PneuMum: Pneumococcal Vaccination of Australian Indigenous Mothers to See if it Protects Their Babies From Ear Disease
NCT ID: NCT00310349
Last Updated: 2007-12-13
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
PHASE3
210 participants
INTERVENTIONAL
2006-03-31
2009-01-31
Brief Summary
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The study aims to recruit 210 Indigenous women aged 18-39 years who have an uncomplicated pregnancy. Following recruitment, subjects will be randomly assigned to one of the three groups.
Each mother and infant will be followed from pregnancy until the baby is seven months of age. Children will receive all of their routinely recommended vaccinations in accordance with the standard vaccination schedule.
The primary outcome will be prevalence of ear infection at seven months of age, defined as middle ear effusion or tympanic membrane perforation or acute otitis media. Pneumatic otoscopy, video-otoscopy and tympanometry will be used in the ear examinations. The primary analyses will be a direct comparison of the proportion of infants in the control group who have nasopharyngeal carriage of vaccine type pneumococci at seven months of age compared to infants in each of the other two groups and a similar comparison of the proportion with middle ear disease.
Detailed Description
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* The 23 valent pneumococcal polysaccharide vaccine (23vPPV), is currently recommended for all Indigenous people in the Northern Territory from 15 years of age but uptake among women of child-bearing age has been low.
* Adult diphtheria, tetanus and acellular pertussis vaccine (dTPa) will be used as the control vaccine. This vaccine is recommended for all new parents who have not previously been immunised but is not currently funded so would normally need to be purchased on prescription through a pharmacist.
Rationale
Indigenous children experience the highest rates of acute and chronic ear infections in the world, resulting in permanent ear damage, hearing loss and educational disadvantage. These infections are mainly bacterial. Streptococcus pneumoniae (pneumococcus) is the predominant pathogen. Pneumococcal colonisation and infection begins within days of birth, months before any potential immunological protection from infant pneumococcal conjugate vaccine may be expected. New strategies are needed to eliminate, or at least delay, this early-onset pneumococcal colonisation.
Maternal vaccination with the 23 valent pneumococcal polysaccharide vaccine (23vPPV) during pregnancy or at delivery is one strategy that may protect newborn infants through mechanisms such as transplacental antibody transfer, increased secretory antibody in breast milk, and/or by reducing nasopharyngeal carriage (and transmission to the infant) of maternal pneumococci. Previous small studies using this strategy have been encouraging, but there have been no studies properly evaluating nasopharyngeal carriage or disease endpoints in infants.
Methods
We hope to recruit 210 Indigenous women aged 18-39 years who have an uncomplicated pregnancy. Following recruitment, subjects will be randomly assigned to one of three groups:
* Group A will receive 23vPPV in the last few months of pregnancy
* Group B will receive 23vPPV soon after childbirth
* Group C will receive 23vPPV seven months after childbirth (the control group).
Women in Groups A and C will receive dTPa soon after childbirth (to conceal the intervention groups), whereas women in Group C will be offered dTpa seven months after childbirth (end of the observation period).
Study participants will be visited at least five times:
1. During the last few months of pregnancy (30-36 weeks gestation)
* The group of mothers receiving 23vPPV at this visit will also have a sample taken of their blood
2. At Royal Darwin Hospital when the baby is born
* Each mother will receive either 23vPPV or dTpa depending on their allocation
* Each mother will have a sample taken of their blood, the cord blood, a nasopharyngeal swab and a sample of expressed breast milk
3. When the baby is one month old
* Each baby will have their ears checked and a nasopharyngeal swab taken. A swab will also be taken of any discharge from the baby's ear/s. Mothers will be asked for sample of expressed breast milk.
4. When the baby is two months old
* The same checks and samples as the previous month.
5. When the baby is seven months old
* Each mother and baby will have the same checks and samples as the previous months. Babies will also have a sample taken of their blood. Mothers who have not yet had 23vPPV will be offered that vaccine as will those who have not yet had dTpa.
Primary Outcome
The primary outcome will be prevalence of ear infection at seven months of age, defined as middle ear effusion or tympanic membrane perforation or acute otitis media. Pneumatic otoscopy, video-otoscopy and tympanometry will be used in the ear examinations. The primary analyses will be a direct comparison of the proportion of infants in the control group (Group C) who have nasopharyngeal carriage of vaccine type pneumococci at seven months of age compared to infants in each of the other two groups and a similar comparison of the proportion with middle ear disease.
Conditions
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Keywords
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Study Design
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RANDOMIZED
SINGLE_GROUP
PREVENTION
SINGLE
Interventions
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23 valent pneumococcal polysaccharide vaccine
Eligibility Criteria
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Inclusion Criteria
* Reside in Darwin, Maningrida, Wadeye or the Tiwi Islands
* Intends to deliver child at the Royal Darwin Hospital
* Has given informed consent to participate
Exclusion Criteria
* Had a previous dose of dTpa
* intends to leave the study area during the follow-up period
* HIV positive
* History of severe allergy, uncontrolled asthma or splenectomy
16 Years
39 Years
FEMALE
Yes
Sponsors
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National Health and Medical Research Council, Australia
OTHER
Menzies School of Health Research
OTHER
University of Melbourne
OTHER
Principal Investigators
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Ross M Andrews, PhD
Role: PRINCIPAL_INVESTIGATOR
The University of Melbourne and Murdoch Childrens Research Institute
Jonathan R Carapetis, PhD
Role: PRINCIPAL_INVESTIGATOR
The University of Melbourne and Murdoch Childrens Research Institute
Amanda J Leach, PhD
Role: PRINCIPAL_INVESTIGATOR
Menzies School of Health Research
Peter S Morris, PhD
Role: PRINCIPAL_INVESTIGATOR
Menzies School of Health Research
Edward K Mulholland, DM
Role: PRINCIPAL_INVESTIGATOR
The Univeristy of Melbourne and Murdoch Childrens Research Institute
Locations
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Menzies School of Health Research
Darwin, Northern Territory, Australia
Countries
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Central Contacts
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Facility Contacts
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Amanda J Leach, PhD
Role: primary
Peter S Morris, PhD
Role: backup
References
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Martinovich KM, Seppanen EJ, Bleakley AS, Clark SL, Andrews RM, Richmond PC, Binks MJ, Thornton RB, Kirkham LS. Evidence of maternal transfer of antigen-specific antibodies in serum and breast milk to infants at high-risk of S. pneumoniae and H. influenzae disease. Front Immunol. 2022 Sep 21;13:1005344. doi: 10.3389/fimmu.2022.1005344. eCollection 2022.
Other Identifiers
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2 November 2005
Identifier Type: -
Identifier Source: org_study_id