Enhancing Protection Against Influenza and COVID-19 for Pregnant Women and Medically at Risk Children

NCT ID: NCT05613751

Last Updated: 2024-01-17

Study Results

Results pending

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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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1038 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-26

Study Completion Date

2024-12-31

Brief Summary

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Pregnant women and children with chronic medical conditions are at increased risk of hospitalisation, intensive care admission and death from influenza and COVID-19 infections. However, there appears to be a high level of vaccine hesitancy among women of reproductive age. We will develop "nudge" interventions to improve influenza and COVID vaccine uptake and test the effectiveness of the interventions using randomised controlled trials in

* pregnant women
* medically at risk children.

Detailed Description

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Pregnant women and children with chronic medical conditions are at an unacceptable risk of hospitalisation and death from influenza and COVID-19 infections. Pregnant women are 3 times more likely to die from COVID-19 and over 7 times more likely to be admitted to an intensive care unit (ICU) with influenza compared to non-pregnant women. Children with chronic disease are already compromised with a higher risk of hospitalisation from influenza and requirement for ICU management and long term disability following COVID-19. Uptake of the recommended influenza vaccine among pregnant women and medically at risk children in Australia is only \~50%. Based on recent surveys, the predicted uptake of COVID-19 vaccine among both groups is also likely to be \~50%. These two groups preferentially receive care from medical specialists (obstetricians and paediatricians) and specialist nursing staff in hospitals, and are less likely to engage with primary care, the usual providers of immunisation.

The aim of this project is to develop a nudge (i.e. small changes in the environment that alter people's behaviour) and evaluate the effectiveness of the nudge intervention in improving the uptake of COVID and influenza vaccine by conducting four randomised control trials in

* pregnant women
* medically at risk children.

Conditions

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Influenza COVID-19

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Four multi-centre, parallel group, superiority, randomized control trials (with 1:1 allocation) of nudge interventions to improve influenza and COVID-19 vaccine uptake among pregnant women and medically at risk children. Each RCT will enroll 1038 participants (n = 519 each in intervention and control groups), with a total of 4154 participants in the four RCTs:

* pregnant women's RCTs

* COVID-19 vaccine (n= 1038): Arm #1 (Standard care, n=519); Arm #2 (Nudge intervention, n=519)
* Influenza vaccine (n= 1038): Arm #1 (Standard care, n=519); Arm #2 (Nudge intervention, n=519)
* medically at-risk children's RCTs

* COVID-19 vaccine (n= 1038): Arm #1 (Standard care, n=519); Arm #2 (Nudge intervention, n=519)
* Influenza vaccine (n= 1038): Arm #1 (Standard care, n=519); Arm #2 (Nudge intervention, n=519)

There are eight arms in total for four RCTs.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Blinding is considered desirable; however, it will depend on the type of nudge and will be determined after the nudge is developed. Endpoint measurements will involve low level contact of study staff, however when contact is required (such as AIR/ confirmation of influenza/COVID-19 vaccine receipt etc), this will be carried out by trial staff shielded from information that might reveal trial group assignment. The study statistician undertaking the analysis and study investigators will remain blinded to trial intervention assignment.

Study Groups

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Pregnant women-COVID-19 vaccine RCT - intervention group

Women randomized to the intervention group will receive the nudge (three text messages four weeks apart) to remind them to get the COVID-19 booster vaccine

Group Type EXPERIMENTAL

Nudge

Intervention Type BEHAVIORAL

Three text messages that are sent four weeks apart reminding to obtain the vaccines

Pregnant women-COVID-19 vaccine RCT - standard care group

Women randomized to the standard care group will not receive the nudge (three text messages four weeks apart) to remind them to get the COVID-19 booster vaccine. They will receive normal care at the hospital.

Group Type NO_INTERVENTION

No interventions assigned to this group

Pregnant women-influenza vaccine RCT - intervention group

Women randomized to the intervention group will receive the nudge (three text messages four weeks apart) to remind them to get the annual influenza vaccine

Group Type EXPERIMENTAL

Nudge

Intervention Type BEHAVIORAL

Three text messages that are sent four weeks apart reminding to obtain the vaccines

Pregnant women-influenza vaccine RCT - standard care group

Women randomized to the standard care group will not receive the nudge (three text messages four weeks apart) to remind them to get the annual influenza vaccine. They will receive normal care at the hospital.

Group Type NO_INTERVENTION

No interventions assigned to this group

Medically at risk children-COVID-19 vaccine RCT - intervention group

Parents of medically at risk children randomized to the intervention group will receive the nudge (three text messages four weeks apart) to remind them to get their child the COVID-19 vaccine

Group Type EXPERIMENTAL

Nudge

Intervention Type BEHAVIORAL

Three text messages that are sent four weeks apart reminding to obtain the vaccines

Medically at risk children-COVID-19 vaccine RCT - standard care group

Parents of medically at risk children randomized to the standard care group will not receive the nudge (three text messages four weeks apart) to remind them to get their child the COVID-19 vaccine. They will receive normal care at the hospital.

Group Type NO_INTERVENTION

No interventions assigned to this group

Medically at risk children-influenza vaccine RCT - intervention group

Parents of medically at risk children randomized to the intervention group will receive the nudge (three text messages four weeks apart) to remind them to get their child the annual influenza vaccine

Group Type EXPERIMENTAL

Nudge

Intervention Type BEHAVIORAL

Three text messages that are sent four weeks apart reminding to obtain the vaccines

Medically at risk children-influenza vaccine RCT - standard care group

Parents of medically at risk children randomized to the standard care group will not receive the nudge (three text messages four weeks apart) to remind them to get their child the annual influenza vaccine. They will receive normal care at the hospital.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Nudge

Three text messages that are sent four weeks apart reminding to obtain the vaccines

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* COVID-19 pregnant women RCT: Pregnant women have received 2 or less doses of a recommended COVID-19 vaccine
* Influenza pregnant women RCT: Pregnant women have not received the influenza vaccine during pregnancy
* COVID-19 medically at risk children RCT: Medically at risk children aged 5 years to 18 years with a cardiac, endocrine, respiratory, gastrointestinal, haematological, musculoskeletal, neurological condition
* Influenza medically at risk children RCT: Children aged ≥6 months and \< 18 years with medical conditions specified in this list: immunocompromising conditions including malignancy, chronic steroid use, haematopoietic stem cell transplant; functional or anatomical asplenia including sickle cell disease or other haemoglobinopathies, congenital or acquired asplenia (for example, splenectomy) or hyposplenia; cardiac disease including cyanotic congenital heart disease, congestive heart failure, coronary artery disease; chronic respiratory conditions including suppurative lung disease, bronchiectasis, cystic fibrosis, chronic obstructive pulmonary disease, severe asthma (requiring frequent medical consultations or the use of multiple medicines); chronic neurological conditions including hereditary and degenerative CNS diseases, seizure disorders, spinal cord injuries, neuromuscular disorders; chronic metabolic disorders including Type 1 or 2 diabetes, amino acid disorders, carbohydrate disorders, cholesterol biosynthesis disorders, fatty acid oxidation defects, lactic acidosis, mitochondrial disorders, organic acid disorders, urea cycle disorders, vitamin/cofactor disorders, porphyria; chronic renal failure; children aged 5 to 10 years receiving long term aspiring therapy; Down syndrome; obesity (body mass index ≥30 kg/m2); children born less than 37 weeks gestation

Exclusion Criteria

* COVID-19 pregnant women RCT: Pregnant women have contraindications to COVID-19 vaccines and already randomised to influenza RCT.
* Influenza pregnant women RCT: Pregnant women have contraindications to Influenza vaccines and already randomised to COVID-19 RCT.
* COVID-19 medically at risk children RCT:

* Known contraindications to COVID-19 vaccine
* Up to date for COVID-19 vaccine (≥ two doses) at the time of enrolment,
* Sibling of a child already enrolled in the trial (only the sibling who is eligible and scheduled to attend a paediatric clinic first will be eligible)
* Previous participation in the influenza nudge RCT
* Influenza medically at risk children RCT:

* Known contraindications to influenza vaccine
* Already received an influenza vaccine during the flu season in 2023
* Sibling of a child already participating in the trial (the sibling who is eligible and scheduled to attend a paediatric clinic first will be eligible)
* Previous participation in the COVID-19 nudge RCT
Minimum Eligible Age

6 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Adelaide

OTHER

Sponsor Role lead

Responsible Party

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Helen Marshall

Clinical Research Director, Women's and Children's Health Network Consultant in Vaccinology and Medical Director, Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Women's and Children's Hospital

Adelaide, South Australia, Australia

Site Status RECRUITING

Flinders Medical Centre

Bedford Park, South Australia, Australia

Site Status RECRUITING

Lyell McEwin Hospital

Elizabeth Vale, South Australia, Australia

Site Status RECRUITING

Mercy Hospital For Women

Heidelberg, Victoria, Australia

Site Status RECRUITING

The Royal Children's Hospital

Parkville, Victoria, Australia

Site Status RECRUITING

Perth Children's Hospital

Nedlands, Western Australia, Australia

Site Status RECRUITING

King Edward Memorial Hospital

Subiaco, Western Australia, Australia

Site Status NOT_YET_RECRUITING

Countries

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Australia

Facility Contacts

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Helen Marshall, MBBS, MD

Role: primary

+61 8161 8115

Prabha Andraweera, MBBS, PhD

Role: backup

+61 8 8161 8117

Dylan Mordaunt, FRACP

Role: primary

+61 8 8204 4888

Gus Dekker, MD, FFANZCOG

Role: primary

+61 82821626

Dimi Simatos, FRACP

Role: backup

+61 82821626

Margie Danchin, FRACP

Role: primary

+61 3 9345 5522

Margie Danchin, FRACP

Role: primary

T +61 3 9345 5522

Christopher Blyth, FRACP

Role: primary

+61 8 6456 5614

Christopher Blyth, FRACP

Role: primary

+61 8 6456 5614

References

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Wang B, Andraweera P, Danchin M, Blyth CC, Vlaev I, Ong J, Dodd JM, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop LJ, Marshall H. Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics. BMJ Open. 2024 Feb 17;14(2):e076194. doi: 10.1136/bmjopen-2023-076194.

Reference Type DERIVED
PMID: 38367966 (View on PubMed)

Andraweera PH, Wang B, Danchin M, Blyth C, Vlaev I, Ong J, Dodd J, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop L, Marshall HS. Randomised controlled trials of behavioural nudges delivered through text messages to increase influenza and COVID-19 vaccines among pregnant women (the EPIC study): study protocol. Trials. 2023 Jul 12;24(1):454. doi: 10.1186/s13063-023-07485-9.

Reference Type DERIVED
PMID: 37438776 (View on PubMed)

Other Identifiers

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WCHN HREC/2022/HREC00082

Identifier Type: -

Identifier Source: org_study_id

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