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Updated: Mar 28, 2026

Using a Bacterial Pathogen to Probe for Cellular and Organismic-level Host Responses
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The permuted locus trial--Well suited for emerging pathogens?

Travis C Porco1, Jeremy D Keenan2, Wayne T A Enanoria3

  • 1F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA; Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.

Contemporary Clinical Trials
|December 22, 2015
PubMed
Summary

A novel permuted locus trial design offers an alternative to traditional randomized controlled trials for studying novel pathogen outbreaks. This method is useful when standard trial designs are not optimal for rapid response.

Keywords:
Cluster randomized controlled trialEbolaPermuted locus trialTrachomaWater wells

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Area of Science:

  • Epidemiology
  • Clinical Trials

Background:

  • The recent Ebola epidemic highlighted the need for rapid, evidence-based responses to novel pathogens.
  • Traditional randomized controlled trials (RCTs) may not be optimal for swiftly deploying interventions during epidemics.

Purpose of the Study:

  • To present a design for a randomized controlled trial suitable for novel pathogen outbreaks.
  • To introduce the permuted locus trial as an alternative to classic trial designs.

Main Methods:

  • The permuted locus trial randomizes potential sites (e.g., index cases in epidemics) rather than individuals or groups.
  • Outcomes are measured at the individual level, but randomization occurs at a higher level.
  • This design was originally developed for studying the impact of water wells on trachoma.

Main Results:

  • The permuted locus trial provides a flexible framework for epidemic research.
  • It addresses situations where classic individual and cluster-randomized trial designs are suboptimal.

Conclusions:

  • The permuted locus trial is a viable and potentially optimal design for epidemic research.
  • This trial design facilitates evidence-based responses to emerging infectious diseases.