1) The study evaluated the efficacy, safety, and immunogenicity of the RTS,S/AS01 malaria vaccine in young infants and children across 11 sites in Africa.
2) The vaccine provided protection against clinical and severe malaria in children aged 5-17 months, with efficacy of 40-46% against clinical malaria. Efficacy was lower in young infants at 27%.
3) Vaccine efficacy waned over time in both children and infants. Safety profiles were similar between vaccine and control groups.
New Vaccines in the immediate pipeline - Slideset by Professor Susanna EspositoWAidid
Slideset by Professor Esposito on: Vaccines for adolescents/young adults/children; Maternal vaccines; Vaccines for the tropics.
It shows how several new vaccines will be available in the future with different targets and underlines the importance of better information and communication, that are keys to relevant use of vaccines.
New Vaccines in the immediate pipeline - Slideset by Professor Susanna EspositoWAidid
Slideset by Professor Esposito on: Vaccines for adolescents/young adults/children; Maternal vaccines; Vaccines for the tropics.
It shows how several new vaccines will be available in the future with different targets and underlines the importance of better information and communication, that are keys to relevant use of vaccines.
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
Bacteriological profile of childhood sepsis at a tertiary health centre in so...QUESTJOURNAL
Introduction: Sepsis is a leading cause of morbidity and mortality in children worldwide, even more so in developing countries. Knowledge of common pathogens and their antibiotic susceptibility pattern is useful for guiding initial treatment while awaiting blood culture results. Objective:To determine the major causative organisms and their antibiotic sensitivity pattern of childhood sepsis at the Niger Delta University TeachingHospital (NDUTH), with the aim of revising existing treatment protocols. Methods: Within a 2 year period (1st January 2014 to 31st December 2015) blood culture results of children with clinical suspicion of sepsis were retrospectively studied. Results:During the study period, 116 (12.11%) of the 958 children admitted into the Children Emergency Ward had blood culture tests. Thirty one (26.72%) had positive blood cultures.Eighteen (58.06%) of the organisms were gram positive while thirteen (41.93%) were gram negative. The predominant organism was Staphylococcus aureus in 16 (51.61%) followed by Klebsiella pneumoniae in 5 (16.13%) patients. The bacterial isolates demonstrated the highest sensitivity to the quinolones. Conclusion:There is need for periodic surveillance of the causative organisms and antibiotic susceptibility pattern of childhood sepsis to guide effective management of patients.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is one of the world’s leading causes of death, particularly among children in developing countries.
Introduction Malaria
Chronology in Malaria
Epidemology
Life cycle
Pathogenesis and clinical feature
Lab Test
Treatment of Malaria
Prevention of Malaria
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
Bacteriological profile of childhood sepsis at a tertiary health centre in so...QUESTJOURNAL
Introduction: Sepsis is a leading cause of morbidity and mortality in children worldwide, even more so in developing countries. Knowledge of common pathogens and their antibiotic susceptibility pattern is useful for guiding initial treatment while awaiting blood culture results. Objective:To determine the major causative organisms and their antibiotic sensitivity pattern of childhood sepsis at the Niger Delta University TeachingHospital (NDUTH), with the aim of revising existing treatment protocols. Methods: Within a 2 year period (1st January 2014 to 31st December 2015) blood culture results of children with clinical suspicion of sepsis were retrospectively studied. Results:During the study period, 116 (12.11%) of the 958 children admitted into the Children Emergency Ward had blood culture tests. Thirty one (26.72%) had positive blood cultures.Eighteen (58.06%) of the organisms were gram positive while thirteen (41.93%) were gram negative. The predominant organism was Staphylococcus aureus in 16 (51.61%) followed by Klebsiella pneumoniae in 5 (16.13%) patients. The bacterial isolates demonstrated the highest sensitivity to the quinolones. Conclusion:There is need for periodic surveillance of the causative organisms and antibiotic susceptibility pattern of childhood sepsis to guide effective management of patients.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is one of the world’s leading causes of death, particularly among children in developing countries.
Introduction Malaria
Chronology in Malaria
Epidemology
Life cycle
Pathogenesis and clinical feature
Lab Test
Treatment of Malaria
Prevention of Malaria
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Journal : PLOS Medicine
Published : July 29,2014
Randomized controlled trial ,Double blinded
Funded by: GSK Biologicals SA and the PATH Malaria
Vaccine Initiative (MVI)
Impact factor:11.61
Citation index :331
3. Duffy, P.E., Patrick Gorres, J. Malaria vaccines since 2000: progress, priorities, products. npj
Vaccines 5, 48 (2020). https://doi.org/10.1038/s41541-020-0196-3
4. RTS,S
• the most advanced PEV
• R- P. falciparum CSP fragment comprising central
repeat
• T- C-terminal regions (containing T cell epitopes,
hence “T”)
• S- hepatitis B surface antigen
• S- RTS is expressed in yeast that also carry
hepatitis B “S” expression cassettes, and thus
synthesize S and RTS polypeptides that
spontaneously co-assemble into mixed
lipoprotein particles (or “RTS,S”) with the CSP
fragment on their surface
Duffy, P.E., Patrick Gorres, J. Malaria vaccines since 2000: progress, priorities, products. npj
Vaccines 5, 48 (2020). https://doi.org/10.1038/s41541-020-0196-3
5. Children from 6 week to 17 months
0.5 ml intramuscular
3 doses at montly interval
Booster dose 18 months after 1st dose
WHO approved
FDA approval pending
6. Introduction
Plasmodium falciparum estimated
• cases:207 million cases of malaria
• deaths 627,000
• mostly in young children
• sub-Saharan Africa
• Newer problems like emerging insecticide and
drug resistance
7. Phase 1 outcome
targets the preerythrocytic stage of P. falciparum
induces humoral and cellular immune responses to the
circumsporozoite protein
identified as a potential candidate for further development
9. • Randomized, controlled, double blind trial of the candidate
malaria vaccine
•GSK and all coinvestigators remain blinded.
•External statisticians run the analyses.
• conducted at 11 sites in seven African countries
•Target population: children and young infants
•Duration: March 27, 2009, through January 31, 2011
•Intervention: RTS,S/AS01
•Controls: Comparator vaccine
•Outcome: Trial is ongoing
10. Hypothesis
• Vaccination in infants and children reduces the
incidence of malaria
AIM
• to evaluate VE, safety, and immunogenicity
during an average period of 49 mo (range: 41–
55 mo) and 41 mo (range: 32–48 mo) after the
first dose of study vaccine in children and
young infants respectively.
11. Inclusion criteria Exclusion criteria
•Infants aged 6–12 week
•Children aged 5–17 months
•Children with a moderate or severe
illness;
•Major congenital defect;
•Malnutrition requiring hospitalization;
•Hemoglobin concentration ,5.0 g/dl, or
8 g/dl with clinical signs of
decompensation;
•History of atypical febrile seizures;
•Neurological disorder;
•WHO stage III or stage IV HIV disease
at the time of presentation
14. Study design & Randomization
15460 young infants and children
Infants:6537
Children:8923
RTS,S/AS01 group
Primary doses
with booster
RTS,S/AS01
group
Primary doses
without booster
Control grp
Children: Rabies vaccine (Sanofi
Pasteur)
Infants: Meningococcal C conjugate
vaccine (Novartis)
Randomly assigned in
1:1:1 ratio
15. Surveillance for Clinical and Severe Malaria
• passive surveillance
• Clinical malaria was defined as an illness
accompanied by a temperature ≥37.5 °C
• P. falciparum asexual parasitemia (˃5,000
parasites/mm3 ) or
• as an algorithm-defined case of severe malaria
16. Safety Surveillance
• Data on serious adverse events (SAEs) were
collected by passive surveillance
• clinical evidence based
• not bound by stringent laboratory or
diagnostic criteria.
• Autopsies were conducted on deaths that
occurred outside a hospital.
17. Immunogenicity
• Anti-circumsporozoite (anti-CS) antibodies
were measured by ELISA in the first 200
participants in each age category at each
study site at enrollment and 1 mo after the
third dose of vaccine.
• The threshold for a positive titer was 0.5
EU/ml
18. Laboratory and Radiologic Procedures
• All blood smears were read by two independent
microscopists, and parasite densities were
determined using standardized procedures.
• Discrepant findings were resolved according to a
formal algorithm.
• Standardized, automated biochemical and
hematological methods were used.
• Standard microbiology methods for blood and
CSF culture were followed using automated
Bactec incubators and pediatric bottles (Bactec
BD Diagnostic Systems).
• Rigorous external quality assurance process was
implemented
19. Results
Vaccine Efficacy in Children Vaccine Efficacy in Infant
incidence of all
episodes of clinical
malaria
RTS,S/AS01 group : 0.69/person-
year
RTS,S/AS01 group : 0.71/person-
year
control group : 1.17/person-year control group : 0.92/person-year
VE 46% 27%
VE, ITT 45% 27%
Reduction in incidence of clinical malaria after 3 doses in VE/VE,ITT
VE VE,ITT VE VE, ITT
1-6 months 68% 60% 47% 44%
7-12 months 41% 41% 23% 23%
13-18 months 26% 28% 12% 13%
Clinical malaria
20. Results
Vaccine Efficacy in Children Vaccine Efficacy in Infant
VE 36% 15%
VE, ITT 34% 8%
Hospitalization due to malaria
VE 42% 17%
VE,ITT 41% 13%
Hospitalization due to all cause
VE 19% 6%
VE,ITT 19% 5%
Severe malaria
VE waned off over period of time in children and infants
24. Results
Safety
• SAEs were less frequent in the children
vaccinated with RTS,S/ AS01 than in control
children: 18.6% versus 22.7%
25. Results
17 children
16 RTS,S group
10 unidentified
pathogen
4 Meningococcus
1 Pneumococcus
1 H.influenza
1 control group
1 unidentified
pathogen
6 children died :5 RTS,S group and 1 control group
Meningitis
26. Results
12 infants
9 RTS,S group
3 unidentified
pathogen
4 Pneumococcus
3 Salmonella
3 control group
2 unidentified
pathogen
4 infant died :2 RTS,S group and 2 control group
Meningitis
27. Discussion
• protection against clinical and severe malaria,
among children aged 5–17 months at first
vaccination
• VE against clinical malaria was 40% or higher in
each setting but varied significantly between
sites
• VE was lower in young infants.
• Severe malaria was more frequent among
young infant RTS,S/AS01 recipients compared
with controls
• young infants with detectable anti-CS
antibodies at enrollment had a lower post-
vaccination anti-CS response
28. Discussion
• No evidence that priming with hepatitis B
vaccine in children explained their enhanced
anti-CS antibody response
• VE waned over time in both young infants and
children
• Incidence of SAEs was similar in participant in
each group
• No impact of RTS,S/ AS01 on overall mortality,
incidence of hospitalized pneumonia or
septicemia
29. limitations
• presence of moderate anemia at enrollment, >>reflect
malaria exposure at the individual level >>negatively
associated with VE
• Incidence of malaria correlation with genetic and
environmental factors, nutritional factors??
• no correlation found between VE and transmission
• Differences in anti CS antibody GMT across sites??
• vaccine interfered with the acquisition of natural
immunity??
• Impact of maternal antibody ?? Not thoroughly studied
• Give at time EPI, immune interference of other vaccines??
30. conclusion
• During 18 mo of follow-up, RTS,S/AS01
prevented many cases of clinical and severe
malaria across the 11 sites in the trial
• Despite its lower efficacy in young infants,
RTS,S/AS01 prevented a substantial number of
cases of clinical malaria in young infants.
• reductions in clinical cases on this scale as a
result of vaccination with RTS,S/AS01
• major public health impact.
RTS,S, the most advanced PEV, incorporates a
R-P. falciparum CSP fragment comprising central repeat (hence “R”) and
C-terminal regions (containing T cell epitopes, hence “T”) fused to
hepatitis B surface antigen (“S”), or
altogether “RTS”. RTS is expressed in yeast that also carry hepatitis B “S” expression cassettes, and thus synthesize S and RTS polypeptides that spontaneously co-assemble into mixed lipoprotein particles (or “RTS,S”) with the CSP fragment on their surface6.
and provided protection against clinical episodes of malaria in the range of 30%–60% [8– 10].
The adjuvant was shown to be more immunogenic
Maternal antibodies are likely to have played a role, as young infants with detectable anti-CS antibodies at enrollment had a lower post-vaccination anti-CS response than young infants without detectable anti-CS antibodies at enrollment, and a high post-vaccination anti-CS antibody titer was associated with VE in young infants