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Estimating the impact of the RTS,S/AS01 malaria vaccine in Benin: A mathematical modelling study
Sena V Alohoutade1, Rachel Hounsell1,2, Codjo Dandonougbo3
1Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.
Insights
Malaria vaccination in Benin, combined with nets, could cut child malaria cases by 40%. However, reduced net use may negate these gains, highlighting the need for integrated strategies to combat this disease.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Vaccinology
Background:
- Malaria remains a critical public health issue in sub-Saharan Africa, particularly in Benin, where it is a leading cause of mortality in young children.
- The World Health Organization recommends the RTS,S/AS01 malaria vaccine for children in endemic areas, yet data on its impact in West Africa is limited.
- There is a need for localized studies to model the effectiveness of malaria vaccination programs in specific regions like Benin.
Purpose of the Study:
- To model the potential impact of the RTS,S/AS01 malaria vaccine on reducing clinical and severe malaria cases in children under five in Benin.
- To evaluate the combined effect of malaria vaccination and long-lasting insecticidal net (LLIN) use over a 10-year period.
- To assess the influence of vaccine introduction on LLIN usage and its subsequent effect on malaria burden.
Main Methods:
- Development of a compartmental mathematical model to simulate malaria transmission dynamics.
- Inclusion of scenarios with varying RTS,S/AS01 vaccine coverage levels, aligned with DTP3 vaccine coverage.
- Integration of LLIN use as a concurrent intervention and analysis of potential changes in net usage post-vaccine introduction.
Main Results:
- The combined strategy of childhood malaria vaccination (at DTP3 coverage levels) and current LLIN use is projected to reduce malaria clinical cases and deaths by 40% in children under five from 2025 to 2034.
- A 1.5-fold decrease in LLIN use, potentially resulting from vaccine introduction, could offset the cumulative benefits and lead to an increased malaria burden.
- Vaccine introduction is a valuable tool for malaria control, but its full impact is contingent on sustained or increased LLIN usage.
Conclusions:
- Childhood malaria vaccination with RTS,S/AS01 is a promising additional tool for advancing malaria control efforts in Benin.
- Maintaining high LLIN coverage alongside vaccination is crucial to maximize the reduction in malaria cases and deaths.
- Potential unintended consequences, such as reduced LLIN use, must be carefully monitored and mitigated to ensure the long-term success of malaria control strategies.
Abstract:
Malaria constitutes a major public health burden in sub-Saharan Africa. It remains a key health concern and the leading cause of death in children under five in Benin. Since October 2021, the World Health Organization has recommended the use of malaria vaccines for the prevention of Plasmodium falciparum malaria in children living in malaria endemic areas, prioritizing areas of moderate and high transmission in sub-Saharan Africa. However, with the exception of Ghana, there is a scarcity of studies modelling the potential impact of the RTS,S/AS01 vaccine in the context of West Africa. A compartmental mathematical model was developed to estimate clinical and severe malaria cases averted in children under five with the primary series of the RTS,S/AS01 malaria vaccine in Benin. Over a period of 10 years, scenarios involving vaccine introduction at different coverage levels alongside the use of long-lasting insecticidal nets were modelled to assess the impact of the RTS,S/AS01 vaccine on malaria transmission. The combination of childhood malaria vaccination at a coverage similar to that of the third dose of diphtheria, tetanus, and pertussis (DTP3) vaccine, along with the current use of nets, is projected to result in a 40% reduction in malaria clinical cases and deaths among children under five years old, compared to using nets alone, from 2025 to 2034. However, if the introduction of a malaria vaccine has the unintended consequence of decreased net use, cumulative benefits may be offset. A 1.5-fold decrease in the use of nets is projected to result in an increase in malaria burden. This modelling exercise concludes that childhood vaccination is expected to avert clinical and severe cases of malaria and is an additional tool to advance malaria control efforts in Benin but potential unintended consequences of a reduction in net usage may reduce these gains.
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