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Year-to-Year Variation in the Age-Specific Incidence of Clinical Malaria in Two Potential Vaccine Testing Sites in Mali With Different Levels of Malaria Transmission Intensity

To explore the feasibility of field sites for malaria vaccine trials, we conducted a prospective study of clinical malaria incidence during two consecutive transmission seasons in children and young adults living in two areas of Mali with different entomologic inoculation rates (EIRs). Approximately 200 subjects (3 months to 2 years of age) were enrolled per site and followed weekly. Malaria smears were performed monthly in all participants and when symptoms or signs of malaria were present. In Sotuba (annual EIR < 15 infective bites per person), the incidence of clinical malaria was comparable across all age groups but varied significantly between the 2 years. In contrast, in Donéguébougou (annual EIR > 100 infective bites per person), incidence rates decreased significantly with increasing age but remained stable between years. Our results suggest that, although the age distribution of clinical malaria depends on transmission intensity, the total burden of disease may be similar or higher in settings of low transmission.

Received February 13, 2007. Accepted for publication August 19, 2007.

Acknowledgments: The authors thank the populations of the two villages for cooperation throughout the study, Mahamadou Thera, Mamadou Ba, Aldiouma Guindo, Mady Sissoko, and Mahamadou Assadou for help in the field and in the laboratory, and Richard Sakai and Souleymane Karembé for logistical support.

Financial support: This study was supported by the NIAID Intramural Program.

^* Address correspondence to Ogobara K. Doumbo, University of Bamako, Faculty of Medicine, Pharmacy and Odonto-Stomatology, B.P. 1805 Bamako, Mali. E-mail: okd{at}mrtcbko.org

Authors’ addresses: Alassane Dicko, Issaka Sagara, Moussa Sogoba, Mohamed B. Niambele, Adama Dao, Guimogo Dolo, Daniel Yalcouye, Dapa A. Diallo, and Ogobara K. Doumbo, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, PO Box 1805, Bamako, Mali, Telephone: 223-222-8109, Fax: 223-222-4987, E-mails: adicko{at}mrtcbko.org, isagara{at}mrtcbko.org, msogoba{at}mrtcbko.org, jballa{at}mrtcbko.org, adama{at}mrtcbko.org, dolo{at}mrtcbko.org, msogoba{at}mrtcbko.org, dadiallo{at}mrtcbko.org, and okd{at}mrtcbko.org. David Diemert, Human Hookworm Vaccine Initiative, Sabin Vaccine Institute, 1889 F Street, NW, Suite 200S, Washington, DC 20006, Telephone: 202-842-8467, Fax: 202-842-8467, E-mail: david.diemert{at}sabin.org. Allan Saul, Laboratory of Malaria and Vaccine Research, NIAID/NIH, Twinbrook III, Room 1E-04, 12735 Twinbrook Parkway, Rockville, MD 20852, Telephone: 301-594-2701, E-mail: ASaul{at}niaid.nih.gov. Louis H. Miller, Malaria Vaccine Development Branch, NIAID, NIH Twinbrook 1, Room 1111, 5640 Fishers Lane, Rockville, MD 20852, Telephone: 301-435-2177, Fax: 301-480-1958, E-mail: lomiller{at}mail.nih.gov. Yeya T. Toure, Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, PO Box 1805, Bamako, Mali, Telephone: 223-222-8109, Fax: 223-222-4987, E-mail: tourey{at}who.int. Amy D. Klion, Bldg. 4, Rm. 126, National Institutes of Health, 4 Center Drive, Bethesda, MD 20892, Telephone: 301-435-8903, Fax: 301-480-3757, E-mail: aklion{at}nih.gov.