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Meta-Analysis
. 2006 Apr 19;2006(2):CD005966.
doi: 10.1002/14651858.CD005966.

Vaccines for preventing malaria (SPf66)

P Graves  1 , H Gelband
Affiliations
Meta-Analysis

Vaccines for preventing malaria (SPf66)

P Graves et al. Cochrane Database Syst Rev. .

Abstract

Background: A malaria vaccine is badly needed. SPf66 was one of the earliest vaccines developed. It is a synthetic peptide vaccine containing antigens from the blood stages of malaria linked together with an antigen from the sporozoite stage, and is targeted mainly against the blood (asexual) stages.

Objectives: To assess the effect of SPf66 malaria vaccines against Plasmodium falciparum, P. vivax, P. malariae, and P. ovale in preventing infection, disease, and death.

Search strategy: We searched the Cochrane Infectious Diseases Group Specialized Register (September 2005), CENTRAL (The Cochrane Library 2005, Issue 3), MEDLINE (1966 to September 2005), EMBASE (1980 to September 2005), LILACS (1982 to September 2005), Science Citation Index (1981 to September 2005), and reference lists of articles. We also contacted organizations and researchers in the field.

Selection criteria: Randomized and quasi-randomized controlled trials comparing SPf66 vaccine with placebo or routine antimalarial control measures in people of any age receiving an artificial challenge or natural exposure to malaria infection (any species).

Data collection and analysis: Two people independently assessed trial quality and extracted data, including adverse events. Results were expressed as relative risks (RR) with 95% confidence intervals (CI).

Main results: Ten efficacy trials of SPf66 involving 9698 participants were included. Results with SPf66 in reducing new episodes of P. falciparum malaria were heterogeneous: it was not effective in four African trials (RR 0.98, 95% CI 0.90 to 1.07; 2371 participants) or in one Asian trial (RR 1.06, 95% CI 0.90 to 1.25; 1221 participants). In four trials in South America the number of first attacks with P. falciparum was reduced by 28% (RR 0.72, 95% CI 0.63 to 0.82; 3807 participants). It did not reduce episodes of P. vivax malaria or admission to hospital with severe malaria. Trials have not indicated any serious adverse events with SPf66 vaccine.

Authors' conclusions: There is no evidence for protection by SPf66 vaccines against P. falciparum in Africa. There is a modest reduction in attacks of P. falciparum malaria following vaccination with SPf66 in South America. There is no justification for further trials of SPf66 in its current formulation. Further research with SPf66 vaccines in South America or with new formulations of SPf66 may be justified.

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Conflict of interest statement

None known.

Figures

1
1
Plasmodium life cycle (CDC/Alexander J. da Silva, PhD/Melanie Moser)
2
2
Number of systemic reactions[1] in each group of participants after each dose of SPf66 vaccine or placebo
3
3
Number of local reactions[1] in each group of participants occurring after each dose of SPf66 vaccine or placebo
1.1
1.1. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 1 New malaria episode (P. falciparum).
1.2
1.2. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 2 New malaria episode (P. falciparum): year 2.
1.3
1.3. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 3 New malaria episode (P. vivax).
1.4
1.4. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 4 Death.
1.5
1.5. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 5 Admission to hospital.
1.6
1.6. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 6 Admission to hospital with diagnosis of malaria.
1.7
1.7. Analysis
Comparison 1 SPf66 vaccine versus placebo, Outcome 7 Prevalence of P. falciparum.
See this image and copyright information in PMC

References

References to studies included in this review

Acosta 1999 {published data only}
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Sempertegui 1994 {published data only}
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Urdaneta 1998 {published data only}
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Valero 1993 {published data only}
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Valero 1996 {published data only}
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References to studies excluded from this review

Amador 1992 {published data only}
    1. Amador R, Moreno A, Valero V, Murillo L, Mora AL, Rojas M, et al. The first field trials of the chemically synthesized malaria vaccine SPf66: safety, immunogenicity and protectivity. Vaccine 1992;10(3):179‐84. - PubMed
Gordon 1996 {published data only}
    1. Gordon DM, Duffy PE, Heppner DG, Lyon JA, Williams JS, Scheumann D, et al. Phase I safety and immunogenicity testing of clinical lots of the synthetic Plasmodium falciparum vaccine SPf66 produced under good manufacturing procedure conditions in the United States. American Journal of Tropical Medicine and Hygiene 1996;55(1):63‐8. - PubMed
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References to other published versions of this review

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