title: Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial.
abstract: 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.
authors: Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu Province, China.
authors: Feng-Cai
authors: FC
authors: Zhu
authors: Jun
authors: J
authors: Zhang
authors: Xue-Feng
authors: XF
authors: Zhang
authors: Cheng
authors: C
authors: Zhou
authors: Zhong-Ze
authors: ZZ
authors: Wang
authors: Shou-Jie
authors: SJ
authors: Huang
authors: Hua
authors: H
authors: Wang
authors: Chang-Lin
authors: CL
authors: Yang
authors: Han-Min
authors: HM
authors: Jiang
authors: Jia-Ping
authors: JP
authors: Cai
authors: Yi-Jun
authors: YJ
authors: Wang
authors: Xing
authors: X
authors: Ai
authors: Yue-Mei
authors: YM
authors: Hu
authors: Quan
authors: Q
authors: Tang
authors: Xin
authors: X
authors: Yao
authors: Qiang
authors: Q
authors: Yan
authors: Yang-Ling
authors: YL
authors: Xian
authors: Ting
authors: T
authors: Wu
authors: Yi-Min
authors: YM
authors: Li
authors: Ji
authors: J
authors: Miao
authors: Mun-Hon
authors: MH
authors: Ng
authors: James Wai-Kuo
authors: JW
authors: Shih
authors: Ning-Shao
authors: NS
authors: Xia
mesh_terms: 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
chemical_list: D007074:Immunoglobulin G; D014614:Vaccines, Synthetic; D014761:Viral Hepatitis Vaccines; C577000:hecolin