Infectious Disease

The combination of vaccination and chemoprevention significantly reduces malaria

August 26, 2021

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Chandramohan does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors. Healio was unable to confirm any relevant financial information for Birkett at the time of publication.

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A combination of seasonal vaccination and chemoprevention reduced malaria episodes and deaths in children by about 70% compared to either intervention alone during a three-year study in two African countries.

The vaccine RTS, S / AS01E (GlaxoSmithKline) was the first vaccine that could significantly reduce malaria in children. It is being administered in a pilot program in three African countries – Ghana, Kenya and Malawi.

Chandramohan D, et al.  New Engl J Med. 2021;  doi: 10.1056 / NEJMoa2026330

Chandramohan D, et al. New Engl J Med. 2021; doi: 10.1056 / NEJMoa2026330

The results of the study, published this week in the New England Journal of Medicine, come from a study conducted in Burkina Faso and Mali from 2017-2020.

Daniel Chandramohan,

“The exposure to severe malaria remains high in countries that have chemoprevention against seasonal malaria, so it is clear that we need effective intervention in addition to chemoprevention for seasonal malaria.” Daniel Chandramohan, MBBS, PhD, MSc, a public health professor at the London School of Hygiene and Tropical Medicine, said Healio.

“The RTS, S malaria vaccine has been shown to provide good protection for at least the first 6 months after vaccination,” said Chandramohan. “This prompted our study to test the hypothesis that a combination of seasonal malaria vaccination with chemoprevention will reduce the malaria burden in this region.”

Chandramohan and colleagues conducted an individually randomized, controlled study to assess whether the seasonal vaccination with RTS, S, administered with the adjuvant AS01E, was not inferior to chemoprevention in the prevention of uncomplicated malaria and whether the interventions used in combination with the Prevention of uncomplicated malaria was superior to the sole and severe malaria-related consequences.

According to the study, from April to May 2017, the researchers randomly assigned 6,861 children, ages 5 to 17 months, to seasonal chemoprevention with sulfadoxine-pyrimethamine and amodiaquine alone (n = 2,287), the vaccine alone (n = 2,288). , and 2,286 to get a combination of the two.

A total of 1,716 children in the chemoprevention single group, 1,734 in the vaccine single group, and 1,740 in the combination group received their first treatment dose and completed follow-up by May 31, 2020.

In total, there were 305 cases of uncomplicated clinical malaria per 1,000 person-years at risk in the chemoprevention alone group, 278 in the vaccine alone group, and 113 in the combination group, the researchers reported. The calculated protective effectiveness of the combination compared to chemoprevention alone was 62.8% (95% CI 58.4-66.8) against clinical malaria, 70.5% (95% CI 41.9-85) against hospitalization with severe malaria according to WHO definition, and 72.9% (95% CI, 2.9-92.4) against malarial death.

They calculated the protective effectiveness of the combination compared to the vaccine alone against these endpoints as 59.6% (95% CI, 54.7-64), 70.6% (95% CI, 42.3-85) and 75, 3% (95% CI, 12.5.). -93) or

Ashley Birkett, PhD, PATH’s director of Malaria Vaccine Initiative called the results “remarkable”. PATH provided part of the funding for the study.

“This represents a potential breakthrough in how the world’s first malaria vaccine could be used in new ways to save children’s lives,” Birkett said in a press release. “The evidence from Burkina Faso and Mali suggests that in areas with highly seasonal malaria, using the RTS, S vaccine just before the main transmission season combined with current malaria control measures could have a major impact.”

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