (Hib) Conjugate Vaccine (Adsorbed) polyribosylribitol
phosphate (PRP) 10 mcg conjugated to tetanus toxoid (TT) (carrier protein) 19 to 33
mcg]
Other Name: HEXASIIL

Biological: Pneumococcal Polysaccharide Conjugate Vaccine

Administered by intramuscular injection. Each 0.5 mL dose contains 2 mcg each Saccharide
for serotypes 1, 5, 9V, 14, 19A, 19F, 23F, 7F, 6A and 4 mcg Saccharide for serotype 6B.
Other Name: PNEUMOSIL

Biological: Rotavirus, Live Attenuated (Oral) Vaccine

Administered orally. Each 2.0 mL dose contains: Live Attenuated Bovine-Human Rotavirus
Reassortant [G1, G2, G3, G4 and G9], 5.6 focus-forming units (FFU) / serotype.
Other Name: ROTASIIL

Biological: Measles and Rubella Vaccine

Administered by subcutaneous injection. Each 0.5 mL dose contains not less than 1000 cell
culture infectious dose 50% (CCID50) of Measles virus and 1000 CCID50 of Rubella virus.

Biological: Meningococcal A conjugate vaccine

Administered by intramuscular injection. Each 0.5 mL dose contains Meningococcal A
polysaccharide 10 mcg and tetanus toxoid (TT) (carrier protein) 10 to 33 mcg.
Other Name: MenAfriVac

Biological: Yellow Fever vaccine

Yellow fever vaccine will be locally sourced by each trial site in accordance with the
countries' EPI program.

Biological: Typhoid Conjugate vaccine

Typhoid conjugate vaccine will be locally sourced by each trial site in accordance with
the countries' EPI program.

Eligibility Criteria

Inclusion Criteria:

- Signed informed consent or thumb-printed and witnessed informed consent obtained
from the parent/legal guardian of the infant.

- Infants must have been born full-term (at ≥37 weeks of gestation) and > 2500 grams
at birth.

- Immunization schedule Cohorts 1, 2, and 3: : Male and female infants 42-49 days
(inclusive) of age at time of enrollment. For infants in Cohort 1, randomization to
receive vaccine dose 1 (Groups 1 and 2 of R21/MM or placebo, respectively) will
occur at 42-49 days of age. For infants in Cohort 2, randomization to receive
vaccine dose 1 (Groups 3 and 4 of R21/MM or placebo, respectively) will occur at 2
months (56-63 days of age). For infants in Cohort 3, randomization to receive
vaccine dose 1 (Groups 5 and 6 of R21/MM or placebo, respectively) will occur at 3
months (84-91 days of age).

- The participant's parent/guardian must be willing to avoid travel, particularly in
the 28 days after each study vaccination, must confirm willingness to contact the
study team in the event of unexpected/unavoidable travel and, for the safety cohort,
must confirm availability for the home visits to be conducted by a field worker to
collect solicited AEs over the 7 days (day of vaccination and 6 subsequent days)
following each study vaccine.

- The participant's parent/guardian must confirm willingness to bring their child to
the study clinic / local health care clinic, and capacity to contact the study team
in the event the subject has any illnesses or other health concerns during the
study.

- Participants who the investigator believes that their parent/guardian can and will
comply with the requirements of the protocol (e.g. return for follow-up visits) may
be enrolled in the study.

Exclusion Criteria:

- Acute disease at the time of enrolment (acute disease is defined as the presence of
a moderate or severe illness with or without fever. All vaccines can be administered
to participants with a minor illness such as diarrhea, mild upper respiratory
infection, without low-grade febrile illness, i.e. axillary temperature < 37.5°C).

- Clinically significant pulmonary, cardiovascular, gastrointestinal, endocrine,
neurological, skin, hepatic or renal functional abnormality, as determined by
medical history, physical examination or laboratory tests which, in the opinion of
the Investigator, may either put the participants at risk because of participation
in the trial, or may influence the result of the trial.

- At time of enrollment, any infant who has received any dose of the
hexavalent/pentavalent vaccines, pneumococcal vaccine, rotavirus vaccine, IPV or has
received more than one dose of oral polio virus or more than one dose of hepatitis B
vaccine.

- Weight-for-height/length Z score of less than -3 or other clinical signs of
malnutrition.

- Infant with major congenital defects.

- The infant has anaemia associated with clinical signs of symptoms of decompensation,
or a haemoglobin of ≤ 5.0 g/dL.

- History of allergic disease or reactions likely to be exacerbated by any component
of the vaccines.

- Any confirmed or suspected immunosuppressive or immunodeficient state (including HIV
or asplenia) or known maternal HIV infection (no HIV testing will be routinely done
by the study team).

- Administration of immunoglobulins and/or any blood products/blood transfusion from
birth to time of planned administration of the vaccine candidate.

- Previous vaccination of participant or biological mother with a malaria vaccine.

- Participation in another research study involving receipt of an investigational
product or planned use during the study period.

- Any other findings that the investigator feels would increase the risk of having an
adverse outcome from participation in the trial.

Eligibility Gender
All
Eligibility Age
Minimum: 42 Days ~ Maximum: 49 Days
Countries
Burkina Faso
Locations

Institut de Recherche en Science de la Santé (IRSS)
Bobo-Dioulasso, Burkina Faso

Groupe de Recherche Action en Santé (GRAS)
Ouagadougou, Burkina Faso

Contacts

Robert Choy
+1 206 285 3500
rchoy@path.org

Not Provided

NCT Number
Keywords
Plasmodium falciparum
R21/Matrix-M Malaria Vaccine
MeSH Terms
Malaria
Vaccines