Intervention Review

Vaccines for preventing malaria (SPf66)

  1. Patricia M Graves1,*,
  2. Hellen Gelband2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 19 APR 2006

Assessed as up-to-date: 17 MAR 2008

DOI: 10.1002/14651858.CD005966


How to Cite

Graves PM, Gelband H. Vaccines for preventing malaria (SPf66). Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005966. DOI: 10.1002/14651858.CD005966.

Author Information

  1. 1

    EpiVec Consulting, Atlanta, Georgia, USA

  2. 2

    Resources for the Future, Washington, DC, USA

*Patricia M Graves, EpiVec Consulting, Atlanta, Georgia, GA 30341, USA. epivec@comcast.net. pmgraves@aol.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 APR 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

We searched the Cochrane Infectious Diseases Group Specialized Register (March 2008), CENTRAL (The Cochrane Library 2008, Issue 1), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), LILACS (1982 to March 2008), Science Citation Index (1981 to March 2008), 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 risk ratios (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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

The SPf66 vaccine has little or no effect on preventing malaria

The SPf66 vaccine was one of the first malaria vaccines to be tested extensively in endemic areas. SPf66 is a synthetic peptide vaccine containing antigens from the blood stages of malaria linked together with an antigen from the sporozoite stage. SPf66 has had 10 trials in Africa, Asia, and South America. Results were initially promising, but further trials showed only a small effect in some trials, and no effect in Africa. There is no evidence that SPf66 is effective enough to be introduced on a routine basis for prevention of malaria.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用於預防瘧疾之疫苗(SPf66)

我們非常需要瘧疾疫苗。SPf66是其中一種最早研發出之疫苗。其為一種合成?疫苗,含有取自瘧疾血液期之抗原,與取自孢子期之抗原彼此連結,且其主要係靶向對抗血液(無性)期。

目標

評估SPf66瘧疾疫苗對抗惡性瘧原蟲(Plasmodium falciparum)、間日瘧原蟲(P. vivax)、三日瘧原蟲(P. malariae)、及蛋形瘧原蟲(P. ovale)而預防感染、疾病、及死亡之效應。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2005年9月)、 CENTRAL (Cochrane Library 2005, Issue 3)、 MEDLINE (1966年−2005年9月)、 EMBASE (1980年−2005年9月)、 LILACS (1982年−2005年9月)、 Science Citation Index (1981年−2005年9月)、以及文章的參考資料清單。我們並與本領域相關機構及研究人員聯繫。

選擇標準

針對接受人工挑戰或是天然接觸瘧疾感染(任何品種)之任何年齡試驗者,比較SPf66疫苗與安慰劑或慣常抗瘧疾控制措施的隨機及半隨機對照試驗。

資料收集與分析

由2位作者獨立評估試驗品質並摘錄數據,包括不良作用。結果係以相對風險(relative risks;RR)及95%信賴區間(confidence interval;CI)表示。

主要結論

共收錄包括9698名參與者之10項功效試驗。SPf66對於降低新惡性瘧疾事件發生之結果各異:其在其中4項非洲之試驗中為無效(RR 0.98, 95% CI 0.90 to 1.07; 2371名參與者),在其中1項亞洲之試驗亦然(RR 1.06, 95% CI 0.90 to 1.25; 1221名參與者)。在4項試驗南非之試驗中,首次受到惡性瘧疾侵襲之數目減少28% (RR 0.72,95% CI 0.63 to 0.82; 3807名參與者)。其並未減少間日瘧之發生或是因為嚴重瘧疾而入院之情形。試驗並未指出SPf66疫苗具有任何嚴重之不良作用。

作者結論

並無證據支持SPf66疫苗可保護對抗非洲之惡性瘧原蟲(P. falciparum)。在南非,接種SPf66可造成惡性瘧疾侵襲之普通降低。並無理由應對SPf66目前之配方進行進一步之研究。可能應在南非對SPf66疫苗進行進一步之研究或是研究新配方之SPf66。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

SPf66疫苗對於預防瘧疾僅有極少或無之效應。SPf66疫苗為首先在瘧疾流行區域進行廣泛試驗的疫苗之一。SPf66為一種合成?疫苗,含有取自瘧疾血液期之抗原,與取自孢子期之抗原彼此連結。SPf66共有10項在非洲、亞洲、及南非進行之試驗。結果之最初看來相當具有希望,但是進一步之試驗顯示其僅在部分試驗中具有少量作用,並在非洲則完全無效。並無證據顯示SPf66具有足夠之有效性,得以常規作為預防瘧疾之措施。