Alonso 2005a.
Methods | Randomized controlled trial Generation of allocation sequence: computer generated in blocks of 6 Allocation concealment: central randomization was done at GlaxoSmithKline and the code released to the investigators after completion of follow up; opaque masked and coded syringes were used Blinding: investigator, participants, and outcome assessors blinded for first 6 months; investigators were not blinded during next 12 months Inclusion of all randomized participants: 1493/1605 (93.0%) of those randomized received 3 doses; 1380/1605 (86.0%) completed 6‐month follow up (92.4% of those who received 3 doses); 1442 entered single‐blind phase of whom 1319 (91.5%) completed follow up Length of follow up: 18 months after third dose |
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Participants | Number: 1605 children Inclusion criteria: aged 1 to 4 years; resident in study area; full immunization with Expanded Programme of Immunization (EPI) vaccines; parental consent Exclusion criteria: history of allergic disease; packed cell volume ≤ 25%; weight for height ≤ 3 Z score; clinically significant chronic or acute disease; abnormal haematology or biochemistry variables |
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Interventions | 1. RTS,S vaccine: 3 doses, 25 µg in 250 µL AS02A adjuvant, intramuscularly in deltoid (alternating arms) at 0, 1, and 2 months 2. Pneumococcal conjugate vaccine (under 24‐months old; first and third doses) plus Hib vaccine (second dose) or hepatitis B vaccine (over 24‐months old; 3 doses) | |
Outcomes | 1. Time to first clinical episode of symptomatic Plasmodium falciparum malaria (case definition: child presenting with temperature > 37.5 °C and parasitaemia > 2500/µL) 2. Clinical episodes of malaria 3. Malaria needing admission: (P. falciparum sole cause of illness or important contributing factor) 4. All‐cause admission 5. Severe malaria (derived from World Health Organization definition: asexual P. falciparum parasitaemia; no other more probable cause of illness; plus composite of severe malaria anaemia (packed cell volume < 15%), cerebral malaria (Blantyre coma score < 2), and severe disease of other body systems (multiple seizures, prostration, hypoglycaemia, clinically suspected acidosis, or circulatory collapse) 6. Prevalence of parasitaemia 7. Prevalence of anaemia (packed cell volume < 25%) 8. Geometric mean parasite density in first clinical episode 9. Geometric mean parasite density in parasitaemic children at 6.5 months 10. Geometric mean titre to CS protein and hepatitis B surface antigen (HBsAg) 11. Seropositivity rates for anti‐CS antibody (> 0.5 international units/mL) and anti‐hepatitis B surface antigen (HBsAg) antibody (≥ 10 international units/mL) 12. Adverse events | |
Notes | Location: within 10 km radius of Manhica, Mozambique where the entomological inoculation rate in 2002 was 38 infective bites/year Method of surveillance: passive surveillance of illness and adverse events through health centre staffed 24/7; observation for 1 h after vaccination and once/day at home for 3 days after each dose for adverse events; home visits once per month starting 60 days after third dose to check residence and document unreported adverse events; complete blood count done 1 month after dose 3; creatinine, alanine aminotransferase (ALT), and bilirubin at months 1 and 6.5 after dose 3; cross‐sectional surveys with blood slide and axillary temperature taken at 6.5 months and 18 months after dose 3 This trial reported in same publication as Alonso 2005b |