High Dose Influenza Vaccine in Nursing Home - Pilot Study

NCT ID: NCT01720277

Last Updated: 2018-05-23

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

2957 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-09-30

Study Completion Date

2016-05-31

Brief Summary

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The purpose of this pilot evaluation is to help determine the feasibility and power needed to prospectively evaluate relative effectiveness of high-dose influenza vaccine in preventing influenza mortality and hospitalization in a nursing home population in the U.S., compared to the standard-dose influenza vaccine.

Detailed Description

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Influenza remains the most common preventable respiratory viral infection of older adults. Older adults incur more than 90% of the disease burden, and those residing in nursing homes are the most affected subset given their immune senescence, multi-morbidity, and close living quarters. Each year, the majority of influenza-related hospitalizations occur during the period with the greatest influenza activity.

Influenza vaccination has been associated with reduced hospitalization, strokes, heart attacks and death in non-institutional older adult populations, but the benefit of influenza vaccine for the oldest population has been questioned. The new high-dose influenza vaccine is considerably more immunogenic in older adults, and has recently been approved for use in individuals aged 65 years and older. No clinical data yet confirm whether the improved immunogenicity translates into added clinical benefit, such as further reduction in hospitalization or death. Estimating the benefit of influenza vaccination among older adults in long-term care settings using randomized controlled trials requires extensive effort and is costly. Instead, a pragmatic RCT in a nursing home population has several advantages as a model for comparing therapeutic approaches.

This clinical trial aims to test the feasibility of our protocol for a subsequent larger study. We aim to demonstrate that we can recruit and enroll facilities; randomly assign and coordinate vaccine delivery; collect data; conduct site audits for data validation; create outcomes using multiple data sources; and conduct analyses.

Conditions

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Influenza

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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HD Fluzone Vaccine

NH facilities randomized to receive high dose trivalent influenza vaccine (HD Fluzone) for the residents.

Group Type EXPERIMENTAL

HD Fluzone Vaccine

Intervention Type BIOLOGICAL

Nursing home residents over 65 years are allocated to receive high dose trivalent vaccine. Residents under 65 years are provided standard dose trivalent vaccine (TIV).

SD Fluzone Vaccine

NH facilities randomized to standard dose trivalent influenza vaccine (SD Fluzone) for the residents.

Group Type ACTIVE_COMPARATOR

SD Fluzone Vaccine

Intervention Type BIOLOGICAL

Nursing home residents are allocated to receive standard trivalent vaccine (TIV).

Interventions

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HD Fluzone Vaccine

Nursing home residents over 65 years are allocated to receive high dose trivalent vaccine. Residents under 65 years are provided standard dose trivalent vaccine (TIV).

Intervention Type BIOLOGICAL

SD Fluzone Vaccine

Nursing home residents are allocated to receive standard trivalent vaccine (TIV).

Intervention Type BIOLOGICAL

Other Intervention Names

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Fluzone High Dose influenza vaccine Fluzone influenza vaccine

Eligibility Criteria

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Inclusion Criteria

* Long-term care facilities in one of the 122 cities that serve as Center for Disease Control and Prevention (CDC) surveillance sites

Exclusion Criteria

* Facilities already systematically administering HD vaccine to their residents
* Facilities for whom over half the residents are on Medicare (short-stay)
* Facilities in which over half the residents are on Medicare Part A (SNF)
* Facilities having fewer than 50 long-stay residents
* Hospital-based facilities
* Facilities with more than 20% of the population under age 65
* Facilities with mandated (employment-dependent) seasonal influenza vaccination
* Facilities not submitting MDS data
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Brown University

OTHER

Sponsor Role collaborator

Insight Therapeutics, LLC

OTHER

Sponsor Role lead

Responsible Party

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Stefan Gravenstein, MD, MPH

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stefan Gravenstein, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Case Western Reserve University

Ed Davidson, PharmD, MPH

Role: PRINCIPAL_INVESTIGATOR

Insight Therapeutics, LLC

Vincent Mor, PhD

Role: PRINCIPAL_INVESTIGATOR

Brown University

Locations

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Brown Univeristy

Providence, Rhode Island, United States

Site Status

Insight Therapeutics

Norfolk, Virginia, United States

Site Status

Countries

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United States

References

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Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003 Jan 8;289(2):179-86. doi: 10.1001/jama.289.2.179.

Reference Type BACKGROUND
PMID: 12517228 (View on PubMed)

Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K. Influenza-associated hospitalizations in the United States. JAMA. 2004 Sep 15;292(11):1333-40. doi: 10.1001/jama.292.11.1333.

Reference Type BACKGROUND
PMID: 15367555 (View on PubMed)

Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, Murad S, Watson JM. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial. BMJ. 2006 Dec 16;333(7581):1241. doi: 10.1136/bmj.39010.581354.55. Epub 2006 Dec 1.

Reference Type BACKGROUND
PMID: 17142257 (View on PubMed)

Deguchi Y, Nishimura K. Efficacy of Influenza Vaccine in Elderly Persons in Welfare Nursing Homes: Reduction in Risks of Mortality and Morbidity During an Influenza A (H3N2) Epidemic. J Gerontol A Biol Sci Med Sci. 2001 Jun;56(6):M391-4. doi: 10.1093/gerona/56.6.m391.

Reference Type BACKGROUND
PMID: 11382801 (View on PubMed)

Gozalo PL, Pop-Vicas A, Feng Z, Gravenstein S, Mor V. Effect of influenza on functional decline. J Am Geriatr Soc. 2012 Jul;60(7):1260-7. doi: 10.1111/j.1532-5415.2012.04048.x. Epub 2012 Jun 21.

Reference Type BACKGROUND
PMID: 22724499 (View on PubMed)

Barker WH, Borisute H, Cox C. A study of the impact of influenza on the functional status of frail older people. Arch Intern Med. 1998 Mar 23;158(6):645-50. doi: 10.1001/archinte.158.6.645.

Reference Type BACKGROUND
PMID: 9521230 (View on PubMed)

Jackson LA, Jackson ML, Nelson JC, Neuzil KM, Weiss NS. Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int J Epidemiol. 2006 Apr;35(2):337-44. doi: 10.1093/ije/dyi274. Epub 2005 Dec 20.

Reference Type BACKGROUND
PMID: 16368725 (View on PubMed)

Simonsen L, Viboud C, Taylor R. Influenza vaccination in elderly people. Lancet. 2005 Dec 17;366(9503):2086. doi: 10.1016/S0140-6736(05)67884-1. No abstract available.

Reference Type BACKGROUND
PMID: 16360785 (View on PubMed)

Fiore AE, Shay DK, Haber P, Iskander JK, Uyeki TM, Mootrey G, Bresee JS, Cox NJ; Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC). Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep. 2007 Jul 13;56(RR-6):1-54.

Reference Type BACKGROUND
PMID: 17625497 (View on PubMed)

Kingston BJ, Wright CV Jr. Influenza in the nursing home. Am Fam Physician. 2002 Jan 1;65(1):75-8, 72.

Reference Type BACKGROUND
PMID: 11804444 (View on PubMed)

Menec VH, Black C, MacWilliam L, Aoki FY. The impact of influenza-associated respiratory illnesses on hospitalizations, physician visits, emergency room visits, and mortality. Can J Public Health. 2003 Jan-Feb;94(1):59-63. doi: 10.1007/BF03405054.

Reference Type BACKGROUND
PMID: 12583681 (View on PubMed)

Mor V, Intrator O, Unruh MA, Cai S. Temporal and Geographic variation in the validity and internal consistency of the Nursing Home Resident Assessment Minimum Data Set 2.0. BMC Health Serv Res. 2011 Apr 15;11:78. doi: 10.1186/1472-6963-11-78.

Reference Type BACKGROUND
PMID: 21496257 (View on PubMed)

Other Identifiers

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GRC75-HD Nursing Home Pilot

Identifier Type: -

Identifier Source: org_study_id

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