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InfectionPhase 3COVID-BCGNCT04384549

Efficacy of BCG Vaccination in the Prevention of COVID19 Via the Strengthening of Innate Immunity in Health Care Workers

A Phase 3 study testing BCG GROUP in people with Infection and Viral, Agent as Cause of Disease Classified Elsewhere, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Healthcare Workers (HCW) are at high risk for COVID-19. In addition to the risk of serious forms among HCW, significant absenteeism due to illness would have dramatic consequences in our ability to fight COVID-19. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
What is being tested?
BCG GROUP
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1,120 participants
Where
1 siteFrance
Study dates
20 May 2020to 20 Feb 2021
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Individual (Male and female) aged 18 or over.
  • Healthcare Worker (medical or non-medical) from hospitals in direct contact with COVID-19 patients.
  • Participants must give their written consent before any trial procedure.
  • Participants covered by social security regimen (excepting AME).
  • Healthy according to the opinion of the investigator.

Who cannot join

  • Has any BCG vaccine contraindication, known allergy to the BCG vaccine or SAE to prior BCG vaccination.
  • History of tuberculosis
  • People with acquired or innate immunodeficiency.
  • People have already been infected with SARS Cov-2 (virological documentation or TDM or seropositive if serology available).
  • People who could not commit to follow-up for 6 months.
  • People not in good general condition, as assessed by the investigator.
Show all 19Show fewer
  • People included in other clinical trials assessing treatment.
  • Pregnant or breastfeeding or positive urine pregnancy at enrolment visit.
  • BCG vaccine given within the last year.
  • Another live vaccine administered in the month prior to randomization.
  • History of anaphylaxis following vaccination.
  • Receiving medical treatment that affects the immune response or other immunosuppressive therapy in the last year. These therapies include systemic corticosteroids (more than or equal to 10 mg for more than or equal to 2 weeks), immunosuppressant, biological agents (such as monoclonal antibodies against tumour necrosis factor (TNF)-alpha).
  • Another vaccine administered in the month prior to inclusion and randomization.
  • Fever > 38°C within the past 24 hours
  • People with malignancies (e.g. lymphoma, leukemia, Hodgkin's disease or other tumors of the reticuloendothelial system) or infected with HIV
  • Receipt of immune globulins, blood or blood-derived products in the past 3 months
  • Acute severe febrile illness
  • Generalized infected skin conditions
  • People under legal protection measure (tutorship, curatorship or safeguard measures)

Trial locations and contacts

1 site in 1 country.

Odile LAUNAY, Professor contact

01 58 41 28 58

odile.launay@aphp.fr

France1 site, 1 recruiting
  • I-REIVAC/CIC 1417 Cochin Hospital, APHP

    Paris, 75014

    Odile LAUNAY, Professor, 01 58 41 28 58, odile.launay@aphp.fr

    Ahlam SAAD, '01 58 41 33 54, ahlam.saad@aphp.fr

    Recruiting

Other trials in France

About this study

Official title: Randomized Controlled Trial Evaluating the Efficacy of Vaccination With Bacillus Calmette and Guérin (BCG) in the Prevention of COVID-19 Via the Strengthening of Innate Immunity in Health Care Workers

Healthcare Workers (HCW) are at high risk for COVID-19. In addition to the risk of serious forms among HCW, significant absenteeism due to illness would have dramatic consequences in our ability to fight COVID-19. No coronavirus vaccine is available today and drug treatments are only at the start of clinical evaluation. Available since 1921, the bacillus Calmette and Guérin (BCG) is the most widely used vaccine in the world (> 3 billion doses administered) with an extremely low rate of adverse effects. BCG is indicated for the prevention of tuberculosis (TB), but more recent studies have shown that it also has nonspecific immune properties which may be interesting in the current COVID-19 epidemic. Data in mice and in humans have demonstrated protection conferred by BCG against viral respiratory infections such as influenza. In countries with high endemic TB, BCG decreases the incidence of acute respiratory infections by up to 80%, neonatal BCG vaccination has been shown to greatly reduce the risk of sepsis and of hospitalization of children for reasons other than TB. A recent study conducted in South Africa showed that re-vaccination with BCG in adults reduced the incidence of respiratory infections by 70% compared to unvaccinated controls. Beyond respiratory infections, BCG has also shown protective effects against inflammatory diseases. These non-specific beneficial effects are likely linked to the induction of "trained innate immunity", implying epigenetic and metabolic re-programming of innate immune cells. It is therefore possible that revaccination with BCG could significantly reduce the incidence and severity of COVID-19. Very recent ecological observations indeed suggest an inverse correlation between BCG vaccination coverage and the morbidity and mortality of COVID-19. In this context several trials began in Europe and Australia to evaluate the efficacy of BCG vaccination in populations at risk of exposure (HCW) or severe disease (elderly). This study is aligned with studies carried out in Australia, The Netherlands and Spain. In contrast to these latter studies, virtually all French study participants have been vaccinated in their childhood, since BCG vaccination was mandatory in France in neonates until 2007, and in HCW until recently. Therefore, the French study will be in a unique situation to evaluate the effect of re-vaccination with BCG in the context of BCG priming decades before revaccination.

Read the detailed description

Randomized, multicenter phase III controlled trial, in 2 parallel arms:

  • One group vaccinated with BCG
  • One group receiving placebo (0.9 % saline) Randomization in a 1: 1 ratio will be stratified on the center. The study will be proposed to all heath care workers eligible. At screening, the investigator will propose the study to the participant and explain the details by providing an information letter. After signature of the consent, evaluations specific for the study will be undertaken, such as clinical examination, blood sampling, nasopharyngeal sampling in case of clinical signs.

At the inclusion visit, participants corresponding to the inclusion criteria will be randomized to receive BCG or placebo.

Participants will receive a single dose of BCG vaccine (or placebo). The adult dose of BCG vaccine (or placebo) is 0.1 mL injected intradermally over the distal insertion of the deltoid muscle onto the humerus (approximately one third down the upper arm).

Follow-up visits will be done respectively at M3 and M6 and phone contacts between these two visits.

Blood samples will be collected prior to randomization (V0) and at 3 and 6 months to determine exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Where required, swab/blood samples will be taken at illness episodes to assess SARS-CoV-2 infection.

Participants will be followed for 6 months with regular mobile phone text messages 2 times weekly to collect local and general reactions until 30 days after vaccination and during the study to identify and detail COVID-19 infection.

Immunological studies will be conducted at a central Laboratory. Analysis will take place after M6 visits.

A nested study will be carried out on blood samples of 72 study subjects in order to evaluate the impact of COVID-19 on innate immunity. These blood samples will be collected at M6 among 6 groups, each containing 12 study subjects:

  • One group of subjects vaccinated with BCG that have remained sero-negative for SARS CoV2
  • One group of subjects having received placebo that have remained sero-negative for SARS CoV2
  • One group of symptomatic subjects vaccinated with BCG
  • One group of symptomatic subjects having received placebo.
  • One group without symptoms but sero-positive for SARS CoV2 vaccinated with BCG
  • One group without symptoms but sero-positive for SARS CoV2 vaccinated with placebo
Being tested
BCG GROUP, PLACEBO GROUP
Keywords
Vaccinology, Infectiology, COVID-19, Health Workers
Medical subject headings
Infections, COVID-19

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BCG GROUPBiological

    Also called Experimental GROUP

    One intradermal injection of 0.1 ml of BCG vaccine (AJ Vaccine).Each 0.1 ml vaccine contains between 2 to 8 x 105 colony forming units.

  • PLACEBO GROUPOther

    Also called Control GROUP

    One intradermal injection of 0.1ml NaCl

Study groups in NCT04384549
Study groupRoleWhat they receive
BCG ArmExperimentalOne intradermal injection of 0.1 ml of BCG vaccine (AJ Vaccine).Each 0.1 ml vaccine contains between 2 to 8 x 105 colony forming units.
Receives: Biological: BCG GROUP
PLACEBO ArmPlacebo comparatorOne intradermal placebo injection.
Receives: Other: PLACEBO GROUP

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of documented COVID-19 among health care workers exposed to SARS CoV2 and vaccinated with BCG compared to placebo.

    Documented COVID-19, i.e. symptomatic COVID-19 confirmed by either

    • positive nasopharyngeal tests for SARS CoV2
    • and/or by thoracic tomodensitometry compatible with the diagnosis.
    • and/or SARS CoV2 seroconversion

    Measured: during the study period of 6 months

Secondary outcomes (6)
  1. Numbers of COVID-19 patients requiring hospitalization in ICU and O2, artificial ventilation or extracorporal membrane oxygenation, or deaths in BCG-vaccinated health care workers compared to placebo

    Participants having developed a severe form of COVID-19, as defined by the necessity for hospitalization in ICU and O2 or artificial ventilation, or extracorporeal membrane oxygenation, or death

    Measured: during the study period of 6 months.

  2. Incidence of asymptomatic SARS CoV2 seropositive subjects among BCG-vaccinated health care workers compared to placebo.

    Participants with seroconversion during the study, without symptoms related to COVID-19

    Measured: during the study period of 6 months.

  3. Incidence of subjects with any respiratory infection among BCG-vaccinated health care workers compared to placebo.

    Participants presenting any kind of respiratory infection due to any cause

    Measured: during the study period of 6 months.

  4. Numbers of sick days and numbers of sick leaves among BCG-vaccinated health care workers compared to placebo.

    Numbers of sick days and number of sick leaves

    Measured: during the study period of 6 months

  5. Numbers of subjects with BCG-related advers events among BCG-vaccinated health care workers compared to placebo.

    Local and general events following BCG revaccination after BCG revaccination

    Measured: 30 days after BCG revaccination

  6. Numbers and intensity of changes in innate immune markers after SARS CoV2 infection among BCG-vaccinated health care workers compared to placebo.

    Potentially modified markers of innate immunity upon SARS CoV-2 infection to be identified

    Measured: during the study period of 6 months.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 May 2020
  2. Study start20 May 2020
  3. Primary completion20 Feb 2021 (estimated)
  4. Study completion20 Feb 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
1,120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04384549
Sponsor's protocol ID
APHP200462
Other IDs
2020-001678-31
Acronym
COVID-BCG
Status last verified
Aug 2020
First submitted
6 May 2020
Last updated
18 Aug 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Moorlag SJCFM, Arts RJW, van Crevel R, Netea MG. Non-specific effects of BCG vaccine on viral infections. Clin Microbiol Infect. 2019 Dec;25(12):1473-1478. doi: 10.1016/j.cmi.2019.04.020. Epub 2019 May 2.

    PubMed 31055165
  • Nemes E, Geldenhuys H, Rozot V, Rutkowski KT, Ratangee F, Bilek N, Mabwe S, Makhethe L, Erasmus M, Toefy A, Mulenga H, Hanekom WA, Self SG, Bekker LG, Ryall R, Gurunathan S, DiazGranados CA, Andersen P, Kromann I, Evans T, Ellis RD, Landry B, Hokey DA, Hopkins R, Ginsberg AM, Scriba TJ, Hatherill M; C-040-404 Study Team. Prevention of M. tuberculosis Infection with H4:IC31 Vaccine or BCG Revaccination. N Engl J Med. 2018 Jul 12;379(2):138-149. doi: 10.1056/NEJMoa1714021.

    PubMed 29996082
  • Kowalewicz-Kulbat M, Locht C. BCG and protection against inflammatory and auto-immune diseases. Expert Rev Vaccines. 2017 Jul;16(7):1-10. doi: 10.1080/14760584.2017.1333906. Epub 2017 May 30.

    PubMed 28532186
  • Netea MG, Dominguez-Andres J, Barreiro LB, Chavakis T, Divangahi M, Fuchs E, Joosten LAB, van der Meer JWM, Mhlanga MM, Mulder WJM, Riksen NP, Schlitzer A, Schultze JL, Stabell Benn C, Sun JC, Xavier RJ, Latz E. Defining trained immunity and its role in health and disease. Nat Rev Immunol. 2020 Jun;20(6):375-388. doi: 10.1038/s41577-020-0285-6. Epub 2020 Mar 4.

    PubMed 32132681

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing BCG GROUP in people with Infection and Viral, Agent as Cause of Disease Classified Elsewhere, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 18 Aug 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Odile LAUNAY, Professor (01 58 41 28 58, odile.launay@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of documented COVID-19 among health care workers exposed to SARS CoV2 and vaccinated with BCG compared to placebo. (time frame: during the study period of 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04384549, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2020.

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