The objective of this randomized clinical trial is to test whether administration of live attenuated MMR vaccine (measles mumps rubella; Merck) to eligible adults at highest risk for contracting COVID-19 (healthcare workers, first responders), can induce non-specific trained innate immune leukocytes that can prevent/dampen pathological inflammation and sepsis associated with COVID-19-infection, if exposed.
Clinical Design. Eligible healthcare workers (HCW) or first responders in the greater New
Orleans area (n=60) meeting eligibility criteria will be enrolled into a 12 month study by
the Louisiana State University Health Sciences Center Clinical & Translational Research
Center (LSUHSC CTRC) clinical staff affiliated with the Louisiana Clinical and Translational
Research Science (LA CaTS) Center and blindly randomized to receive the live attenuated
M-M-R® II vaccine or placebo (sterile saline) via subcutaneous injection in the arm at a
baseline visit following informed consent. Subjects will be recruited from local hospitals
and EMS stations throughout the greater New Orleans area by distributing recruitment flyers
at the local facilities. The flyers will have contact information for HCWs and EMS first
responders to call for more information or to schedule an appointment. Additionally, subjects
may be referred to the study by other HCWs or first responders aware of study activities.
Subject consenting, interviewing, vaccine administration and biospecimen collection will be
performed by the CTRC staff, under full Personal Protective Equipment (PPE) protection.
Following informed consent, subjects will be asked to complete the Baseline Demographic &
History Questionnaire disclosing their demographic information, employment, medication,
vaccination, and medical history. Specifically, the medical history will place emphasis on
the presence of diabetes, hypertension, heart disease, and their treatments/medications.
Subjects will then have their height, weight, body mass index (BMI), vital signs, and pulse
oximetry measured. Subjects will also have their body composition and fat percentage measured
using the BOD POD Body Composition Tracking System. Female subjects of childbearing potential
will be given a urine-based pregnancy test. Approximately 10cc of blood will be collected
along with a nasopharyngeal swab for baseline laboratory analysees (serology, RNA, flow
cytometry). When available, a finger prick blood sample will be obtained in addition to the
other biospecimens for COVID-19 serological analysis. Those subjects that satisfy the
inclusion and exclusion criteria (Eligibility Criteria) will be blindly randomized to receive
the live attenuated M-M-R® II vaccine or placebo (sterile saline) via subcutaneous injection.
Repeat biosampling will occur on days 14, 30, 60, and at 12 months post-vaccination. At each
follow-up, anthropometric measurements, vital signs measurement, and symptom assessment for
the presence of symptoms related to COVID-19 infection (fever, headache, myalgia, cough, loss
of taste or smell, breathing problems), general well-being (i.e., pain, dental concerns,
sleep patterns, general stress level, fatigue), and any changes in medications, medical
status, and employment will be collected utilizing the Follow-up Symptom & History
Questionnaire. Telephone follow-up calls utilizing the Follow-up Symptom Assessment & History
Questionnaire will be made on a monthly basis between the 60-day follow-up visit and the
12-month endpoint visit. Should a subject develop symptoms potentially associated with
COVID-19 infection at any point during the 12-month study period, that subject will be seen
in the clinic by the Infectious Disease (ID) Co-investigator, and a repeat collection of
blood and nasopharyngeal biospecimens will be performed for analysis, and the subject will be
asked to complete the Follow-up Symptom & History Questionnaire and get another body
composition analysis via BOD POD. Subjects will be asked to report the development of any
potential COVID-19 infection-related symptoms or positive COVID-19 infection testing outside
of the study, as well as any symptoms potentially related to MMR vaccination. Should a
subject become admitted to the hospital related to COVID-19 infection, in-patient information
will be obtained via the electronic medical record (EMR) when available.
Primary outcome measures will be peripheral blood monocytic MDSCs (M-MDSC) and/or
granulocytic MDSCs (G-MDSC) determined by flow cytometry from whole blood samples.
Specifically, documented increases in the MDSCs per subject from baseline through 30-60 days
post-vaccination is expected in the MMR group compared to placebo group. Measles antibody are
also expected to increase in the MMR group and will serve as a control for the MMR
vaccination. Stationary levels of MDSCs and measles antibodies are expected in the MMR group
over the 12-month period.
The investigators will perform the COVID-19 RNA testing at baseline, 14, 30, and 60 days
post-vaccination, and at any point over the 12-month period that symptoms arise. All patients
that are COVID-19+ at baseline or become COVID-19+ through the study will be included for
secondary outcome analyses. The Secondary outcome measures will be COVID-19 antibodies
(seropositive) as evidence of infection, sepsis/lung inflammation, ICU/ventilator usage,
in-patient health related co-morbidities and self-reporting mental status (such as general
fatigue/stress level) over the 12-month period post-vaccination. In-patient information will
be obtained through the EMR when available. Out-patient information will be obtained via
self-reporting utilizing the Follow-up Symptom & History Questionnaire.
Biological: MMR vaccine
Merck MMR-II vaccine
Inclusion Criteria:
- 18-70 years of age
- Employed as a HCW (hospital, outpatient clinic, private office or 1st responder (EMS)
in the greater New Orleans region
- Able to provide a signed and dated informed consent
- Able to provide pre-randomized blood specimen
Exclusion Criteria:
- Any known MMR vaccine contraindication
- Fever
- Weakened resistance toward infections due to a disease in/of the immune system
- Individuals receiving medical treatment that affects the immune response or other
immunosuppressive therapy in the last year (see excluded medications).
- Individuals with a congenital cellular immunodeficiency
- Individuals with a malignancy involving bone marrow or lymphoid systems
- Individuals with any serious underlying illness (such as malignancy). People with
cardiovascular disease, hypertension, diabetes, and/or chronic respiratory disease are
eligible if not immunocompromised (at the discretion of the ID Co-investigator)
- Individuals with known or suspected HIV infection, even if asymptomatic or has normal
immune function. (Due to the risk of disseminated MMR infection)
- Individuals with an active skin disease such as eczema, dermatitis or psoriasis at or
near the site of vaccination. A different site can be chosen if necessary
- Pregnant or women who think they may test positive for pregnancy in this next month
following MMR vaccine administration.
- Individuals who have received a MMR or another live vaccine (i.e., Zostavax, nasal flu
vaccine) within the last year
- Individuals with known anaphylactic reaction to any of the ingredients present in the
MMR vaccine
- Individuals previously testing positive for SARS-CoV-2 or documented seropositive for
SARS-CoV-2 antibodies prior to enrollment in this study
Clinical and Translational Research Center
New Orleans, Louisiana, United States
Paul L Fidel, PhD, Principal Investigator
Louisiana State University Health Sciences Center - New Orleans