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Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care

Vekemans, Johan, Marsh, Kevin, Greenwood, Brian, Leach, Amanda J., Kabore, William, Soulanoudjingar, Solange, Asante, Kwaku, Ansong, Daniel, Evans, Jennifer, Sacarlal, Jahit, Bejon, Philip, Kamthunzi, Portia, Salim, Nahya, Njuguna, Patricia, Hamel, Mary J., Otieno, Walter, Gesase, Samwel and Schellenberg, David (2011). Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care. Malaria Journal,10:1-12.

Document type: Journal Article
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IRMA ID 75039815xPUB482
Title Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care
Author Vekemans, Johan
Marsh, Kevin
Greenwood, Brian
Leach, Amanda J.
Kabore, William
Soulanoudjingar, Solange
Asante, Kwaku
Ansong, Daniel
Evans, Jennifer
Sacarlal, Jahit
Bejon, Philip
Kamthunzi, Portia
Salim, Nahya
Njuguna, Patricia
Hamel, Mary J.
Otieno, Walter
Gesase, Samwel
Schellenberg, David
Journal Name Malaria Journal
Publication Date 2011
Volume Number 10
ISSN 1475-2875   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-79961123833
Start Page 1
End Page 12
Total Pages 12
Place of Publication United Kingdom
Publisher BioMed Central
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
An effective malaria vaccine, deployed in conjunction with other malaria interventions, is likely to substantially reduce the malaria burden. Efficacy against severe malaria will be a key driver for decisions on implementation. An initial study of an RTS, S vaccine candidate showed promising efficacy against severe malaria in children in Mozambique. Further evidence of its protective efficacy will be gained in a pivotal, multi-centre, phase III study. This paper describes the case definitions of severe malaria used in this study and the programme for standardized assessment of severe malaria according to the case definition.

Methods
Case definitions of severe malaria were developed from a literature review and a consensus meeting of expert consultants and the RTS, S Clinical Trial Partnership Committee, in collaboration with the World Health Organization and the Malaria Clinical Trials Alliance. The same groups, with input from an Independent Data Monitoring Committee, developed and implemented a programme for standardized data collection.
The case definitions developed reflect the typical presentations of severe malaria in African hospitals. Markers of disease severity were chosen on the basis of their association with poor outcome, occurrence in a significant proportion of cases and on an ability to standardize their measurement across research centres. For the primary case definition, one or more clinical and/or laboratory markers of disease severity have to be present, four major co-morbidities (pneumonia, meningitis, bacteraemia or gastroenteritis with severe dehydration) are excluded, and a Plasmodium falciparum parasite density threshold is introduced, in order to maximize the specificity of the case definition. Secondary case definitions allow inclusion of co-morbidities and/or allow for the presence of parasitaemia at any density. The programmatic implementation of standardized case assessment included a clinical algorithm for evaluating seriously sick children, improvements to care delivery and a robust training and evaluation programme for clinicians.

Conclusions
The case definition developed for the pivotal phase III RTS, S vaccine study is consistent with WHO recommendations, is locally applicable and appropriately balances sensitivity and specificity in the diagnosis of severe malaria. Processes set up to standardize severe malaria data collection will allow robust assessment of the efficacy of the RTS, S vaccine against severe malaria, strengthen local capacity and benefit patient care for subjects in the trial.

Trial registration
Clinicaltrials.gov NCT00866619

DOI http://dx.doi.org/10.1186/1475-2875-10-221   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 2.0 License
URL https://creativecommons.org/licenses/by/2.0/


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