simulated impact of rts,sas01 vaccination programs in the context of changing malaria transmission模拟的影响rts,sas01疫苗接种程序的上下文中改变疟疾传播.pdfVIP

Simulated Impact of RTS,S/AS01 Vaccination Programs in the Context of Changing Malaria Transmission 1,2 ¨ 1,2 1,2 3 1,2 Alan Brooks *, Olivier J. T. Briet , Diggory Hardy , Richard Steketee , Thomas A. Smith 1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 University of Basel, Basel, Switzerland, 3 Malaria Control and Evaluation Partnership for Africa, PATH, Seattle, Washington, United States of America Abstract Introduction: The RTS,S/AS01 pre-erythrocytic malaria vaccine is in phase III clinical trials. It is critical to anticipate where and how it should be implemented if trials are successful. Such planning may be complicated by changing levels of malaria transmission. Methods/results: Computer simulations were used to examine RTS,S/AS01 impact, using a vaccine profile based on phase II trial results, and assuming that protection decays only slowly. Settings were simulated in which baseline transmission (in the absence of vaccine) was fixed or varied between 2 and 20 infectious mosquito bites per person per annum (ibpa) over ten years. Four delivery strategies were studied: routine infant immunization (EPI), EPI plus infant catch-up, EPI plus school- based campaigns, and EPI plus mass campaigns. Impacts in changing transmission settings were similar to those in fixed settings. Assuming a persistent effect of vaccination, at 2 ibpa, the vaccine averted approximately 5–7 deaths per 1000 doses of vaccine when delivered via mass campaigns, but the benefit was less at higher transmission levels. EPI, catch-up and school-based strategies averted 2–3 deaths per 1000 doses in settings with 2 ibpa. In settings where transmission was