Abstract
ObjectiveThe purpose of this double-blind, randomised, controlled trial is to compare allergic outcomes in children following vaccination with acellular pertussis (aP) antigen (standard of care in Australia) given at 2 months of age versus whole cell pertussis (wP) in the infant vaccine schedule.ParticipantsUp to 3000 Australian infants 6 to <12 weeks of age born ≥32 weeks gestation.InterventionsThe intervention is a wP containing vaccine as the first scheduled pertussis vaccine dose instead of an aP containing vaccine.OutcomesThe primary outcome is a binary indicator of history of IgE-mediated food allergy at the age of 12 months confirmed, where necessary, with an oral food challenge before 18 months of age. Secondary outcomes include (1) history of parent-reported clinician-diagnosed new onset of atopic dermatitis by 6 or 12 months of age with a positive skin prick test to any allergen before 12 months of age, (2) geometric mean concentration in pertussis toxin-specific IgG before and 21 to 35 days after a booster dose of aP at 18 months of age, and (3) sensitisation to at least one allergen by 12 months of age.ResultsOperating characteristics of trial decision rules were evaluated by trial simulation. The selected rules for success and futility approximately maintain type I error of 0.05 and achieved power 0.85 for a reduction in the primary outcome from 10% in the control group to 7% in the intervention group.DiscussionA detailed, prospective statistical analysis plan (SAP) is presented for this Bayesian adaptive design. The plan was written by the trial statistician and details the study design, pre-specified adaptive elements, decision thresholds, statistical methods, and the simulations used to evaluate the operating characteristics of the trial. Application of this SAP will minimise bias and supports transparent and reproducible research.Trial registrationAustralia & New Zealand Clinical Trials Registry, ACTRN12617000065392. Registered on 12 January 2017Study protocolhttps://doi.org/10.1136/bmjopen-2020-042838
Highlights
Combination vaccines containing whole-cell pertussis antigens were phased out from the Australian National Immunisation Program (NIP) between 1997 and 1999 and replaced by vaccines containing less reactogenic acellular pertussis antigens
The plan was written by the trial statistician and details the study design, pre-specified adaptive elements, decision thresholds, statistical methods, and the simulations used to evaluate the operating characteristics of the trial
In a case-control study of Australian children born during the transition period, those with allergist diagnosed IgE-mediated food allergy were less likely to have received whole-cell vaccine in early infancy than matched population controls [odds ratio 0.77, 95% confidence interval (0.62, 0.95)] [1]
Summary
Combination vaccines containing whole-cell pertussis (wP) antigens were phased out from the Australian National Immunisation Program (NIP) between 1997 and 1999 and replaced by vaccines containing less reactogenic acellular pertussis (aP) antigens. In a case-control study of Australian children born during the transition period, those with allergist diagnosed IgE-mediated food allergy were less likely to have received whole-cell vaccine in early infancy than matched population controls [odds ratio 0.77, 95% confidence interval (0.62, 0.95)] [1]. We hypothesise that a single dose of whole-cell vaccine in early infancy is protective against IgE-mediated food allergy in early childhood. This statistical analysis plan (SAP) provides a priori specification of the decision-making rules and the statistical methods to be used in a prospective clinical trial. The SAP is written to be consistent with the CONSORT 2010 Statement and further guidelines and supports transparent and reproducible research
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