Elevated Levels of Alanine Aminotransferase and Hepatitis A in the Context of a Pediatric Malaria Vaccine Trial in a Village in Mali

Ruth D. Ellis Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Alassane Dicko Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Issaka Sagara Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Beh Kamate Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Ousmane Guindo Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Mohamed Balla Niambele Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Moussa Sogoba Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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Ogobara Doumbo Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, and Department of Public Health, Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali

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A Phase 1 study of the apical membrane antigen malaria vaccine AMA1-C1/Alhydrogel was conducted in 2–3-year-old children in a village in Mali. A high frequency of elevated levels of alanine aminotransferase (ALT) caused by hepatitis A was seen, with 8 of 36 children diagnosed by specific IgM antibody over the course of the study. Hepatitis A is a common cause of asymptomatic elevations of ALT levels in children, particularly in less-developed settings. Investigators should be aware of the frequency of hepatitis A in this age group to guard against inadvertently facilitating transmission at study facilities and to properly evaluate symptomatic or asymptomatic elevations of ALT levels.

Author Notes

  • 1

    Dicko A, Sagara I, Ellis RD, Miura K, Guindo O, Kamate B, Sogoba M, Niambelé MB, Sissoko M, Baby M, Dolo A, Mullen GED, Fay MP, 2008. Pierce, Diallo DA, Saul A, Miller LH, Doumbo OK. Phase 1 study of a combination AMA1 blood stage malaria vaccine in Malian children, 2008. PLoS ONE 3 :e1563.

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  • 2

    Bell BP, 2002. Global epidemiology of hepatitis A: implications for control strategies. Margolis HS, Alter MJ, Liang TJ, Dienstag JL, eds. Viral Hepatitis and Liver Disease. London: International Medical Press, 9–14.

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  • 3

    Ajdukiewicz A, Mosley JW, 1980. Hepatitis A antibody in West Africa. Lancet 2 :695.

  • 4

    Barin F, Denis F, Chotard J, Paulin R, Chiron JP, Maupas PH, Goudeau A, Coursaget P, 1980. Early asymptomatic hepatitis A in Senegalese children. Lancet 1 :212–213.

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  • 5

    Hodges M, Sanders E, Aitken C, 1998. Seroprevalence of hepatitis markers: HAV, HBC, HCV, and HEV amongst primary school children in Freetown, Sierra Leone. West Afr J Med 17 :36–37.

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  • 6

    Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), 1999. MMWR Morb Mortal Wkly Rep 48 (RR-12): 1–37.

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  • 7

    Macete E, Aponte JJ, Guiinovart C, Sacarlal J, Ofori-Anyinam O, Mandomando I, Espasa M, Bevilacqua C, Leach A, Dubois MC, Heppner DG, Tello L, Milman J, Cohen J, Dubovsky F, Tornieporth N, Thompson R, Alonso PL, 2007. Safety and immunogenicity of the RTS,S/AS02A candidate malaria vaccine in children aged 1–4 in Mozambique. Trop Med Int Health 12 :37–46.

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