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. 2006 Oct 18;2006(4):CD006198.
doi: 10.1002/14651858.CD006198.

Vaccines for preventing malaria (pre-erythrocytic)

P Graves  1 , H Gelband
Affiliations

Vaccines for preventing malaria (pre-erythrocytic)

P Graves et al. Cochrane Database Syst Rev. .

Abstract

Background: Vaccines against all stages of the malaria parasite are in development, mainly for Plasmodium falciparum, which causes the most serious form of malaria. Pre-erythrocytic vaccines act to prevent or delay a malaria attack by attacking the sporozoite and liver stages before the parasite reaches the bloodstream.

Objectives: To assess the efficacy and safety of pre-erythrocytic malaria vaccines against any type of human malaria.

Search strategy: In March 2006, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and the Science Citation Index. We also searched conference proceedings and reference lists of articles, and contacted organizations and researchers in the field.

Selection criteria: Randomized controlled trials comparing pre-erythrocytic vaccines with placebo, control vaccine, or routine antimalarial control measures in people of any age receiving an artificial challenge or natural exposure to malaria infection.

Data collection and analysis: Both authors independently assessed trial quality and extracted data. Results of meta-analyses were expressed as relative risks with 95% confidence intervals (CI) using an intention-to-treat analysis.

Main results: Nine safety and efficacy trials, and two safety trials, with over 3000 participants were included. In semi-immune children, RTS,S vaccine reduced clinical episodes of malaria by 26% (95% CI 13% to 37%) and severe malaria by 58% (95% CI 15% to 79%) for up to 18 months. Prevalence of parasitaemia was also reduced by 26% (95% CI 11% to 38%) at six months after immunization. RTS,S also reduced clinical malaria episodes by 63% (95% CI 18% to 83%) in semi-immune adult men in the second year of follow up after a booster dose. No severe adverse events were judged to be related to RTS,S vaccine, although the frequencies of injection site pain, swelling, arm motion limitation, headache, and malaise were increased in the vaccine groups. There was no evidence for effect of the CS-NANP vaccines (307 participants, 3 trials), CS102 peptide vaccine (14 participants, 1 trial), or the ME-TRAP vaccine (372 participants, 1 trial).

Authors' conclusions: RTS,S vaccine was effective in preventing a significant number of clinical malaria episodes, including good protection against severe malaria in children for 18 months. No severe adverse events were attributable to the vaccine. Progression of this vaccine towards licensing is justified while efforts to increase its efficacy continue. The other vaccines do not look promising and further research is a priority.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 CS‐NANP vaccine versus control, Outcome 1 New malaria infection.
2.1
2.1. Analysis
Comparison 2 CS‐102 vaccine versus control, Outcome 1 Nausea.
2.2
2.2. Analysis
Comparison 2 CS‐102 vaccine versus control, Outcome 2 Fever.
2.3
2.3. Analysis
Comparison 2 CS‐102 vaccine versus control, Outcome 3 Malaise.
3.1
3.1. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 1 New infection: by type of challenge.
3.2
3.2. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 2 New infection: by age group.
3.3
3.3. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 3 Clinical malaria episodes.
3.4
3.4. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 4 Clinical malaria episodes: by year.
3.5
3.5. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 5 Severe malaria.
3.6
3.6. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 6 Malaria requiring admission.
3.7
3.7. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 7 Admission to hospital for any cause.
3.8
3.8. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 8 Prevalence of parasitaemia.
3.9
3.9. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 9 Anaemia (packed cell volume < 25%).
3.10
3.10. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 10 Adverse events.
3.11
3.11. Analysis
Comparison 3 RTS,S vaccine versus control, Outcome 11 Severe adverse events.
4.1
4.1. Analysis
Comparison 4 ME‐TRAP vaccine versus control, Outcome 1 New malaria infection.
4.2
4.2. Analysis
Comparison 4 ME‐TRAP vaccine versus control, Outcome 2 Clinical malaria episodes.
4.3
4.3. Analysis
Comparison 4 ME‐TRAP vaccine versus control, Outcome 3 Density of Plasmodium falciparum.
4.4
4.4. Analysis
Comparison 4 ME‐TRAP vaccine versus control, Outcome 4 Mean packed cell volume.
4.5
4.5. Analysis
Comparison 4 ME‐TRAP vaccine versus control, Outcome 5 Adverse events.
See this image and copyright information in PMC

References

References to studies included in this review

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