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NCT Number: NCT02606526

Early Versus Late BCG Vaccination in HIV-1 Exposed Infants in Uganda in Uganda

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:

1. Severe illness in the first 14 weeks of life, 2. Innate and adaptive immune responses to mycobacterial, non-mycobacterial antigens and TLR-agonists 3. 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.

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Key information

Conditions

Severe Illness Diarrhea Diarrhoea Infections Lower Respiratory Infection Pathological Conditions, Signs and Symptoms Septicaemia Signs and Symptoms Signs and Symptoms, Digestive Toxemia

Age range

Up to 1 day

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Health Centers in Mukono and Kampala districts

Kampala, Uganda

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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

Exclusion criteria

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

Treatment and study plan

BCG at birth

Biological

See previous description

Control arm: Delayed BCG

Biological

See previous description

Primary outcomes

  1. Severe illness

    Time frame: 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.

  2. Innate and adaptive immune responses against mycobacterial and non-mycobacterial antigens.

    Time frame: 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).

Secondary outcomes

  1. Severe illness from 48 h after randomization to 14 weeks of life

    Time frame: 48 hours to 14 weeks of life

    Severe illness as defined for primary outcome 1

  2. Severe illness in weeks 0-52 and 14-52 of life

    Time frame: First 0-52 and 14-52 weeks of life

    Severe illness as defined for primary outcome 1

  3. Adverse events

    Time frame: First 52 weeks of life

    Axillary and cervical lymphadenopathy

  4. Infant death

    Time frame: First year of life

    Death during the first year of life

  5. BCG scar at 52 weeks of age

    Time frame: First year of life

    Presence or absence of a BCG scar at the vaccination site

  6. Growth up to 52 weeks of life

    Time frame: First year of life

    Growth measured by weight and length

  7. Severe illness until 6 weeks of age

    Time frame: 6 weeks

    Severe illness as defined for primary outcome 1

  8. Severe illness until 14 weeks of age within strata of presence or absence of maternal BCG scar

    Time frame: 14 weeks

    In addition to the above-mentioned outcomes, an analysis plan will be developed which may include any necessary new or modifications in the current secondary outcomes and describe any new secondary analyses, including for sub-group effects".

Sponsors and collaborators

Lead sponsor

Makerere University

Other

Collaborators

  • Radboud University Medical Center
  • University of Bergen

Registry information

Official study title

A Randomised Controlled Trial in HIV-1 Exposed Ugandan Infants to Estimate Additional Benefits (Non-specific Effects) of BCG

Important dates

Study start
2016
Primary completion
2024
Study completion
2024
First posted
Nov 17, 2015
Registry last updated
Mar 4, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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