Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial.
BACKGROUND
Seroprevalence data suggest that a third of the world's population has been infected with the hepatitis E virus. Our aim was to assess efficacy and safety of a recombinant hepatitis E vaccine, HEV 239 (Hecolin; Xiamen Innovax Biotech, Xiamen, China) in a randomised, double-blind, placebo-controlled, phase 3 trial.


METHODS
Healthy adults aged 16-65 years in, Jiangsu Province, China were randomly assigned in a 1:1 ratio to receive three doses of HEV 239 (30 microg of purified recombinant hepatitis E antigen adsorbed to 0.8 mg aluminium hydroxide suspended in 0.5 mL buffered saline) or placebo (hepatitis B vaccine) given intramuscularly at 0, 1, and 6 months. Randomisation was done by computer-generated permuted blocks and stratified by age and sex. Participants were followed up for 19 months. The primary endpoint was prevention of hepatitis E during 12 months from the 31st day after the third dose. Analysis was based on participants who received all three doses per protocol. Study participants, care givers, and investigators were all masked to group and vaccine assignments. This trial is registered with ClinicalTrials.gov, number NCT01014845.


RESULTS
11,165 of the trial participants were tested for hepatitis E virus IgG, of which 5285 (47%) were seropositive for hepatitis E virus. Participants were randomly assigned to vaccine (n=56,302) or placebo (n=56,302). 48,693 (86%) participants in the vaccine group and 48,663 participants (86%) in the placebo group received three vaccine doses and were included in the primary efficacy analysis. During the 12 months after 30 days from receipt of the third dose 15 per-protocol participants in the placebo group developed hepatitis E compared with none in the vaccine group. Vaccine efficacy after three doses was 100.0% (95% CI 72.1-100.0). Adverse effects attributable to the vaccine were few and mild. No vaccination-related serious adverse event was noted.


CONCLUSIONS
HEV 239 is well tolerated and effective in the prevention of hepatitis E in the general population in China, including both men and women age 16-65 years.


BACKGROUND
Chinese National High-tech R&D Programme (863 programme), Chinese National Key Technologies R&D Programme, Chinese National Science Fund for Distinguished Young Scholars, Fujian Provincial Department of Sciences and Technology, Xiamen Science and Technology Bureau, and Fujian Provincial Science Fund for Distinguished Young Scholars.
Zhu
Feng-Cai
FC
Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu Province, China.
Zhang
Jun
J
Zhang
Xue-Feng
XF
Zhou
Cheng
C
Wang
Zhong-Ze
ZZ
Huang
Shou-Jie
SJ
Wang
Hua
H
Yang
Chang-Lin
CL
Jiang
Han-Min
HM
Cai
Jia-Ping
JP
Wang
Yi-Jun
YJ
Ai
Xing
X
Hu
Yue-Mei
YM
Tang
Quan
Q
Yao
Xin
X
Yan
Qiang
Q
Xian
Yang-Ling
YL
Wu
Ting
T
Li
Yi-Min
YM
Miao
Ji
J
Ng
Mun-Hon
MH
Shih
James Wai-Kuo
JW
Xia
Ning-Shao
NS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D004311:Double-Blind Method; D005260:Female; D016751:Hepatitis E / Q000276:immunology / Q000517:prevention & control*; D016752:Hepatitis E virus / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014614:Vaccines, Synthetic / Q000008:administration & dosage* / Q000276:immunology*; D014761:Viral Hepatitis Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D055815:Young Adult
D007074:Immunoglobulin G; D014614:Vaccines, Synthetic; D014761:Viral Hepatitis Vaccines; C577000:hecolin