Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage

Abstract Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have a...

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Autores principales:	H. Juliette T. Unwin, Lazaro Mwandigha, Peter Winskill, Azra C. Ghani, Alexandra B. Hogan
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Malaria vaccine RTS,S/AS01 Expanded Programme on Immunization Demographic and Health Surveys DHS Program Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/6d93997075474c7ab28d3094a9705192
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spelling	oai:doaj.org-article:6d93997075474c7ab28d3094a97051922021-11-21T12:33:46ZAnalysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage10.1186/s12936-021-03966-x1475-2875https://doaj.org/article/6d93997075474c7ab28d3094a97051922021-11-01T00:00:00Zhttps://doi.org/10.1186/s12936-021-03966-xhttps://doaj.org/toc/1475-2875Abstract Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions. Methods Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated. Results Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5–10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5–12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9–13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers’ education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage. Conclusions Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.H. Juliette T. UnwinLazaro MwandighaPeter WinskillAzra C. GhaniAlexandra B. HoganBMCarticleMalaria vaccineRTS,S/AS01Expanded Programme on ImmunizationDemographic and Health SurveysDHS ProgramArctic medicine. Tropical medicineRC955-962Infectious and parasitic diseasesRC109-216ENMalaria Journal, Vol 20, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Malaria vaccine RTS,S/AS01 Expanded Programme on Immunization Demographic and Health Surveys DHS Program Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216
spellingShingle	Malaria vaccine RTS,S/AS01 Expanded Programme on Immunization Demographic and Health Surveys DHS Program Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 H. Juliette T. Unwin Lazaro Mwandigha Peter Winskill Azra C. Ghani Alexandra B. Hogan Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
description	Abstract Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions. Methods Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated. Results Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5–10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5–12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9–13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers’ education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage. Conclusions Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.
format	article
author	H. Juliette T. Unwin Lazaro Mwandigha Peter Winskill Azra C. Ghani Alexandra B. Hogan
author_facet	H. Juliette T. Unwin Lazaro Mwandigha Peter Winskill Azra C. Ghani Alexandra B. Hogan
author_sort	H. Juliette T. Unwin
title	Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
title_short	Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
title_full	Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
title_fullStr	Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
title_full_unstemmed	Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
title_sort	analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage
publisher	BMC
publishDate	2021
url	https://doaj.org/article/6d93997075474c7ab28d3094a9705192
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Analysis of the potential for a malaria vaccine to reduce gaps in malaria intervention coverage

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