Vaccine Information: Adenovirus Type 4 and Type 7 Vaccine, Live

ADENOVIRUS TYPE 4 AND TYPE 7 VACCINE, LIVE-
Teva Women’s Health, Inc.

1 INDICATIONS AND USAGE

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral is a vaccine indicated for active immunization for the prevention of febrile acute respiratory disease caused by Adenovirus Type 4 and Type 7. Adenovirus Type 4 and Type 7 Vaccine, Live, Oral is approved for use in military populations 17 through 50 years of age.

2 DOSAGE AND ADMINISTRATION

A single vaccine dose is administered orally as two tablets: one tablet of Adenovirus Type 4 and one tablet of Adenovirus Type 7. (2)

The tablets should be swallowed whole, without chewing, to avoid releasing the virus in the upper respiratory tract [See Mechanism of Action (12.1)].

Postpone administration to individuals with vomiting and/or diarrhea because the effectiveness of the vaccine depends upon the multiplication of orally administered live adenovirus within the intestinal tract [See Mechanism of Action (12.1)].

3 DOSAGE FORMS AND STRENGTHS

A single vaccine dose consists of two tablets: one tablet of Adenovirus Type 4 and one tablet of Adenovirus Type 7.

4 CONTRAINDICATIONS

4.1 Pregnancy

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral should not be administered to pregnant females [See Pregnancy (8.1)]. It is not known whether Adenovirus Type 4 and Type 7 Vaccine, Live, Oral can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Naturally occurring infection with adenoviruses has been associated with fetal harm. Pregnancy should be avoided for 6 weeks following receipt of vaccine.

4.2 Severe Allergic Reaction

Severe allergic reaction (e.g., anaphylaxis) to any component of Adenovirus Type 4 and Type 7 Vaccine, Live, Oral is a Contraindication [See Description (11)].

4.3 Inability to Swallow

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral should not be administered to individuals incapable of swallowing each entire tablet, whole, without chewing. Chewing a tablet could expose the upper respiratory tract to live adenovirus leading to disease [See Mechanism of Action (12.1)].

5 WARNINGS AND PRECAUTIONS

5.1 Altered Immunocompetence

The safety and effectiveness of Adenovirus Type 4 and Type 7 Vaccine, Live, Oral in immunocompromised individuals has not been evaluated.

5.2 Shedding and Transmission

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral contains live viruses that are shed in the stool and can cause disease if transmitted.

People who come in close contact with those who were vaccinated, including other vaccinees, may be exposed to the virus present in the stool and may develop disease [See Pharmacodynamics (12.2)].

Persons vaccinated with Adenovirus Type 4 and Type 7 Vaccine, Live, Oral should exercise caution when in close contact with children less than 7 years of age and immunocompromised individuals such as those with HIV infection and cancer, or those receiving immunosuppressive therapy during the 28 day period of viral shedding following the vaccination [See Use in Specific Populations (8.3) and Pharmacodynamics (12.2)].

Vaccinees should exercise caution when in close contact with pregnant women during the 28 day period of shedding because fetal harm may result if pregnant women are exposed to adenovirus [See Pregnancy (8.1) and Pharmacodynamics (12.2)].

5.3 Planning for Pregnancy

Use effective contraception for 6 weeks after vaccination to avoid pregnancy [See Pregnancy (8.1)].

5.4 Human Serum Albumin

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral contains albumin, a derivative of human blood. It is present at concentrations of <0.3 mg/tablet. Based on effective donor screening, and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) also is considered extremely remote. No cases of transmissions of viral diseases or CJD have ever been identified for human albumin.

6 ADVERSE REACTIONS

6.1 Clinical Trials Experience

Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a vaccine cannot be directly compared to the rates in the clinical trials of another vaccine and may not reflect the rates observed in practice.

Multicenter Safety and Efficacy Trial

Safety of Adenovirus Type 4 and Type 7 Vaccine, Live, Oral was evaluated in a multicenter, double-blind, randomized, placebo-controlled study that enrolled 3031 subjects who received vaccine and 1009 subjects who received placebo (lactose tablets). The study was conducted in healthy male (63%) and female (37%) active duty US Army and Navy military recruits during their basic training. The population had a mean age of 21 years, with an age range of 17 to 42 years. Race was 62% Caucasian, 18% African-American, 11% Hispanic, 3% Asian and 6% other. Subjects in both groups were administered other vaccines concomitantly with Adenovirus Type 4 and Type 7 Vaccine, Live, Oral. The specific vaccines that each subject received varied and were dependent on their immunization history. The vaccines that were co-administered included Hepatitis A Vaccine, Inactivated (Merck & Co., Inc.), Hepatitis A Inactivated and Hepatitis B (Recombinant) Vaccine (GlaxoSmithKline Biologicals), Hepatitis B Vaccine (Recombinant) (Merck & Co., Inc.), Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant (Merck & Co., Inc.), Influenza Vaccine, Live, Intranasal (MedImmune, LLC), Influenza Virus Vaccine (Sanofi Pasteur, Inc.), Measles, Mumps, and Rubella Virus Vaccine Live (Merck & Co., Inc.), Meningococcal (Groups A, C, Y and W-135) Polysaccharide, Diphtheria Toxoid Conjugate Vaccine (Sanofi Pasteur, Inc.), Meningococcal Polysaccharide Vaccine (Groups A, C, Y and W-135 Combined) (Sanofi Pasteur, Inc.), Poliovirus Vaccine Inactivated (Sanofi Pasteur, SA), Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed (Sanofi Pasteur, Ltd.), Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed (GlaxoSmithKline Biologicals), Typhoid Vi Polysaccharide Vaccine (Sanofi Pasteur, SA), Varicella Virus Vaccine Live (Merck & Co., Inc.), Yellow Fever Vaccine (Sanofi Pasteur, Inc.).

Serious Adverse Events

No deaths were reported during the multicenter safety and efficacy trial.

Serious adverse events in vaccine recipients included hematuria, gastroenteritis, febrile gastroenteritis, gastritis, pneumonia, and hematochezia.

Fifty-seven serious adverse events (SAEs) were reported during the six month study period with 39 reported between 0 and 56 days following treatment and 18 reported during the 56 to 180 day follow-up period. Thirty-five subjects (1.2%) who received vaccine (25 between 0 and 56 days from the date of vaccination, 10 during the 56 to 180 day follow-up period) and 12 subjects (1.2%) who received placebo (9 between 0 and 56 days from the date of treatment, 3 during the 56 to 180 day follow-up period) experienced at least one SAE. The SAEs occurring between Day 0 and Day 56 post-vaccination in the vaccine group, possibly associated with the receipt of the vaccine product as determined by the investigator, were as follows: one subject with hematuria and gastroenteritis (at 9 days post vaccination), one subject with febrile gastroenteritis (at 4 days post vaccination, one subject with gastritis (at 23 days post vaccination), and one subject with pneumonia (at 23 days post vaccination); one SAE (hematochezia) in the vaccine group occurred during the 56 to 180 day follow-up period and was determined to be possibly related to the vaccine product. A placebo recipient developed febrile acute respiratory disease where adenovirus Type 4 vaccine strain was detected from posterior pharyngeal and tonsillar swabbing and characterized by serotyping and polymerase chain reaction analysis [See Warnings and Precautions: Shedding and Transmission (5.2)].

Overall, the percentage of subjects who experienced at least one adverse event during the 56 day study period was 91.2% in the Adenovirus Type 4 and Type 7 Vaccine, Live, Oral group compared to 93.9% in the placebo group. No subject in either treatment arm discontinued the study due to an adverse event. Adverse reactions were captured on a 2-Week Daily Diary (for a minimum of the first 780 subjects) or a 1-Week Daily Diary (for all remaining subjects) and were also reported at each study visit up to Day 56 after vaccination. Any reported AEs for Days 0-14 for the safety cohort and for Days 0-7 for the remaining subjects were defined as “solicited” because they were almost exclusively recorded directly by the subject from a pre-defined diary checklist. Although pyrexia was defined as “solicited,” it was not on the pre-defined diary checklist. Any AEs reported spontaneously as part of the regular study visit or during a spontaneous visit to the clinic, for Days 15-56 for the safety cohort and Days 8-56 for the remaining subjects were designated as “non-solicited.”

Solicited Adverse Reactions

The following solicited adverse reactions were collected through daily diaries: stuffy nose, cough, sore throat, stomach pain, headache, diarrhea, nausea, and joint pain (within 14 days post enrollment for subjects in the initial safety cohort (n=878) and within 7 days post enrollment all subjects (n= 4040) for the rest of safety population). Those solicited adverse reactions reported by ≥ 5 % of subjects in either the vaccine or placebo treatment groups are presented in Table 1.

Table 1: Solicited Adverse Reactions, Days 0-7 for All Subjects and Days 8-14 for the Safety Cohort, Reported by ≥ 5% of Subjects in the Multicenter Safety and Efficacy Trial

Adverse

Reaction*

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral

Placebo

0-7 Days

N = 3031

8-14 Days

N = 660

0-7 Days

N = 1009

8-14 Days

N = 218

n

%

n

%

n

%

n

%

Headache

894

29.5

38

6.5

310

30.7

11

5.6

Nasal Congestion (Stuffy Nose)

463

15.3

49

8.4

141

14.0

12

6.2

Pharyngolaryngeal Pain (Sore Throat)

391

12.9

72

12.3

124

12.3

24

12.3

Cough

375

12.4

59

10.1

130

12.9

14

7.2

Nausea

412

13.6

29

5.0

137

13.6

11

5.6

Diarrhea

310

10.2

18

3.1

84

8.3

10

5.1

* MedDRA Preferred Term

Pyrexia (temp ≥ 100.5°F) within 7 days, was reported to occur in 1.4% (42/3030) of vaccine recipients and 0.5% (5/961) of placebo recipients who were not diagnosed with ARD. During the 8-14 days post vaccination, rates of pyrexia were 0.6% (4/659) and 1.1% (2/170) in vaccine and placebo recipients, respectively.

Non-Solicited Adverse Reactions

Non-solicited adverse reactions that occurred Days 15-56 in the safety cohort and Days 8-56 for all remaining subjects, reported by ≥ 5 % of subjects in either the vaccine or placebo treatment groups, are presented in Table 2.

Table 2: Non-solicited Adverse Reactions, Days 15-56 for the Safety Cohort and Days 8-56 for all Remaining Subjects, Reported by ≥ 5% of Subjects in the Multicenter Safety and Efficacy Trial

Adverse Reaction*

Adenovirus Type 4 and Type 7 Vaccine, Live, Oral N=3031

Placebo N=1009

N

%

N

%

Upper Respiratory Tract Infection

1135

37.5

397

39.4

Arthralgia

524

17.3

180

17.8

Abdominal Pain Upper

443

14.6

157

15.6

Headache

330

10.9

148

14.7

Cough

257

8.5

91

9.0

Pharyngolaryngeal Pain

253

8.4

73

7.2

Nasal Congestion

229

7.6

73

7.2

Vomiting

160

5.3

55

5.5

Chills

77

2.5

51

5.1

* MedDRA Preferred Term

Less common (less than 5%) adverse reactions reported in the clinical trial in military recruits receiving Adenovirus Type 4 and Type 7 Vaccine, Live, Oral, versus placebo, respectively included rhinorrhea (128 [4.22%] vs. 25 [2.48%]), pain in extremity (130 [4.29%] vs. 37 [3.67%]), and pyrexia (fever greater than or equal to 100.5 °F) (126 [4.16%] vs. 49 [4.86%]).

Safety and Immunogenicity Trial

Five SAEs were reported among the 58 subjects in the safety and immunogenicity trial. Two SAEs occurred among the vaccine recipients: one case of pneumonia reported on Day 33 of the follow-up period, and a report of appendicitis occurring on Day 118 of follow-up period. Three SAEs were reported among placebo recipients: one case of pneumonia on Day 10 and one case of upper respiratory infection reported on Day 14, and a right thigh abscess reported at Day 91.

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