Overall, this study was conducted in accordance with Good Clinical Practice guidelines and all applicable regulatory requirements, including the Declaration of Helsinki. The trial was conducted in partnership with the PATH Malaria Vaccine Initiative. An Independent Data Monitoring Committee oversaw the study’s progress and safety of the children, assisted Dabrafenib purchase by a local safety monitor (an experienced physician) at each site. Healthy children aged 5–17 months at the time of first vaccination were eligible for enrolment. As phase II evaluation of RTS,S/AS01 indicated that previous hepatitis B immunization may influence RTS,S-induced antibody responses in children [10], to

be eligible for participation, all participants must have received three doses of hepatitis B vaccine before the study start. Exclusion criteria included a history of DNA Damage inhibitor an immunodeficient or neurological condition, acute disease or fever (axillary temperature

≥37.5 °C) at the time of enrolment, and an acute or chronic, clinically significant pulmonary, cardiovascular, hepatic or renal functional abnormality. Chronic administration of immune-modifying drugs was not permitted. Unapproved use of a drug or vaccine within 30 days before the first study vaccine dose and administration of a licensed vaccine within 7 days of the first dose were also exclusion criteria. Written informed consent was obtained from the children’s parents or guardians. Illiterate parents indicated consent with a thumbprint and a signature was obtained

from an independent literate witness. first Each vaccine dose contained lyophilized RTS,S (25 μg) reconstituted with 500 μl of AS01E (referred to elsewhere in this paper as AS01), a liposome-based Adjuvant System containing monophosphoryl lipid A (MPL) and Quillaja saponaria Molina, fraction 21 (QS21, Antigenics Inc., a wholly owned subsidiary of Agenus Inc., Lexington, Massachusetts, USA). The vaccines were administered intramuscularly to the deltoid muscle of the left arm and vaccine recipients were observed for at least 60 min following each vaccination with appropriate medical treatment available in case of anaphylactic shock. The co-primary objectives of the study were to first demonstrate consistency of anti-CS antibody responses at one month post-dose 3 for three commercial-scale RTS,S/AS01 lots. If the first primary objective was met, then the second primary objective was to demonstrate non-inferiority of anti-CS antibody responses at one month post-dose 3 of the RTS,S/AS01 commercial-scale lots compared to the pilot-scale lot. The safety and reactogenicity of the vaccine lots were evaluated as secondary endpoints. Assessment of anti-CS and anti-hepatitis B surface antigen (anti-HBs) antibody titres were performed at the Centre for Vaccinology, Ghent University, Belgium, on serum samples taken before dose 1 and one month after dose 3.