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BACKGROUND: The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial. METHODS: We administered RTS,S/AS01 or a comparator vaccine to 6537 infants who were 6 to 12 weeks of age at the time of the first vaccination in conjunction with Expanded Program on Immunization (EPI) vaccines in a three-dose monthly schedule. Vaccine efficacy against the first or only episode of clinical malaria during the 12 months after vaccination, a coprimary end point, was analyzed with the use of Cox regression. Vaccine efficacy against all malaria episodes, vaccine efficacy against severe malaria, safety, and immunogenicity were also assessed. RESULTS: The incidence of the first or only episode of clinical malaria in the intention-to-treat population during the 14 months after the first dose of vaccine was 0.31 per person-year in the RTS,S/AS01 group and 0.40 per person-year in the control group, for a vaccine efficacy of 30.1% (95% confidence interval [CI], 23.6 to 36.1). Vaccine efficacy in the per-protocol population was 31.3% (97.5% CI, 23.6 to 38.3). Vaccine efficacy against severe malaria was 26.0% (95% CI, -7.4 to 48.6) in the intention-to-treat population and 36.6% (95% CI, 4.6 to 57.7) in the per-protocol population. Serious adverse events occurred with a similar frequency in the two study groups. One month after administration of the third dose of RTS,S/AS01, 99.7% of children were positive for anti-circumsporozoite antibodies, with a geometric mean titer of 209 EU per milliliter (95% CI, 197 to 222). CONCLUSIONS: The RTS,S/AS01 vaccine coadministered with EPI vaccines provided modest protection against both clinical and severe malaria in young infants. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619.).

Artemisinin combination therapies are considered the mainstay of malaria treatment, but paediatric friendly formulations for the treatments of infants are scarce. We aimed to evaluate the efficacy and safety of a new dispersible tablet formulation of dihydroartemisinin/piperaquine phosphate (DHA/PQP) in comparison to the marketed tablet (Eurartesim(R)) in the treatment of infants with uncomplicated P. falciparum malaria.Reported here are the results of a large phase II, randomized, open label, multicenter trial conducted in African infants (6-12 months of age) from Mozambique, Burkina Faso, The Gambia, DR-Congo and Tanzania. Primary efficacy endpoint was the PCR-corrected Adequate Clinical and Parasitological Response (ACPR) at day 28. Analysis was performed for the Intention-To-Treat (ITT) and Per-Protocol (PP) populations.Two-hundred and one patients received the dispersible tablet formulation and 99 the conventional one administered as crushed tablets. At day 28, the PCR-corrected ACPR was 86.9% (ITT) and 98.3% (PP) in the dispersible tablet group, and 84.9% (ITT) and 100% (PP) in the crushed tablet group. At day 42, it was 85.9% (ITT) and 96.5% (PP) in the dispersible tablet group, and 82.8% (ITT) and 96.4% (PP) in the crushed tablet group. The comparison between survival curves for time to new infections showed no statistically significant differences (p=0.409). The safety and tolerability profile for the two groups was similar in terms of type and frequency of Adverse Events and was consistent with that expected in African infants with malaria.A standard three-day treatment with the new dispersible DHA/PQP formulation is as efficacious as the currently used tablet in African infants, and has a comparable safety profile.