2. The study was designed and performed in accordance with the principles of the Declaration of Helsinki and with Good Clinical Practice mTOR inhibitor Guidelines

established by the International Conference on Harmonization. The study was approved by the Committee for the protection of persons in France (St. Germain en Laye) and discussed at Chad’s National Vaccination Technical Committee before approval by the Ministry of Health in Chad. The head of each participating village provided permission for their village to participate and written informed consent was obtained before enrollment from all participants. All participation was voluntary and no identifying information encoded. The trial was registered at clinicaltrials.org with registry number NCT01559597. A total of 2128 participants residing in 42 villages grouped in 34 clusters

were enrolled in this study (1068 in CTC; 1060 in SCC) (Fig. 1). A total of 952 participants completed the study in each group. The primary ITV analysis included 1830 participants with pre- and post-vaccination antibody level results (913 in CTC; 917 in SCC). The PP population (n = 1563) includes all participants who received click here 2 TT doses 21 to 42 days apart according to the allocated strategy, had blood sampling 21 to 42 days post TT2 and had pre- and post-vaccination serological results. The reasons for exclusion from the PP analysis were an incorrect interval between TT doses and/or blood sampling (n = 240) and receiving TT doses kept in different strategies (n = 27). Baseline

demographics were similar in both arms ( Table 2). Administered CTC vaccines were exposed to temperatures between 21.4 and 38.3 °C (25 ≤ 30 °C during 71.4% of time and ≥30 °C for 20%) for 5 to 27 days with a median of 16 and 14 days for first and second dose (Table 3). Cold chain vaccines were kept between 1.5 and 11.2 °C (<2 or >8 °C for 0.2% of the time). At the time of use, all VVMs indicated that vaccine could be used. At baseline, 272 participants (14.9%), had anti-tetanus IgG levels of <0.16 IU/ml (142 in CTC; 130 in SCC). Among susceptible participants, 95.77% (95%CI = 91.09–98.05) in CTC and 96.15% (95%CI = 91.31–98.35) in SCC had protective antibody levels following two doses of TT (Table see more 4). The upper limit of the 95%CI for the difference in seroconversion was 5.6 in the ITV analysis and 4.4 in the PP analysis. If a protection cutoff of 0.20 IU/ml is used, there were 512 susceptible participants at baseline (259 in CTC; 253 in SCC); the difference in seroconversion was 1.48 (95%CI = −2.8 to 5.7). Following vaccination, overall seroprotection was equal in both groups: 99.34% in the CTC and 99.45% in the SCC groups (Table 4). Pre-vaccination GMC was 0.35 IU/ml in both groups (p = 0.82). After vaccination, GMCs were 1.47 IU/ml (95%CI = 1.40–1.54) in the CTC group and 1.55 IU/ml (95%CI = 1.48–1.62) in the SCC. Inverse cumulative distribution curves of GMCs pre and post-vaccination by group are presented in Fig. 2.