Malaria Vaccine Study Site in Irian Jaya, Indonesia: Plasmodium falciparum Incidence Measurements and Epidemiologic Considerations in Sample Size Estimation

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  • Malaria Program, Naval Medical Research Institute, U.S. Naval Medical Research Unit No. 2, National Institutes of Health Research and Development, Ministry of Health, Republic of Indonesia, Provincial Health Services, Jayapura, Bethesda, Maryland, Indonesia
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Malaria epidemiologic and entomologic studies were performed during both the high transmission and low transmission seasons to characterize the Plasmodium falciparum malaria transmission at a proposed malaria vaccine trial site in Irian Jaya, Indonesia. The study population consisted of two subsets: native Irianese men with lifelong exposure to malaria and transmigrants who arrived from a nonmalarious area 2.5 years before the start of the study. All subjects received a radical cure for malaria and were then monitored weekly by blood film. Both P. falciparum malaria attack rates and incidence densities were calculated; transmigrants had a significantly higher rate (P = 0.003) than the Irianese during the low transmission season study (20-weeks long) but not during the high transmission season study (12-weeks long). Lack of exposure-induced immunity left the transmigrants at a minimum 17–25% greater relative risk of becoming parasitemic compared with the Irianese during the low transmission season study. During the high transmission season study, 50% of the transmigrants were P. falciparum positive by week 6 and 50% of the Irianese by week 9. During the low transmission season, 50% of the transmigrants were positive by week 10 and 43% of the Irianese were positive by week 17. Entomologic studies showed that Anopheles koliensis was the predominant vector (> 98% of anopheline catch). Entomologic inoculation rates for P. falciparum were 0.018 and 0.39 infective bites/person/night for the low and high transmission seasons, respectively. New P. vivax cases represented between 16% and 42% of all initial malaria cases. Factors affecting sample size calculation were evaluated, including causes of loss to follow-up, and sample sizes required to complete the study under several sets of conditions were calculated. The confidence intervals around specific sample sizes were calculated high-lighting the need to determine the sample size based not only on predicted vaccine efficacy and estimated subject attrition but also on a desired width of confidence interval for the observed vaccine efficacy.