Age of Exposure and Immunity to Malaria in Infants

This study has been completed.
Sponsor:
Collaborator:
European Commission
Information provided by:
Hospital Clinic of Barcelona
ClinicalTrials.gov Identifier:
NCT00231452
First received: September 30, 2005
Last updated: October 27, 2011
Last verified: October 2011
  Purpose

The overall objective is to evaluate the effect of exposure to Plasmodium (P.) falciparum erythrocytic stage antigens during different periods of infancy on the development of naturally acquired immunity (NAI).

Hypothesis: Exposure to P. falciparum prior to 5 months of age does not result in the development of NAI, while exposure to P. falciparum after 5 months of age leads to the development of NAI. The risks of clinical malaria and anaemia during the second year of life will be compared between cohorts, as well as their correlations with the type and quality of immune responses (antibodies to several P. falciparum antigens, cytokines), oxidative stress markers and host genetic factors. These results should shed light on the determinants of the development of anti-P. falciparum responses early in life and the potential constraints to early life immunisation.


Condition Intervention
Malaria
Drug: Sulfadoxine-pyrimethamine (SP) + Artesunate (AS)

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Official Title: Age of Exposure and Immunity to Malaria in Infants

Resource links provided by NLM:


Further study details as provided by Hospital Clinic of Barcelona:

Primary Outcome Measures:
  • (Clinical) Time to first or only episode of clinical malaria in the second year of life detected by passive case detection [ Time Frame: from 12 to 24 months of age ] [ Designated as safety issue: Yes ]
    Global comparison between the 3 groups of the time to first or only episode of clinical malaria (according to the primary case definition) in the second year of follow up detected by passive case detection in the According-To-Protocol cohort. In addition, pairwise comparisons of the 3 groups are also presented.


Secondary Outcome Measures:
  • (Clinical) Time to first or only episode of malaria (using other case definitions), anaemia and other clinical endpoints. [ Time Frame: 12 to 24 months of age ] [ Designated as safety issue: Yes ]
    Global comparison between the 3 study groups of the time to first or only episode of clinical malaria (according to the secondary case definitions) in the second year of follow up detected by passive case detection. Other endpoints include multiple episodes of malaria, time to first or only episode of anaemia, total hospital visits and prevalence of parasitaemia and anaemia at different time points. In addition, pairwise comparisons of the 3 groups are also presented.

  • Oxidative stress markers [ Time Frame: multiple time points during the first two years of life (2.5, 5.5, 10.5, 15 and 24 months of age) ] [ Designated as safety issue: No ]
    Quantification of the antioxidant/pro-oxidant status over the first two years of life in relation to age of first exposure to infection.

  • Humoral and cellular immune responses [ Time Frame: multiple time points during the first two years of life (2.5, 5.5, 10.5, 15 and 24 months of age) ] [ Designated as safety issue: No ]
    Quantification of antibody and cytokine responses to P. falciparum protein antigens and toxins over the first two years of life in relation to age of first exposure to infection

  • Host genetics [ Time Frame: 2.5 months of age ] [ Designated as safety issue: No ]
    Analysis of haematological genetic factors, polymorphisms in genes involved in inflammatory or immunological responses to malaria and polymorphisms in genes involved in the Th1/Th2 immunological pathway.


Enrollment: 349
Study Start Date: September 2005
Study Completion Date: March 2009
Primary Completion Date: March 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Late exposure group
Participants received monthly Sulfadoxine-Pyrimethamine (SP) plus Artesunate (AS) from 2.5-4.5 months of age and monthly placebo from 5.5-9.5 months of age.
Drug: Sulfadoxine-pyrimethamine (SP) + Artesunate (AS)
Monthly chemoprophylaxis with SP (Fansidar® 500/25 mg) plus Artesunate (AS, Arsumax® 50 mg) or placebo (provided by Roche and Sanofi-Aventis) was administered according to the following age-based dosing schedule: ½ tablet of SP or placebo and ½ tablet of AS or placebo on the first day and ½ tablet of AS or placebo on the second and third days.
Experimental: Early exposure group
Participants received monthly placebo from 2.5-4.5 months of age and monthly SP+AS from 5.5-9.5 months of age.
Drug: Sulfadoxine-pyrimethamine (SP) + Artesunate (AS)
Monthly chemoprophylaxis with SP (Fansidar® 500/25 mg) plus Artesunate (AS, Arsumax® 50 mg) or placebo (provided by Roche and Sanofi-Aventis) was administered according to the following age-based dosing schedule: ½ tablet of SP or placebo and ½ tablet of AS or placebo on the first day and ½ tablet of AS or placebo on the second and third days.
Placebo Comparator: Control group
Participants received monthly placebo from 2.5 to 9.5 months of age.
Drug: Sulfadoxine-pyrimethamine (SP) + Artesunate (AS)
Monthly chemoprophylaxis with SP (Fansidar® 500/25 mg) plus Artesunate (AS, Arsumax® 50 mg) or placebo (provided by Roche and Sanofi-Aventis) was administered according to the following age-based dosing schedule: ½ tablet of SP or placebo and ½ tablet of AS or placebo on the first day and ½ tablet of AS or placebo on the second and third days.

  Eligibility

Ages Eligible for Study:   up to 1 Week
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

Inclusion criteria for pregnant women:

  • Healthy HIV-negative pregnant females less than 50 years of age who attend the voluntary counseling and testing (VCT) center at the Maragra or Manhiça antenatal clinic,
  • Permanent residents of the Manhiça area and expecting to be living in the area with their infant for at least 2 years.

Inclusion criteria for newborn infants:

  • Healthy infants, weighing >= 2 kg and having an alive mother.

Exclusion Criteria:

Exclusion criteria for pregnant women:

  • Plan to leave the area in less than 2 years from the start of the study;
  • Women not willing to get tested for HIV infection at the VCT center;
  • Test positive for HIV;
  • Not willing to provide informed consent;
  • Cannot understand either Portuguese or Changana (consent forms are written in these languages).

Exclusion criteria for newborn infants:

  • Any obvious congenital malformation;
  • Any signs of cerebral asphyxia;
  • Any obvious neonatal infection;
  • Same gender Twins;
  • Low birth weight (<2 kg).
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00231452

Locations
Mozambique
Centro de Investigaçao em Saude da Manhiça
Manhiça, Maputo, Mozambique, 1929
Sponsors and Collaborators
Hospital Clinic of Barcelona
European Commission
Investigators
Principal Investigator: Pedro Alonso, MD, PhD Barcelona Center for International Health Research, Hospital Clinic/University of Barcelona
Principal Investigator: Carlota Dobaño, PhD Barcelona Center for International Health Research, Hospital Clinic/University of Barcelona
  More Information

Additional Information:
No publications provided by Hospital Clinic of Barcelona

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00231452     History of Changes
Other Study ID Numbers: AgeMal
Study First Received: September 30, 2005
Last Updated: October 27, 2011
Health Authority: Mozambique: Ministry of Health (MISAU)

Keywords provided by Hospital Clinic of Barcelona:
natural acquired immunity,
clinical malaria,
P. falciparum,
age,
exposure,
neonatal immunology,
infants

Additional relevant MeSH terms:
Malaria
Protozoan Infections
Parasitic Diseases
Artesunate
Fanasil, pyrimethamine drug combination
Sulfadoxine
Pyrimethamine
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Anti-Infective Agents, Urinary
Renal Agents
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Folic Acid Antagonists
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Amebicides

ClinicalTrials.gov processed this record on September 29, 2014