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Previous Volume 336:86-91 January 9, 1997 Number 2 Next

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ABSTRACT

Background The candidate vaccines against malaria are poorly immunogenic and thus have been ineffective in preventing infection. We developed a vaccine based on the circumsporozoite protein of Plasmodium falciparum that incorporates adjuvants selected to enhance the immune response.

Methods The antigen consists of a hybrid in which the circumsporozoite protein fused to hepatitis B surface antigen (HBsAg) is expressed together with unfused HBsAg. We evaluated three formulations of this antigen in an unblinded trial in 46 subjects who had never been exposed to malaria.

Results Two of the vaccine formulations were highly immunogenic. Four subjects had adverse systemic reactions that may have resulted from the intensity of the immune response after the second dose, which led us to reduce the third dose. Twenty-two vaccinated subjects and six unimmunized controls underwent a challenge consisting of bites from mosquitoes infected with P. falciparum. Malaria developed in all six control subjects, seven of eight subjects who received vaccine 1, and five of seven subjects who received vaccine 2. In contrast, only one of seven subjects who received vaccine 3 became infected (relative risk of infection, 0.14; 95 percent confidence interval, 0.02 to 0.88; P<0.005).

Conclusions A recombinant vaccine based on fusion of the circumsporozoite protein and HBsAg plus a potent adjuvant can protect against experimental challenge with P. falciparum sporozoites. After additional studies of protective immunity and the vaccination schedule, field trials are indicated for this new vaccine against P. falciparum malaria.

Source Information

From the Walter Reed Army Institute of Research, Washington, D.C. (J.A.S., D.G.H., K.E.K., B.T.W., U.K., W.R.B.); and SmithKline Beecham Biologicals, Rixensart, Belgium (M.S., P.M., P.D., N.G., M.M., J.D.C.). The views of the authors do not necessarily reflect the position of the Department of the Army or the Department of Defense.

Address reprint requests to Dr. Ballou at the Department of Immunology, Walter Reed Army Institute of Research, Washington, DC 20307-5100.

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A Recombinant Circumsporozoite Protein Vaccine against Malaria
Brettler D. B., Bloom B. R., Goldstein S. T., Shapiro C. N., Ballou W. R., Stoute J. A., Cohen J.
Extract | Full Text  
N Engl J Med 1997; 336:1759-1761, Jun 12, 1997. Correspondence

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