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Multiple malaria episodes in Teotônio occurred mostly in riverside areas.
Multiple malaria episodes and hospital admissions were assessed using Generalised Estimating Equations (GEE) Poisson regression models to take into account intra-individual correlation [48].
Both malaria infection and clinical malaria are overdispersed, meaning that some children suffer multiple malaria episodes while others around them suffer no malaria.
For data pertaining to the period 2.5 to 8.5 vaccine efficacy for other definitions of clinical malaria using different cut-offs for parasitaemia and assessment of vaccine efficacy for multiple malaria episodes was also calculated.
A more detailed analysis of clinical cases occurring in the double-blind phase revealed that 15 children had more than one malaria episode during the double-blind phase (6 in the RTS,S/AS02A group and 9 in the control group) and the adjusted vaccine efficacy for multiple malaria episodes was 30.0% (−1.8 51.9; p = 0.062).
The situation is exacerbated in cases of multiple malaria episodes within a household for a season.
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Among the remaining malaria episodes with multiple infections, 90.6% (222 of 245) occurred among different household members.
As shown in Table 5, the multiple cases of vivax malaria cases in a house was frequently dependent of vivax malaria episodes occurring in the same person.
When multiple episodes were included in analysis, ITN use and older age were again protective against malaria episodes (Incident Rate Ratio [IRR] = 0.43 95%CI 0.27 0.7) and IRR = 0.23, 95%CI 0.13 0.42, respectively) and the interaction term indicated that ITNs did not protect older children (IRR = 2.71, 95%CI 1.3 5.7, p = 0.008).
The children in the two arms were followed for 6 months to determine the incidence of malaria episodes.
The malaria episodes per child per year were 1.5 and 0.79 in the active and passive follow up arms respectively.
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