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Duffy PE, Gorres JP, Healy SA, Fried M. Malaria vaccines: a new era of prevention and control. Nat Rev Microbiol 2024:10.1038/s41579-024-01065-7. [PMID: 39025972 DOI: 10.1038/s41579-024-01065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
Malaria killed over 600,000 people in 2022, a death toll that has not improved since 2015. Additionally, parasites and mosquitoes resistant to existing interventions are spreading across Africa and other regions. Vaccines offer hope to reduce the mortality burden: the first licensed malaria vaccines, RTS,S and R21, will be widely deployed in 2024 and should substantially reduce childhood deaths. In this Review, we provide an overview of the malaria problem and the Plasmodium parasite, then describe the RTS,S and R21 vaccines (the first vaccines for any human parasitic disease), summarizing their benefits and limitations. We explore next-generation vaccines designed using new knowledge of malaria pathogenesis and protective immunity, which incorporate antigens and platforms to elicit effective immune responses against different parasite stages in human or mosquito hosts. We describe a decision-making process that prioritizes malaria vaccine candidates for development in a resource-constrained environment. Future vaccines might improve upon the protective efficacy of RTS,S or R21 for children, or address the wider malaria scourge by preventing pregnancy malaria, reducing the burden of Plasmodium vivax or accelerating malaria elimination.
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Affiliation(s)
- Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - J Patrick Gorres
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sara A Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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2
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King LDW, Pulido D, Barrett JR, Davies H, Quinkert D, Lias AM, Silk SE, Pattinson DJ, Diouf A, Williams BG, McHugh K, Rodrigues A, Rigby CA, Strazza V, Suurbaar J, Rees-Spear C, Dabbs RA, Ishizuka AS, Zhou Y, Gupta G, Jin J, Li Y, Carnrot C, Minassian AM, Campeotto I, Fleishman SJ, Noe AR, MacGill RS, King CR, Birkett AJ, Soisson LA, Long CA, Miura K, Ashfield R, Skinner K, Howarth MR, Biswas S, Draper SJ. Preclinical development of a stabilized RH5 virus-like particle vaccine that induces improved antimalarial antibodies. Cell Rep Med 2024; 5:101654. [PMID: 39019011 DOI: 10.1016/j.xcrm.2024.101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/12/2024] [Accepted: 06/19/2024] [Indexed: 07/19/2024]
Abstract
Plasmodium falciparum reticulocyte-binding protein homolog 5 (RH5) is a leading blood-stage malaria vaccine antigen target, currently in a phase 2b clinical trial as a full-length soluble protein/adjuvant vaccine candidate called RH5.1/Matrix-M. We identify that disordered regions of the full-length RH5 molecule induce non-growth inhibitory antibodies in human vaccinees and that a re-engineered and stabilized immunogen (including just the alpha-helical core of RH5) induces a qualitatively superior growth inhibitory antibody response in rats vaccinated with this protein formulated in Matrix-M adjuvant. In parallel, bioconjugation of this immunogen, termed "RH5.2," to hepatitis B surface antigen virus-like particles (VLPs) using the "plug-and-display" SpyTag-SpyCatcher platform technology also enables superior quantitative antibody immunogenicity over soluble protein/adjuvant in vaccinated mice and rats. These studies identify a blood-stage malaria vaccine candidate that may improve upon the current leading soluble protein vaccine candidate RH5.1/Matrix-M. The RH5.2-VLP/Matrix-M vaccine candidate is now under evaluation in phase 1a/b clinical trials.
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Affiliation(s)
- Lloyd D W King
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - David Pulido
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Jordan R Barrett
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Hannah Davies
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Doris Quinkert
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Amelia M Lias
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Sarah E Silk
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - David J Pattinson
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Ababacar Diouf
- Laboratory of Malaria and Vector Research, NIAID/NIH, Rockville, MD 20852, USA
| | - Barnabas G Williams
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Kirsty McHugh
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Ana Rodrigues
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK
| | - Cassandra A Rigby
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK
| | - Veronica Strazza
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK
| | - Jonathan Suurbaar
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK; West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra LG 54, Ghana
| | - Chloe Rees-Spear
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK; London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - Rebecca A Dabbs
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Andrew S Ishizuka
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Yu Zhou
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Gaurav Gupta
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Jing Jin
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Yuanyuan Li
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | | | - Angela M Minassian
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Ivan Campeotto
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK
| | - Sarel J Fleishman
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Amy R Noe
- Leidos Life Sciences, Frederick, MD, USA
| | - Randall S MacGill
- Center for Vaccine Innovation and Access, PATH, Washington, DC 20001, USA
| | - C Richter King
- Center for Vaccine Innovation and Access, PATH, Washington, DC 20001, USA
| | - Ashley J Birkett
- Center for Vaccine Innovation and Access, PATH, Washington, DC 20001, USA
| | | | - Carole A Long
- Laboratory of Malaria and Vector Research, NIAID/NIH, Rockville, MD 20852, USA
| | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, NIAID/NIH, Rockville, MD 20852, USA
| | - Rebecca Ashfield
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Katherine Skinner
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Mark R Howarth
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK
| | - Sumi Biswas
- The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK
| | - Simon J Draper
- Department of Biochemistry, University of Oxford, Dorothy Crowfoot Hodgkin Building, OX1 3QU Oxford, UK; Kavli Institute for Nanoscience Discovery, Dorothy Crowfoot Hodgkin Building, University of Oxford, OX1 3QU Oxford, UK; The Jenner Institute, University of Oxford, Old Road Campus Research Building, OX3 7DQ Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
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3
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Rautman LH, Eibach D, Boateng FO, Akenten CW, Hanson H, Maiga-Ascofaré O, May J, Krumkamp R. Modeling pediatric antibiotic use in an area of declining malaria prevalence. Sci Rep 2024; 14:16431. [PMID: 39014068 PMCID: PMC11252319 DOI: 10.1038/s41598-024-67492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
In malaria-endemic areas of Sub-Saharan Africa, overlap of clinical symptoms between malarial and non-malarial febrile illnesses can lead to empiric use of antibiotics among children. Our study aimed to illustrate the potential impact of decreasing malaria prevalence from malaria control efforts on antibiotic use. We constructed a probabilistic decision tree model representing antibiotic prescription in febrile children < 5 years. This model was used to predict change in absolute antibiotic use compared to baseline under levels of decreasing malaria prevalence. Model parameters were based on data from a hospital study in Ghana and validated via literature review. The baseline prevalence of malaria diagnoses was 52% among all hospitalized children. For our main results, we reported outcomes for a scenario representing a 50% decrease in malaria prevalence. Compared to baseline, absolute antibiotic prescription decreased from a baseline of 639 doses (95% CI 574-694) to 575 (95% CI 502-638). This reflected a 10% (95% CI 7%-13%) decrease in absolute antibiotic use. Our findings demonstrate that effective malaria control can reduce pediatric antibiotic use. However, until substantial progress is made in developing accurate diagnostics for non-malarial febrile illnesses, further reductions in antibiotic use will remain a challenge.
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Affiliation(s)
- Lydia Helen Rautman
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str 74, 20359, Hamburg, Germany.
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany.
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str 74, 20359, Hamburg, Germany
| | - Felix Osei Boateng
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - Henry Hanson
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Oumou Maiga-Ascofaré
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str 74, 20359, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str 74, 20359, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Str 74, 20359, Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck-Riems, Hamburg, Germany
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4
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Hanboonkunupakarn B, Mukaka M, Jittamala P, Poovorawan K, Pongsuwan P, Stockdale L, Provstgaard-Morys S, Chotivanich K, Tarning J, Hoglund RM, Chimjinda N, Ewer K, Ramos-Lopez F, Day NPJ, Dondorp AM, Hill AV, White NJ, von Seidlein L, Pukrittayakamee S. A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults. NPJ Vaccines 2024; 9:124. [PMID: 38971837 PMCID: PMC11227592 DOI: 10.1038/s41541-024-00920-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024] Open
Abstract
In preparation for mass vaccinations with R21/Matrix-M™ combined with mass administrations of dihydroartemisinin, piperaquine, and a single low dose primaquine we assessed the tolerability, safety, and potential interactions of this combination affecting immunogenicity or pharmacokinetics. 120 healthy Thai volunteers were randomised to receive either antimalarials combined with vaccinations (n = 50), vaccinations alone (n = 50), or antimalarials only (n = 20). Three rounds of vaccines and antimalarials were administered one month apart. The vaccine was well tolerated alone and in combination with the antimalarials. None of the participants failed completion of the 3-dose vaccine course. There was no significant difference in the vaccine immunogenicity or in the pharmacokinetics of piperaquine given individually or in combination. This study supports proceeding to a large trial of mass vaccinations with R21/Matrix-M™ combined with mass antimalarial administration in Bangladesh.
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Affiliation(s)
- Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Podjanee Jittamala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kittiyod Poovorawan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pongphaya Pongsuwan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lisa Stockdale
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | | | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Natenapa Chimjinda
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Katie Ewer
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
- GSK, GSK Vaccines Institute for Global Health, Siena, Italy
| | - Fernando Ramos-Lopez
- Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Adrian V Hill
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Sasithon Pukrittayakamee
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Society of Thailand, Dusit, Bangkok, Thailand
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Olawade DB, Wada OZ, Ezeagu CN, Aderinto N, Balogun MA, Asaolu FT, David-Olawade AC. Malaria vaccination in Africa: A mini-review of challenges and opportunities. Medicine (Baltimore) 2024; 103:e38565. [PMID: 38875411 PMCID: PMC11175883 DOI: 10.1097/md.0000000000038565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024] Open
Abstract
Malaria remains an endemic public health concern in Africa, significantly contributing to morbidity and mortality rates. The inadequacies of traditional prevention measures, like integrated vector management and antimalarial drugs, have spurred efforts to strengthen the development and deployment of malaria vaccines. In addition to existing interventions like insecticide-treated bed nets and artemisinin-based combination therapies, malaria vaccine introduction and implementation in Africa could drastically reduce the disease burden and hasten steps toward malaria elimination. The malaria vaccine rollout is imminent as optimistic results from final clinical trials are anticipated. Thus, determining potential hurdles to malaria vaccine delivery and uptake in malaria-endemic regions of sub-Saharan Africa will enhance decisions and policymakers' preparedness to facilitate efficient and equitable vaccine delivery. A multisectoral approach is recommended to increase funding and resources, active community engagement and participation, and the involvement of healthcare providers.
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Affiliation(s)
- David B. Olawade
- Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, UK
| | - Ojima Z. Wada
- Division of Sustainable Development, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Chiamaka Norah Ezeagu
- Department of Public Health, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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Boyle MJ, Engwerda CR, Jagannathan P. The impact of Plasmodium-driven immunoregulatory networks on immunity to malaria. Nat Rev Immunol 2024:10.1038/s41577-024-01041-5. [PMID: 38862638 DOI: 10.1038/s41577-024-01041-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/13/2024]
Abstract
Malaria, caused by infection with Plasmodium parasites, drives multiple regulatory responses across the immune landscape. These regulatory responses help to protect against inflammatory disease but may in some situations hamper the acquisition of adaptive immune responses that clear parasites. In addition, the regulatory responses that occur during Plasmodium infection may negatively affect malaria vaccine efficacy in the most at-risk populations. Here, we discuss the specific cellular mechanisms of immunoregulatory networks that develop during malaria, with a focus on knowledge gained from human studies and studies that involve the main malaria parasite to affect humans, Plasmodium falciparum. Leveraging this knowledge may lead to the development of new therapeutic approaches to increase protective immunity to malaria during infection or after vaccination.
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Affiliation(s)
- Michelle J Boyle
- Life Sciences Division, Burnet Institute, Melbourne, Victoria, Australia.
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | | | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, CA, USA.
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.
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7
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Huang S, Baker K, Ibinaiye T, Oresanya O, Nnaji C, Richardson S. Impact of seasonal malaria chemoprevention based on the number of medicines doses received on malaria burden among children aged 3-59 months in Nigeria: A propensity score-matched analysis. Trop Med Int Health 2024. [PMID: 38842452 DOI: 10.1111/tmi.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Seasonal malaria chemoprevention using sulfadoxine-pyrimethamine plus amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine on Day 1 and amodiaquine on both Day 2 and Day 3) is delivered to children aged 3-59 months in areas of highly season malaria transmission. While the overall population-level impact of seasonal malaria chemoprevention on malaria control has been documented in various countries and time periods, there is no clear evidence regarding seasonal malaria chemoprevention impact based on the number of medicine doses children receive in one cycle in routine programmatic conditions. METHODS Data were extracted from Nigeria's routinely collected seasonal malaria chemoprevention end-of-round coverage surveys (2021, 2022). We matched seasonal malaria chemoprevention-targeted children who received specific numbers of seasonal malaria chemoprevention medicines with those who did not receive any doses of seasonal malaria chemoprevention medicines (non-sulfadoxine-pyrimethamine plus amodiaquine) using multiple sets of propensity score matches. We performed multilevel logistic regression for each matched group to evaluate the association between the number of doses of seasonal malaria chemoprevention medicines and monthly confirmed malaria cases (caregiver-reported malaria infection diagnosed by rapid diagnostic test at a health facility following the penultimate cycle of seasonal malaria chemoprevention). RESULTS Among 21,621 SMC-targeted children, 9.7% received non-sulfadoxine-pyrimethamine plus amodiaquine, 0.5% received only Day 1 sulfadoxine-pyrimethamine plus amodiaquine, 1.0% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and either Day 2 amodiaquine or Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine), and 88.8% received Day 1 sulfadoxine-pyrimethamine plus amodiaquine and both Day 2 and Day 3 amodiaquine (sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine). Children receiving only Day 1 sulfadoxine-pyrimethamine plus amodiaquine did not have significant lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.77, 0.42-1.42). However, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine had significantly lower odds of rapid diagnostic tests-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.42, 95% CI 0.28-0.63). Similarly, children receiving sulfadoxine-pyrimethamine plus amodiaquine + amodiaquine + amodiaquine also had significantly lower odds of rapid diagnostic test-confirmed malaria than those receiving non-sulfadoxine-pyrimethamine plus amodiaquine (OR 0.54, 95% CI 0.47-0.62). CONCLUSION Adherence to at least one daily dose of amodiaquine administration following receipt of Day 1 sulfadoxine-pyrimethamine plus amodiaquine by eligible children is crucial to ensure the effectiveness of seasonal malaria chemoprevention. This demonstrates the importance of enhancing caregiver awareness regarding the importance of amodiaquine and identifying barriers toward amodiaquine administration at the community level.
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Affiliation(s)
- Sikai Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kevin Baker
- Malaria Consortium UK, The Green House, London, UK
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | | | - Chuks Nnaji
- Malaria Consortium UK, The Green House, London, UK
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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8
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Laurenson AJ, Laurens MB. A new landscape for malaria vaccine development. PLoS Pathog 2024; 20:e1012309. [PMID: 38935630 PMCID: PMC11210751 DOI: 10.1371/journal.ppat.1012309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Affiliation(s)
- Alexander J. Laurenson
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Molecular Microbiology and Immunology Program, Graduate Program in Life Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Matthew B. Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Gbaguidi MLE, Adamou R, Edslev S, Hansen A, Domingo ND, Dechavanne C, Massougbodji A, Garcia A, Theisen M, Milet J, Donadi EA, Courtin D. IgG and IgM responses to the Plasmodium falciparum asexual stage antigens reflect respectively protection against malaria during pregnancy and infanthood. Malar J 2024; 23:154. [PMID: 38764069 PMCID: PMC11103834 DOI: 10.1186/s12936-024-04970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is a public health issue mostly seen in tropical countries. Until now, there is no effective malaria vaccine against antigens specific to the blood-stage of P. falciparum infection. Because the pathogenesis of malarial disease results from blood-stage infection, it is essential to identify the most promising blood-stage vaccine candidate antigens under natural exposure to malaria infection. METHODS A cohort of 400 pregnant women and their infants was implemented in South Benin. An active and passive protocol of malaria surveillance was established during pregnancy and infancy to precisely ascertain malaria infections during the follow-up. Twenty-eight antibody (Ab) responses specific to seven malaria candidate vaccine antigens were repeatedly quantified during pregnancy (3 time points) and infancy (6 time points) in order to study the Ab kinetics and their protective role. Abs were quantified by ELISA and logistic, linear and cox-proportional hazard model were performed to analyse the associations between Ab responses and protection against malaria in mothers and infants, taking into account socio-economic factors and for infants an environmental risk of exposure. RESULTS The levels of IgM against MSP1, MSP2 and MSP3 showed an early protective response against the onset of symptomatic malaria infections starting from the 18th month of life, whereas no association was found for IgG responses during infancy. In women, some IgG responses tend to be associated with a protection against malaria risk along pregnancy and at delivery, among them IgG3 against GLURP-R0 and IgG2 against MSP1. CONCLUSION The main finding suggests that IgM should be considered in vaccine designs during infanthood. Investigation of the functional role played by IgM in malaria protection needs further attention.
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Affiliation(s)
- Mahugnon L Erasme Gbaguidi
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- IRD, MERIT, Université Paris Cité, 75006, Paris, France
- Centre d'Etude Et de Recherche Sur Les Pathologies Associées À La Grossesse Et À L'Enfance, Cotonou, Bénin
| | - Rafiou Adamou
- IRD, MERIT, Université Paris Cité, 75006, Paris, France
- Centre d'Etude Et de Recherche Sur Les Pathologies Associées À La Grossesse Et À L'Enfance, Cotonou, Bénin
| | - Sofie Edslev
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Anita Hansen
- Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin
| | - Nadia D Domingo
- Centre d'Etude Et de Recherche Sur Les Pathologies Associées À La Grossesse Et À L'Enfance, Cotonou, Bénin
| | | | | | - André Garcia
- IRD, MERIT, Université Paris Cité, 75006, Paris, France
| | - Michael Theisen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | | | - Eduardo A Donadi
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - David Courtin
- IRD, MERIT, Université Paris Cité, 75006, Paris, France.
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10
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Kayentao K, Ongoiba A, Preston AC, Healy SA, Hu Z, Skinner J, Doumbo S, Wang J, Cisse H, Doumtabe D, Traore A, Traore H, Djiguiba A, Li S, Peterson ME, Telscher S, Idris AH, Adams WC, McDermott AB, Narpala S, Lin BC, Serebryannyy L, Hickman SP, McDougal AJ, Vazquez S, Reiber M, Stein JA, Gall JG, Carlton K, Schwabl P, Traore S, Keita M, Zéguimé A, Ouattara A, Doucoure M, Dolo A, Murphy SC, Neafsey DE, Portugal S, Djimdé A, Traore B, Seder RA, Crompton PD. Subcutaneous Administration of a Monoclonal Antibody to Prevent Malaria. N Engl J Med 2024; 390:1549-1559. [PMID: 38669354 PMCID: PMC11238904 DOI: 10.1056/nejmoa2312775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Subcutaneous administration of the monoclonal antibody L9LS protected adults against controlled Plasmodium falciparum infection in a phase 1 trial. Whether a monoclonal antibody administered subcutaneously can protect children from P. falciparum infection in a region where this organism is endemic is unclear. METHODS We conducted a phase 2 trial in Mali to assess the safety and efficacy of subcutaneous administration of L9LS in children 6 to 10 years of age over a 6-month malaria season. In part A of the trial, safety was assessed at three dose levels in adults, followed by assessment at two dose levels in children. In part B of the trial, children were randomly assigned, in a 1:1:1 ratio, to receive 150 mg of L9LS, 300 mg of L9LS, or placebo. The primary efficacy end point, assessed in a time-to-event analysis, was the first P. falciparum infection, as detected on blood smear performed at least every 2 weeks for 24 weeks. A secondary efficacy end point was the first episode of clinical malaria, as assessed in a time-to-event analysis. RESULTS No safety concerns were identified in the dose-escalation part of the trial (part A). In part B, 225 children underwent randomization, with 75 children assigned to each group. No safety concerns were identified in part B. P. falciparum infection occurred in 36 participants (48%) in the 150-mg group, in 30 (40%) in the 300-mg group, and in 61 (81%) in the placebo group. The efficacy of L9LS against P. falciparum infection, as compared with placebo, was 66% (adjusted confidence interval [95% CI], 45 to 79) with the 150-mg dose and 70% (adjusted 95% CI, 50 to 82) with the 300-mg dose (P<0.001 for both comparisons). Efficacy against clinical malaria was 67% (adjusted 95% CI, 39 to 82) with the 150-mg dose and 77% (adjusted 95% CI, 55 to 89) with the 300-mg dose (P<0.001 for both comparisons). CONCLUSIONS Subcutaneous administration of L9LS to children was protective against P. falciparum infection and clinical malaria over a period of 6 months. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT05304611.).
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MESH Headings
- Adult
- Child
- Female
- Humans
- Male
- Dose-Response Relationship, Drug
- Double-Blind Method
- Endemic Diseases/prevention & control
- Injections, Subcutaneous
- Kaplan-Meier Estimate
- Malaria, Falciparum/drug therapy
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/prevention & control
- Mali/epidemiology
- Plasmodium falciparum
- Treatment Outcome
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Directly Observed Therapy
- Artemether, Lumefantrine Drug Combination/administration & dosage
- Artemether, Lumefantrine Drug Combination/therapeutic use
- Young Adult
- Middle Aged
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Affiliation(s)
- Kassoum Kayentao
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Aissata Ongoiba
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Anne C Preston
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Sara A Healy
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Zonghui Hu
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Jeff Skinner
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Safiatou Doumbo
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Jing Wang
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Hamidou Cisse
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Didier Doumtabe
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Abdrahamane Traore
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Hamadi Traore
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Adama Djiguiba
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Shanping Li
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Mary E Peterson
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Shinyi Telscher
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Azza H Idris
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - William C Adams
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Adrian B McDermott
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Sandeep Narpala
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Bob C Lin
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Leonid Serebryannyy
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Somia P Hickman
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Andrew J McDougal
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Sandra Vazquez
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Matthew Reiber
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Judy A Stein
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Jason G Gall
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Kevin Carlton
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Philipp Schwabl
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Siriman Traore
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Mamadou Keita
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Amatigué Zéguimé
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Adama Ouattara
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - M'Bouye Doucoure
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Amagana Dolo
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Sean C Murphy
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Daniel E Neafsey
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Silvia Portugal
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Abdoulaye Djimdé
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Boubacar Traore
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Robert A Seder
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
| | - Peter D Crompton
- From the Malaria Research and Training Center, Mali International Center of Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali (K.K., A. Ongoiba, S.D., D.D., A.T., H.T., A. Djiguiba, S. Traore, M.K., A.Z., A. Ouattara, M.D., A. Dolo, A. Djimdé, B.T.); the Malaria Infection Biology and Immunity Section, Laboratory of Immunogenetics, Division of Intramural Research (A.C.P., S.A.H., J.S., H.C., S.L., M.E.P., P.D.C.), and the Biostatistics Research Branch, Division of Clinical Research (Z.H.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, the Vaccine Research Center (S. Telscher, A.H.I., W.C.A., A.B.M., S.N., B.C.L., L.S., S.P.H., A.J.M., S.V., M.R., J.A.S., J.G.G., K.C., R.A.S.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, and the Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick (J.W.) - all in Maryland; the Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston (P.S., D.E.N.); the Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, and the Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle (S.C.M.); and the Max Planck Institute for Infection Biology, Berlin (S.P.)
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Schmit N, Topazian HM, Natama HM, Bellamy D, Traoré O, Somé MA, Rouamba T, Tahita MC, Bonko MDA, Sourabié A, Sorgho H, Stockdale L, Provstgaard-Morys S, Aboagye J, Woods D, Rapi K, Datoo MS, Lopez FR, Charles GD, McCain K, Ouedraogo JB, Hamaluba M, Olotu A, Dicko A, Tinto H, Hill AVS, Ewer KJ, Ghani AC, Winskill P. The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study. THE LANCET. INFECTIOUS DISEASES 2024; 24:465-475. [PMID: 38342107 DOI: 10.1016/s1473-3099(23)00816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum clinical malaria in children in sub-Saharan Africa. Using trial data, we aimed to estimate the public health impact and cost-effectiveness of vaccine introduction across sub-Saharan Africa. METHODS We fitted a semi-mechanistic model of the relationship between anti-circumsporozoite protein antibody titres and vaccine efficacy to data from 3 years of follow-up in the phase 2b trial of R21/Matrix-M in Nanoro, Burkina Faso. We validated the model by comparing predicted vaccine efficacy to that observed over 12-18 months in the phase 3 trial. Integrating this framework within a mathematical transmission model, we estimated the cases, malaria deaths, and disability-adjusted life-years (DALYs) averted and cost-effectiveness over a 15-year time horizon across a range of transmission settings in sub-Saharan Africa. Cost-effectiveness was estimated incorporating the cost of vaccine introduction (dose, consumables, and delivery) relative to existing interventions at baseline. We report estimates at a median of 20% parasite prevalence in children aged 2-10 years (PfPR2-10) and ranges from 3% to 65% PfPR2-10. FINDINGS Anti-circumsporozoite protein antibody titres were found to satisfy the criteria for a surrogate of protection for vaccine efficacy against clinical malaria. Age-based implementation of a four-dose regimen of R21/Matrix-M vaccine was estimated to avert 181 825 (range 38 815-333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868-405 702) clinical cases per 100 000 fully vaccinated children in seasonal settings. Similar estimates were obtained for seasonal or hybrid implementation. Under an assumed vaccine dose price of US$3, the incremental cost per clinical case averted was $7 (range 4-48) in perennial settings and $6 (3-63) in seasonal settings and the incremental cost per DALY averted was $34 (29-139) in perennial settings and $30 (22-172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PfPR2-10. INTERPRETATION Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. FUNDING The Wellcome Trust, the Bill & Melinda Gates Foundation, the UK Medical Research Council, the European and Developing Countries Clinical Trials Partnership 2 and 3, the NIHR Oxford Biomedical Research Centre, and the Serum Institute of India, Open Philanthropy.
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Affiliation(s)
- Nora Schmit
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Hillary M Topazian
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - H Magloire Natama
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Duncan Bellamy
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Ousmane Traoré
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Marc Christian Tahita
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Massa Dit Achille Bonko
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Aboubakary Sourabié
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Lisa Stockdale
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | | | - Jeremy Aboagye
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Danielle Woods
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Katerina Rapi
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Mehreen S Datoo
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | | | - Giovanni D Charles
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Kelly McCain
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Jean-Bosco Ouedraogo
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso; Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mainga Hamaluba
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ally Olotu
- Clinical Trials and Interventions Unit, Ifakara Health Institute, Bagamoyo, Tanzania
| | - Alassane Dicko
- The Malaria Research and Training Centre, University of Science, Technology, and Techniques of Bamako, Bamako, Mali
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso; Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Adrian V S Hill
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK
| | - Katie J Ewer
- The Jenner Institute Laboratories, University of Oxford, Oxford, UK; GSK Vaccines Institute for Global Health (Global Health Vaccines R&D), GSK, Siena, Italy
| | - Azra C Ghani
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Peter Winskill
- UK Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
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Grembi JA, Nguyen AT, Riviere M, Heitmann GB, Patil A, Athni TS, Djajadi S, Ercumen A, Lin A, Crider Y, Mertens A, Karim MA, Islam MO, Miah R, Famida SL, Hossen MS, Mutsuddi P, Ali S, Rahman MZ, Hussain Z, Shoab AK, Haque R, Rahman M, Unicomb L, Luby SP, Arnold BF, Bennett A, Benjamin-Chung J. Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh. PLoS Negl Trop Dis 2024; 18:e0012157. [PMID: 38739632 PMCID: PMC11115220 DOI: 10.1371/journal.pntd.0012157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/23/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. OBJECTIVES Our objectives were to identify weather and environmental risk factors associated with diarrhea and enteropathogen prevalence in young children in rural Bangladesh, a population with high diarrheal disease burden and vulnerability to weather shifts under climate change. METHODS We matched temperature, precipitation, surface water, and humidity data to observational longitudinal data from a cluster-randomized trial that measured diarrhea and enteropathogen prevalence in children 6 months-5.5 years from 2012-2016. We fit generalized additive mixed models with cubic regression splines and restricted maximum likelihood estimation for smoothing parameters. RESULTS Comparing weeks with 30°C versus 15°C average temperature, prevalence was 3.5% higher for diarrhea, 7.3% higher for Shiga toxin-producing Escherichia coli (STEC), 17.3% higher for enterotoxigenic E. coli (ETEC), and 8.0% higher for Cryptosporidium. Above-median weekly precipitation (median: 13mm; range: 0-396mm) was associated with 29% higher diarrhea (adjusted prevalence ratio 1.29, 95% CI 1.07, 1.55); higher Cryptosporidium, ETEC, STEC, Shigella, Campylobacter, Aeromonas, and adenovirus 40/41; and lower Giardia, sapovirus, and norovirus prevalence. Other associations were weak or null. DISCUSSION Higher temperatures and precipitation were associated with higher prevalence of diarrhea and multiple enteropathogens; higher precipitation was associated with lower prevalence of some enteric viruses. Our findings emphasize the heterogeneity of the relationships between hydrometeorological variables and specific enteropathogens, which can be masked when looking at composite measures like all-cause diarrhea. Our results suggest that preventive interventions targeted to reduce enteropathogens just before and during the rainy season may more effectively reduce child diarrhea and enteric pathogen carriage in rural Bangladesh and in settings with similar meteorological characteristics, infrastructure, and enteropathogen transmission.
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Affiliation(s)
- Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Anna T. Nguyen
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Marie Riviere
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Gabriella Barratt Heitmann
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Arusha Patil
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Tejas S. Athni
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Stephanie Djajadi
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California, United States of America
| | - Yoshika Crider
- King Center on Global Development, Stanford University, Stanford, California, United States of America
| | - Andrew Mertens
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Md Abdul Karim
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Ohedul Islam
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rana Miah
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syeda L. Famida
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Saheen Hossen
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Palash Mutsuddi
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shahjahan Ali
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zahir Hussain
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abul K. Shoab
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California, United States of America
- PATH, Seattle, Washington, United States of America
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
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Osoro CB, Ochodo E, Kwambai TK, Otieno JA, Were L, Sagam CK, Owino EJ, Kariuki S, Ter Kuile FO, Hill J. Policy uptake and implementation of the RTS,S/AS01 malaria vaccine in sub-Saharan African countries: status 2 years following the WHO recommendation. BMJ Glob Health 2024; 9:e014719. [PMID: 38688566 PMCID: PMC11085798 DOI: 10.1136/bmjgh-2023-014719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
In October 2021, the WHO recommended the world's first malaria vaccine-RTS,S/AS01-to prevent malaria in children living in areas with moderate-to-high transmission in sub-Saharan Africa (SSA). A second malaria vaccine, R21/Matrix-M, was recommended for use in October 2023 and added to the WHO list of prequalified vaccines in December 2023. This study analysis assessed the country status of implementation and delivery strategies for RTS,S/AS01 by searching websites for national malaria policies, guidelines and related documents. Direct contact with individuals working in malaria programmes was made to obtain documents not publicly available. 10 countries had documents with information relating to malaria vaccine implementation, 7 referencing RTS,S/AS01 and 3 (Burkina Faso, Kenya and Nigeria) referencing RTS,S/AS01 and R21/Matrix-M. Five other countries reported plans for malaria vaccine roll-out without specifying which vaccine. Ghana, Kenya and Malawi, which piloted RTS,S/AS01, have now integrated the vaccine into routine immunisation services. Cameroon and Burkina Faso are the first countries outside the pilot countries to incorporate the vaccine into national immunisation services. Uganda plans a phased RTS,S/AS01 introduction, while Guinea plans to first pilot RTS,S/AS01 in five districts. The RTS,S/AS01 schedule varied by country, with the first dose administered at 5 or 6 months in all countries but the fourth dose at either 18, 22 or 24 months. SSA countries have shown widespread interest in rolling out the malaria vaccine, the Global Alliance for Vaccines and Immunization having approved financial support for 20 of 30 countries which applied as of March 2024. Limited availability of RTS,S/AS01 means that some approved countries will not receive the required doses. Vaccine availability and equity must be addressed even as R21/Matrix-M becomes available.
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Affiliation(s)
- Caroline Bonareri Osoro
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenifer Akoth Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lisa Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caleb Kimutai Sagam
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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14
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Nelder MP, Schats R, Poinar HN, Cooke A, Brickley MB. Pathogen prospecting of museums: Reconstructing malaria epidemiology. Proc Natl Acad Sci U S A 2024; 121:e2310859121. [PMID: 38527214 PMCID: PMC11009618 DOI: 10.1073/pnas.2310859121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Malaria is a disease of global significance. Ongoing changes to the earth's climate, antimalarial resistance, insecticide resistance, and socioeconomic decline test the resilience of malaria prevention programs. Museum insect specimens present an untapped resource for studying vector-borne pathogens, spurring the question: Do historical mosquito collections contain Plasmodium DNA, and, if so, can museum specimens be used to reconstruct the historical epidemiology of malaria? In this Perspective, we explore molecular techniques practical to pathogen prospecting, which, more broadly, we define as the science of screening entomological museum specimens for human, animal, or plant pathogens. Historical DNA and pathogen prospecting provide a means of describing the coevolution of human, vector, and parasite, informing the development of insecticides, diagnostics, therapeutics, and vaccines.
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Affiliation(s)
- Mark P. Nelder
- Enteric, Zoonotic and Vector-Borne Diseases, Health Protection, Public Health Ontario, Toronto, ONM5G 1M1, Canada
| | - Rachel Schats
- Laboratory for Human Osteoarchaeology, Faculty of Archaeology, Leiden University, 2333 CCLeiden, The Netherlands
| | - Hendrik N. Poinar
- Department of Anthropology, McMaster University, Hamilton, ONL8S 4L9, Canada
- Department of Biochemistry, McMaster University, Hamilton, ONL8S 4L9, Canada
- McMaster Ancient DNA Centre, Department of Anthropology, McMaster University, Hamilton, ONL8S 4L9, Canada
| | - Amanda Cooke
- Department of Anthropology, McMaster University, Hamilton, ONL8S 4L9, Canada
| | - Megan B. Brickley
- Department of Anthropology, McMaster University, Hamilton, ONL8S 4L9, Canada
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15
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Sarley D, Hwang A, Fenton Hall B, Ford A, Giersing B, Kaslow DC, Wahl B, Friede M. Accelerating access for all through research and innovation in immunization: Recommendations from Strategic Priority 7 of the Immunization Agenda 2030. Vaccine 2024; 42 Suppl 1:S82-S90. [PMID: 36529593 DOI: 10.1016/j.vaccine.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/08/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
Research and innovation have been fundamental to many of the successes in immunization thus far, and will play important roles in the future success of Immunization Agenda 2030 (IA2030). Strategic Priority 7 (SP7) of IA2030, which addresses research and innovation, is explicitly informed by country needs and priorities, and aims to strengthen the innovation ecosystem through capacity building and collaboration at country, regional, and global levels. SP7 identifies four key focus areas: (1) "needs-based innovation", (2) "new and improved products, services, and practices", (3) "evidence for implementation", and (4) "local capacity". Strategic interventions in these key focus areas apply the lessons of the Global Vaccine Action Plan and the "Decade of Vaccines" to emphasize local innovation, promote the use of research by countries to improve program performance and impact, and encourage capacity building for the development and implementation of innovations. The proposed approach will maintain a focus on the development of new vaccines and the improvement of existing vaccines, and increase attention to innovation in service delivery. Monitoring and evaluation will foster evidence-based priority setting at the country level and help to ground the global research and development (R&D) agenda in the needs of communities. Together, these approaches are intended to harness the power of research and innovation more effectively, to meet the challenges of the future and achieve the ambitious goals of IA2030.
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Affiliation(s)
- David Sarley
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - B Fenton Hall
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Ford
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Brian Wahl
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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16
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Rosenthal PJ, Asua V, Bailey JA, Conrad MD, Ishengoma DS, Kamya MR, Rasmussen C, Tadesse FG, Uwimana A, Fidock DA. The emergence of artemisinin partial resistance in Africa: how do we respond? THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00141-5. [PMID: 38552654 DOI: 10.1016/s1473-3099(24)00141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 04/21/2024]
Abstract
Malaria remains one of the most important infectious diseases in the world, with the greatest burden in sub-Saharan Africa, primarily from Plasmodium falciparum infection. The treatment and control of malaria is challenged by resistance to most available drugs, but partial resistance to artemisinins (ART-R), the most important class for the treatment of malaria, was until recently confined to southeast Asia. This situation has changed, with the emergence of ART-R in multiple countries in eastern Africa. ART-R is mediated primarily by single point mutations in the P falciparum kelch13 protein, with several mutations present in African parasites that are now validated resistance mediators based on clinical and laboratory criteria. Major priorities at present are the expansion of genomic surveillance for ART-R mutations across the continent, more frequent testing of the efficacies of artemisinin-based regimens against uncomplicated and severe malaria in trials, more regular assessment of ex-vivo antimalarial drug susceptibilities, consideration of changes in treatment policy to deter the spread of ART-R, and accelerated development of new antimalarial regimens to overcome the impacts of ART-R. The emergence of ART-R in Africa is an urgent concern, and it is essential that we increase efforts to characterise its spread and mitigate its impact.
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Affiliation(s)
- Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Victor Asua
- Infectious Diseases Research Collaboration, Kampala, Uganda; University of Tübingen, Tübingen, Germany
| | - Jeffrey A Bailey
- Center for Computational Molecular Biology, Brown University, Providence, RI, USA; Departments of Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Melissa D Conrad
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Deus S Ishengoma
- National Institute for Medical Research, Dar es Salaam, Tanzania; Department of Biochemistry, Kampala International University in Tanzania, Dar es Salaam, Tanzania; School of Public Health, Harvard University, Boston, MA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Fitsum G Tadesse
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; London School of Hygiene and Tropical Medicine, London, UK
| | - Aline Uwimana
- Rwanda Biomedical Center, Kigali, Rwanda; Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - David A Fidock
- Department of Microbiology and Immunology and Center for Malaria Therapeutics and Antimicrobial Resistance, Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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17
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Gilleran JA, Ashraf K, Delvillar M, Eck T, Fondekar R, Miller EB, Hutchinson A, Dong A, Seitova A, De Souza ML, Augeri D, Halabelian L, Siekierka J, Rotella DP, Gordon J, Childers WE, Grier MC, Staker BL, Roberge JY, Bhanot P. Structure-Activity Relationship of a Pyrrole Based Series of PfPKG Inhibitors as Anti-Malarials. J Med Chem 2024; 67:3467-3503. [PMID: 38372781 DOI: 10.1021/acs.jmedchem.3c01795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Controlling malaria requires new drugs against Plasmodium falciparum. The P. falciparum cGMP-dependent protein kinase (PfPKG) is a validated target whose inhibitors could block multiple steps of the parasite's life cycle. We defined the structure-activity relationship (SAR) of a pyrrole series for PfPKG inhibition. Key pharmacophores were modified to enable full exploration of chemical diversity and to gain knowledge about an ideal core scaffold. In vitro potency against recombinant PfPKG and human PKG were used to determine compound selectivity for the parasite enzyme. P. berghei sporozoites and P. falciparum asexual blood stages were used to assay multistage antiparasitic activity. Cellular specificity of compounds was evaluated using transgenic parasites expressing PfPKG carrying a substituted "gatekeeper" residue. The structure of PfPKG bound to an inhibitor was solved, and modeling using this structure together with computational tools was utilized to understand SAR and establish a rational strategy for subsequent lead optimization.
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Affiliation(s)
- John A Gilleran
- Rutgers Molecular Design and Synthesis Core, Office for Research, Rutgers University, 610 Taylor Road, Piscataway, New Jersey 08854, United States
| | - Kutub Ashraf
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, 225 Warren Street, Newark, New Jersey 07103, United States
| | - Melvin Delvillar
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, 225 Warren Street, Newark, New Jersey 07103, United States
| | - Tyler Eck
- Department of Chemistry and Biochemistry and Sokol Institute of Pharmaceutical Life Sciences, Montclair State University, Montclair, New Jersey 07043, United States
| | - Raheel Fondekar
- Rutgers Molecular Design and Synthesis Core, Office for Research, Rutgers University, 610 Taylor Road, Piscataway, New Jersey 08854, United States
- Rutgers School of Pharmacy, 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States
| | - Edward B Miller
- Schrödinger, Inc., 1540 Broadway, 24th Floor, New York, New York 10036, United States
| | - Ashley Hutchinson
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Aiping Dong
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Alma Seitova
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Mariana Laureano De Souza
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, 225 Warren Street, Newark, New Jersey 07103, United States
| | - David Augeri
- Rutgers Molecular Design and Synthesis Core, Office for Research, Rutgers University, 610 Taylor Road, Piscataway, New Jersey 08854, United States
- Schrödinger, Inc., 1540 Broadway, 24th Floor, New York, New York 10036, United States
| | - Levon Halabelian
- Structural Genomics Consortium, University of Toronto, Toronto, Ontario M5G 1L7, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - John Siekierka
- Department of Chemistry and Biochemistry and Sokol Institute of Pharmaceutical Life Sciences, Montclair State University, Montclair, New Jersey 07043, United States
| | - David P Rotella
- Department of Chemistry and Biochemistry and Sokol Institute of Pharmaceutical Life Sciences, Montclair State University, Montclair, New Jersey 07043, United States
| | - John Gordon
- Moulder Center for Drug Discovery Research, Temple University School of Pharmacy, Philadelphia, Pennsylvania 19140, United States
| | - Wayne E Childers
- Moulder Center for Drug Discovery Research, Temple University School of Pharmacy, Philadelphia, Pennsylvania 19140, United States
| | - Mark C Grier
- Rutgers Molecular Design and Synthesis Core, Office for Research, Rutgers University, 610 Taylor Road, Piscataway, New Jersey 08854, United States
| | - Bart L Staker
- Seattle Structural Genomics Center for Infectious Disease, Seattle, Washington 98109, United States
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington 98109, United States
| | - Jacques Y Roberge
- Rutgers Molecular Design and Synthesis Core, Office for Research, Rutgers University, 610 Taylor Road, Piscataway, New Jersey 08854, United States
| | - Purnima Bhanot
- Department of Microbiology, Biochemistry and Molecular Genetics, Rutgers New Jersey Medical School, 225 Warren Street, Newark, New Jersey 07103, United States
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18
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Moreno M, Barry A, Gmeiner M, Yaro JB, Sermé SS, Byrne I, Ramjith J, Ouedraogo A, Soulama I, Grignard L, Soremekun S, Koele S, Ter Heine R, Ouedraogo AZ, Sawadogo J, Sanogo E, Ouedraogo IN, Hien D, Sirima SB, Bradley J, Bousema T, Drakeley C, Tiono AB. Understanding and maximising the community impact of seasonal malaria chemoprevention in Burkina Faso (INDIE-SMC): study protocol for a cluster randomised evaluation trial. BMJ Open 2024; 14:e081682. [PMID: 38479748 PMCID: PMC10936478 DOI: 10.1136/bmjopen-2023-081682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Seasonal malaria chemoprevention (SMC) involves repeated administrations of sulfadoxine-pyrimethamine plus amodiaquine to children below the age of 5 years during the peak transmission season in areas of seasonal malaria transmission. While highly impactful in reducing Plasmodium falciparum malaria burden in controlled research settings, the impact of SMC on infection prevalence is moderate in real-life settings. It remains unclear what drives this efficacy decay. Recently, the WHO widened the scope for SMC to target all vulnerable populations. The Ministry of Health (MoH) in Burkina Faso is considering extending SMC to children below 10 years old. We aim to assess the impact of SMC on clinical incidence and parasite prevalence and quantify the human infectious reservoir for malaria in this population. METHODS AND ANALYSIS We will perform a cluster randomised trial in Saponé Health District, Burkina Faso, with three study arms comprising 62 clusters of three compounds: arm 1 (control): SMC in under 5-year-old children, implemented by the MoH without directly observed treatment (DOT) for the full course of SMC; arm 2 (intervention): SMC in under 5-year-old children, with DOT for the full course of SMC; arm 3 (intervention): SMC in under 10-year-old children, with DOT for the full course of SMC. The primary endpoint is parasite prevalence at the end of the malaria transmission season. Secondary endpoints include the impact of SMC on clinical incidence. Factors affecting SMC uptake, treatment adherence, drug concentrations, parasite resistance markers and transmission of parasites will be determined. ETHICS AND DISSEMINATION The London School of Hygiene & Tropical Medicine's Ethics Committee (29193) and the Burkina Faso National Medical Ethics Committee (Deliberation No 2023-05-104) approved this study. The findings will be presented to the community; disease occurrence data and study outcomes will also be shared with the Burkina Faso MoH. Findings will be published irrespective of their results. TRIAL REGISTRATION NUMBER NCT05878366.
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Affiliation(s)
- Marta Moreno
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Aissata Barry
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Markus Gmeiner
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Samuel S Sermé
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Isabel Byrne
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jordache Ramjith
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | - Issiaka Soulama
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Lynn Grignard
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Seyi Soremekun
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Koele
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | | | - Jean Sawadogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Edith Sanogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | | | - Denise Hien
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | | | - John Bradley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alfred B Tiono
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
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19
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Littmann J, Achu D, Laufer MK, Karema C, Schellenberg D. Making the most of malaria chemoprevention. Malar J 2024; 23:51. [PMID: 38369497 PMCID: PMC10875741 DOI: 10.1186/s12936-024-04867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Against a backdrop of stalled progress in malaria control, it is surprising that the various forms of malaria chemoprevention are not more widely used. The World Health Organization (WHO) has recommended several malaria chemoprevention strategies, some of them for over a decade, and each with documented efficacy and cost effectiveness. In 2022, the WHO updated and augmented its malaria chemoprevention guidelines to facilitate their wider use. This paper considers new insights into the empirical evidence that supports the broader application of chemoprevention and encourages its application as a default strategy for young children living in moderate to high transmission settings given their high risk of severe disease and death. Chemoprevention is an effective medium-term strategy with potential benefits far outweighing costs. There is a strong argument for urgently increasing malaria chemoprevention in endemic countries.
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Affiliation(s)
- Jasper Littmann
- Bergen Centre for Ethics and Priority Setting-BCEPS, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
- Division for Infection Control, The Norwegian Institute for Public Health, Oslo, Norway.
| | - Dorothy Achu
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - David Schellenberg
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
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20
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Moorthy V, Hamel MJ, Smith PG. Malaria vaccines for children: and now there are two. Lancet 2024; 403:504-505. [PMID: 38310911 DOI: 10.1016/s0140-6736(23)02743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/02/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Vasee Moorthy
- Department of Research for Health, Science Division, World Health Organization, Geneva 1211, Switzerland.
| | - Mary J Hamel
- Department of Immunization, Vaccines & Biologicals, Universal Health Coverage, Life Course, World Health Organization, Geneva, Switzerland
| | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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21
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Locke E, Flores-Garcia Y, Mayer BT, MacGill RS, Borate B, Salgado-Jimenez B, Gerber MW, Mathis-Torres S, Shapiro S, King CR, Zavala F. Establishing RTS,S/AS01 as a benchmark for comparison to next-generation malaria vaccines in a mouse model. NPJ Vaccines 2024; 9:29. [PMID: 38341502 DOI: 10.1038/s41541-024-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
New strategies are needed to reduce the incidence of malaria, and promising approaches include vaccines targeting the circumsporozoite protein (CSP). To improve upon the malaria vaccine, RTS,S/AS01, it is essential to standardize preclinical assays to measure the potency of next-generation vaccines against this benchmark. We focus on RTS,S/AS01-induced antibody responses and functional activity in conjunction with robust statistical analyses. Transgenic Plasmodium berghei sporozoites containing full-length P. falciparum CSP (tgPb-PfCSP) allow two assessments of efficacy: quantitative reduction in liver infection following intravenous challenge, and sterile protection from mosquito bite challenge. Two or three doses of RTS,S/AS01 were given intramuscularly at 3-week intervals, with challenge 2-weeks after the last vaccination. Minimal inter- and intra-assay variability indicates the reproducibility of the methods. Importantly, the range of this model is suitable for screening more potent vaccines. Levels of induced anti-CSP antibody 2A10 equivalency were also associated with activity: 105 μg/mL (95% CI: 68.8, 141) reduced liver infection by 50%, whereas 285 μg/mL (95% CI: 166, 404) is required for 50% sterile protection from mosquito bite challenge. Additionally, the liver burden model was able to differentiate between protected and non-protected human plasma samples from a controlled human malaria infection study, supporting these models' relevance and predictive capability. Comparison in animal models of CSP-based vaccine candidates to RTS,S/AS01 is now possible under well controlled conditions. Assessment of the quality of induced antibodies, likely a determinant of durability of protection in humans, should be possible using these methods.
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Affiliation(s)
- Emily Locke
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Yevel Flores-Garcia
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan T Mayer
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Randall S MacGill
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Bhavesh Borate
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Berenice Salgado-Jimenez
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica W Gerber
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Shamika Mathis-Torres
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Shapiro
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Richter King
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Fidel Zavala
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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22
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Fazli S, Thomas A, Estrada AE, Ross HA, Xthona Lee D, Kazmierczak S, Slifka MK, Montefiori D, Messer WB, Curlin ME. Contralateral second dose improves antibody responses to a 2-dose mRNA vaccination regimen. J Clin Invest 2024; 134:e176411. [PMID: 38227381 PMCID: PMC10940087 DOI: 10.1172/jci176411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUNDVaccination is typically administered without regard to site of prior vaccination, but this factor may substantially affect downstream immune responses.METHODSWe assessed serological responses to initial COVID-19 vaccination in baseline seronegative adults who received second-dose boosters in the ipsilateral or contralateral arm relative to initial vaccination. We measured serum SARS-CoV-2 spike-specific Ig, receptor-binding domain-specific (RBD-specific) IgG, SARS-CoV-2 nucleocapsid-specific IgG, and neutralizing antibody titers against SARS-CoV-2.D614G (early strain) and SARS-CoV-2.B.1.1.529 (Omicron) at approximately 0.6, 8, and 14 months after boosting.RESULTSIn 947 individuals, contralateral boosting was associated with higher spike-specific serum Ig, and this effect increased over time, from a 1.1-fold to a 1.4-fold increase by 14 months (P < 0.001). A similar pattern was seen for RBD-specific IgG. Among 54 pairs matched for age, sex, and relevant time intervals, arm groups had similar antibody levels at study visit 2 (W2), but contralateral boosting resulted in significantly higher binding and neutralizing antibody titers at W3 and W4, with progressive increase over time, ranging from 1.3-fold (total Ig, P = 0.007) to 4.0-fold (pseudovirus neutralization to B.1.1.529, P < 0.001).CONCLUSIONSIn previously unexposed adults receiving an initial vaccine series with the BNT162b2 mRNA COVID-19 vaccine, contralateral boosting substantially increases antibody magnitude and breadth at times beyond 3 weeks after vaccination. This effect should be considered during arm selection in the context of multidose vaccine regimens.FUNDINGM.J. Murdock Charitable Trust, OHSU Foundation, NIH.
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Affiliation(s)
| | - Archana Thomas
- Oregon National Primate Research Center, Division of Neuroscience, and
| | - Abram E. Estrada
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - David Xthona Lee
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven Kazmierczak
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark K. Slifka
- Oregon National Primate Research Center, Division of Neuroscience, and
| | - David Montefiori
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - William B. Messer
- Department of Molecular Microbiology and Immunology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
- Program in Epidemiology, Oregon Health & Science University, Portland State University School of Public Health, Portland, Oregon, USA
| | - Marcel E. Curlin
- Department of Occupational Health
- Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
- Vaccine and Gene Therapy Institute, Oregon Health & Science University, Portland, Oregon, USA
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23
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Ntumngia FB, Kolli SK, Annamalai Subramani P, Barnes SJ, Nicholas J, Ogbondah MM, Barnes BB, Salinas ND, Thawornpan P, Tolia NH, Chootong P, Adams JH. Naturally acquired antibodies against Plasmodium vivax pre-erythrocytic stage vaccine antigens inhibit sporozoite invasion of human hepatocytes in vitro. Sci Rep 2024; 14:1260. [PMID: 38218737 PMCID: PMC10787766 DOI: 10.1038/s41598-024-51820-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024] Open
Abstract
In Plasmodium vivax, the most studied vaccine antigens are aimed at blocking merozoite invasion of erythrocytes and disease development. Very few studies have evaluated pre-erythrocytic (PE) stage antigens. The P. vivax circumsporozoite protein (CSP), is considered the leading PE vaccine candidate, but immunity to CSP is short-lived and variant specific. Thus, there is a need to identify other potential candidates to partner with CSP in a multivalent vaccine to protect against infection and disease. We hypothesize that sporozoite antigens important for host cell infection are considered potential targets. In this study, we evaluated the magnitude and quality of naturally acquired antibody responses to four P. vivax PE antigens: sporozoite surface protein 3 (SSP3), sporozoite protein essential for traversal 1 (SPECT1), cell traversal protein of ookinetes and sporozoites (CelTOS) and CSP in plasma of P. vivax infected patients from Thailand. Naturally acquired antibodies to these antigens were prevalent in the study subjects, but with significant differences in magnitude of IgG antibody responses. About 80% of study participants had antibodies to all four antigens and only 2% did not have antibodies to any of the antigens. Most importantly, these antibodies inhibited sporozoite infection of hepatocytes in vitro. Significant variations in magnitude of antigen-specific inhibitory antibody responses were observed with individual samples. The highest inhibitory responses were observed with anti-CelTOS antibodies, followed by anti-SPECT1, SSP3 and CSP antibodies respectively. These data highlight the vaccine potential of these antigens in protecting against hepatocyte infection and the need for a multi-valent pre-erythrocytic vaccine to prevent liver stage development of P. vivax sporozoites.
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Affiliation(s)
- Francis Babila Ntumngia
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA.
| | - Surendra Kumar Kolli
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA
| | | | - Samantha J Barnes
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA
| | - Justin Nicholas
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Madison M Ogbondah
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA
| | - Brian B Barnes
- College of Marine Science, University of South Florida, St Petersburg, FL, USA
| | - Nichole D Salinas
- Host Pathogen Interactions and Structural Vaccinology Section, Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Pongsakorn Thawornpan
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Niraj H Tolia
- Host Pathogen Interactions and Structural Vaccinology Section, Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Patchanee Chootong
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - John H Adams
- Center for Global Health and Interdisciplinary Research, University of South Florida, Tampa, FL, USA.
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24
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Thawornpan P, Nicholas J, Malee C, Kochayoo P, Wangriatisak K, Tianpothong P, Ntumngia FB, J. Barnes S, H. Adams J, Chootong P. Longitudinal analysis of antibody responses to Plasmodium vivax sporozoite antigens following natural infection. PLoS Negl Trop Dis 2024; 18:e0011907. [PMID: 38277340 PMCID: PMC10817200 DOI: 10.1371/journal.pntd.0011907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND P. vivax malaria is a major global health burden hindering social and economic development throughout many tropical and sub-tropical countries. Pre-erythrocytic (PE) vaccines emerge as an attractive approach for the control and elimination of malaria infection. Therefore, evaluating the magnitude, longevity and prevalence of naturally acquired IgG antibody responses against PE candidate antigens is useful for vaccine design. METHODOLOGY/PRINCIPAL FINDINGS The antigenicity of five recombinant PE antigens (PvCSP-VK210, PvSSP3, PvM2-MAEBL, PvCelTOS and PvSPECT1) was evaluated in plasma samples from individuals residing in low transmission areas in Thailand (Ranong and Chumphon Provinces). The samples were collected at the time of acute vivax malaria and 90, 270 and 360 days later. The prevalence, magnitude and longevity of total IgG and IgG subclasses were determined for each antigen using the longitudinal data. Our results showed that seropositivity of all tested PE antigens was detected during infection in at least some subjects; anti-PvCSP-VK210 and anti-PvCelTOS antibodies were the most frequent. Titers of these antibodies declined during the year of follow up, but notably seropositivity persisted. Among seropositive subjects at post-infection, high number of subjects possessed antibodies against PvCSP-VK210. Anti-PvSSP3 antibody responses had the longest half-life. IgG subclass profiling showed that the predominant subclasses were IgG1 and IgG3 (cytophilic antibodies), tending to remain detectable for at least 360 days after infection. CONCLUSIONS/SIGNIFICANCE The present study demonstrated the magnitude and longevity of serological responses to multiple PE antigens of P. vivax after natural infection. This knowledge could contribute to the design of an effective P. vivax vaccine.
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Affiliation(s)
- Pongsakorn Thawornpan
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Justin Nicholas
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Chayapat Malee
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Piyawan Kochayoo
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Kittikorn Wangriatisak
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Pachara Tianpothong
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Francis Babila Ntumngia
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Samantha J. Barnes
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - John H. Adams
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Patchanee Chootong
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
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25
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Dutta S, Thera MA. Seasonal RTS,S/AS01 E vaccination with or without seasonal malaria chemoprevention. THE LANCET. INFECTIOUS DISEASES 2024; 24:9-11. [PMID: 37625433 DOI: 10.1016/s1473-3099(23)00392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Sheetij Dutta
- Structural Vaccinology Laboratory, Biologics Research & Development Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
| | - Mahamadou A Thera
- Malaria Research and Training Center, Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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26
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Hammershaimb EA, Berry AA. Pre-erythrocytic malaria vaccines: RTS,S, R21, and beyond. Expert Rev Vaccines 2024; 23:49-52. [PMID: 38095048 DOI: 10.1080/14760584.2023.2292204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Elizabeth Adrianne Hammershaimb
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea A Berry
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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27
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Dicko A, Ouedraogo JB, Zongo I, Sagara I, Cairns M, Yerbanga RS, Issiaka D, Zoungrana C, Sidibe Y, Tapily A, Nikièma F, Sompougdou F, Sanogo K, Kaya M, Yalcouye H, Dicko OM, Diarra M, Diarra K, Thera I, Haro A, Sienou AA, Traore S, Mahamar A, Dolo A, Kuepfer I, Snell P, Grant J, Webster J, Milligan P, Lee C, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Chandramohan D, Greenwood B. Seasonal vaccination with RTS,S/AS01 E vaccine with or without seasonal malaria chemoprevention in children up to the age of 5 years in Burkina Faso and Mali: a double-blind, randomised, controlled, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:75-86. [PMID: 37625434 DOI: 10.1016/s1473-3099(23)00368-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Seasonal vaccination with the RTS,S/AS01E vaccine combined with seasonal malaria chemoprevention (SMC) prevented malaria in young children more effectively than either intervention given alone over a 3 year period. The objective of this study was to establish whether the added protection provided by the combination could be sustained for a further 2 years. METHODS This was a double-blind, individually randomised, controlled, non-inferiority and superiority, phase 3 trial done at two sites: the Bougouni district and neighbouring areas in Mali and Houndé district, Burkina Faso. Children who had been enrolled in the initial 3-year trial when aged 5-17 months were initially randomly assigned individually to receive SMC with sulphadoxine-pyrimethamine and amodiaquine plus control vaccines, RTS,S/AS01E plus placebo SMC, or SMC plus RTS,S/AS01E. They continued to receive the same interventions until the age of 5 years. The primary trial endpoint was the incidence of clinical malaria over the 5-year trial period in both the modified intention-to-treat and per-protocol populations. Over the 5-year period, non-inferiority was defined as a 20% increase in clinical malaria in the RTS,S/AS01E-alone group compared with the SMC alone group. Superiority was defined as a 12% difference in the incidence of clinical malaria between the combined and single intervention groups. The study is registered with ClinicalTrials.gov, NCT04319380, and is complete. FINDINGS In April, 2020, of 6861 children originally recruited, 5098 (94%) of the 5433 children who completed the initial 3-year follow-up were re-enrolled in the extension study. Over 5 years, the incidence of clinical malaria per 1000 person-years at risk was 313 in the SMC alone group, 320 in the RTS,S/AS01E-alone group, and 133 in the combined group. The combination of RTS,S/AS01E and SMC was superior to SMC (protective efficacy 57·7%, 95% CI 53·3 to 61·7) and to RTS,S/AS01E (protective efficacy 59·0%, 54·7 to 62·8) in preventing clinical malaria. RTS,S/AS01E was non-inferior to SMC (hazard ratio 1·03 [95% CI 0·95 to 1·12]). The protective efficacy of the combination versus SMC over the 5-year period of the study was very similar to that seen in the first 3 years with the protective efficacy of the combination versus SMC being 57·7% (53·3 to 61·7) and versus RTS/AS01E-alone being 59·0% (54·7 to 62·8). The comparable figures for the first 3 years of the study were 62·8% (58·4 to 66·8) and 59·6% (54·7 to 64·0%), respectively. Hospital admissions for WHO-defined severe malaria were reduced by 66·8% (95% CI 40·3 to 81·5), for malarial anaemia by 65·9% (34·1 to 82·4), for blood transfusion by 68·1% (32·6 to 84·9), for all-cause deaths by 44·5% (2·8 to 68·3), for deaths excluding external causes or surgery by 41·1% (-9·2 to 68·3), and for deaths from malaria by 66·8% (-2·7 to 89·3) in the combined group compared with the SMC alone group. No safety signals were detected. INTERPRETATION Substantial protection against malaria was sustained over 5 years by combining seasonal malaria vaccination with seasonal chemoprevention, offering a potential new approach to malaria control in areas with seasonal malaria transmission. FUNDING UK Joint Global Health Trials and PATH's Malaria Vaccine Initiative (through a grant from the Bill & Melinda Gates Foundation). TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Alassane Dicko
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Jean-Bosco Ouedraogo
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Issaka Zongo
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Issaka Sagara
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Matthew Cairns
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rakiswendé Serge Yerbanga
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Djibrilla Issiaka
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Charles Zoungrana
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Youssoufa Sidibe
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Amadou Tapily
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Frédéric Nikièma
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Frédéric Sompougdou
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Koualy Sanogo
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Mahamadou Kaya
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Hama Yalcouye
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Oumar Mohamed Dicko
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Modibo Diarra
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Kalifa Diarra
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Ismaila Thera
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Alassane Haro
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoul Aziz Sienou
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Seydou Traore
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Almahamoudou Mahamar
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Amagana Dolo
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Irene Kuepfer
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Snell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Grant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Milligan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Halidou Tinto
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Djimde
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
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Cuccurullo EC, Dong Y, Simões ML, Dimopoulos G, Bier E. Development of an anti-Pfs230 monoclonal antibody as a Plasmodium falciparum gametocyte blocker. RESEARCH SQUARE 2023:rs.3.rs-3757253. [PMID: 38196646 PMCID: PMC10775378 DOI: 10.21203/rs.3.rs-3757253/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Vector control is a crucial strategy for malaria elimination by preventing infection and reducing disease transmission. Most gains have been achieved through insecticide-treated nets (ITNs) and indoor residual spraying (IRS), but the emergence of insecticide resistance among Anopheles mosquitoes calls for new tools to be applied. Here, we present the development of a highly effective murine monoclonal antibody, targeting the N-terminal region of the Plasmodium falciparum gametocyte antigen Pfs230, that can decrease the infection prevalence by > 50% when fed to Anopheles mosquitoes with gametocytes in an artificial membrane feeding system. We used a standard mouse immunization protocol followed by protein interaction and parasite-blocking validation at three distinct stages of the monoclonal antibody development pipeline: post-immunization, post-hybridoma generation, and final validation of the monoclonal antibody. We evaluated twenty antibodies identifying one (mAb 13G9) with high Pfs230-affinity and parasite-blocking activity. This 13G9 monoclonal antibody could potentially be developed into a transmission-blocking single-chain antibody for expression in transgenic mosquitoes.
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29
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Poespoprodjo JR, Douglas NM, Ansong D, Kho S, Anstey NM. Malaria. Lancet 2023; 402:2328-2345. [PMID: 37924827 DOI: 10.1016/s0140-6736(23)01249-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 11/06/2023]
Abstract
Malaria is resurging in many African and South American countries, exacerbated by COVID-19-related health service disruption. In 2021, there were an estimated 247 million malaria cases and 619 000 deaths in 84 endemic countries. Plasmodium falciparum strains partly resistant to artemisinins are entrenched in the Greater Mekong region and have emerged in Africa, while Anopheles mosquito vectors continue to evolve physiological and behavioural resistance to insecticides. Elimination of Plasmodium vivax malaria is hindered by impractical and potentially toxic antirelapse regimens. Parasitological diagnosis and treatment with oral or parenteral artemisinin-based therapy is the mainstay of patient management. Timely blood transfusion, renal replacement therapy, and restrictive fluid therapy can improve survival in severe malaria. Rigorous use of intermittent preventive treatment in pregnancy and infancy and seasonal chemoprevention, potentially combined with pre-erythrocytic vaccines endorsed by WHO in 2021 and 2023, can substantially reduce malaria morbidity. Improved surveillance, better access to effective treatment, more labour-efficient vector control, continued drug development, targeted mass drug administration, and sustained political commitment are required to achieve targets for malaria reduction by the end of this decade.
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Affiliation(s)
- Jeanne Rini Poespoprodjo
- Centre for Child Health and Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Mimika District Hospital and District Health Authority, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Daniel Ansong
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Steven Kho
- Timika Malaria Research Facility, Papuan Health and Community Development Foundation, Timika, Indonesia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
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Bosc N, Felix E, Gardner JMF, Mills J, Timmerman M, Asveld D, Rensen K, Mukherjee P, Das R, Chenu E, Besson D, Burrows JN, Duffy J, Laleu B, Guantai EM, Leach AR. MAIP: An Open-Source Tool to Enrich High-Throughput Screening Output and Identify Novel, Druglike Molecules with Antimalarial Activity. ACS Med Chem Lett 2023; 14:1733-1741. [PMID: 38116432 PMCID: PMC10726451 DOI: 10.1021/acsmedchemlett.3c00369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023] Open
Abstract
Efforts to tackle malaria must continue for a disease that threatens half of the global population. Parasite resistance to current therapies requires new chemotypes that are able to demonstrate effectiveness and safety. Previously, we developed a machine-learning-based approach to predict compound antimalarial activity, which was trained on the compound collections of several organizations. The resulting prediction platform, MAIP, was made freely available to the scientific community and offers a solution to prioritize molecules of interest in virtual screening and hit-to-lead optimization. Here, we experimentally validate MAIP and demonstrate how the approach was used in combination with a robust compound selection workflow and a recently introduced innovative high-throughput screening (HTS) cascade to select and purchase compounds from a public library for subsequent experimental screening. We observed a 12-fold enrichment compared with a randomly selected set of molecules, and the eight hits we ultimately selected exhibit good potency and absorption, distribution, metabolism, and excretion (ADME) profiles.
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Affiliation(s)
- Nicolas Bosc
- European
Molecular Biology Laboratory, European Bioinformatics
Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - Eloy Felix
- European
Molecular Biology Laboratory, European Bioinformatics
Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
| | - J. Mark F. Gardner
- AMG
Consultants Ltd, Discovery
Park House, Discovery Park, Sandwich, Kent CT13 9ND, United Kingdom
| | - James Mills
- Sandexis
Medicinal Chemistry Ltd, Innovation House, Discovery Park, Sandwich, Kent CT13 9FF, United Kingdom
| | - Martijn Timmerman
- Pivot
Park Screening Centre, Pivot Park (Frederick Banting Building), Kloosterstraat 9, 5349 AB Oss, The Netherlands
| | - Dennis Asveld
- Pivot
Park Screening Centre, Pivot Park (Frederick Banting Building), Kloosterstraat 9, 5349 AB Oss, The Netherlands
| | - Kim Rensen
- Pivot
Park Screening Centre, Pivot Park (Frederick Banting Building), Kloosterstraat 9, 5349 AB Oss, The Netherlands
| | - Partha Mukherjee
- TCG
Life Sciences, Bengal Intelligent Park Limited, Block EP & GP, Salt Lake Electronics
Complex, Sector V, Kolkata, West Bengal 700091, India
| | - Rishi Das
- TCG
Life Sciences, Bengal Intelligent Park Limited, Block EP & GP, Salt Lake Electronics
Complex, Sector V, Kolkata, West Bengal 700091, India
| | - Elodie Chenu
- Medicines
for Malaria Ventures, 1215 Geneva, Switzerland
| | | | | | - James Duffy
- Medicines
for Malaria Ventures, 1215 Geneva, Switzerland
| | - Benoît Laleu
- Medicines
for Malaria Ventures, 1215 Geneva, Switzerland
| | - Eric M. Guantai
- Department
of Pharmacy, Faculty of Health Sciences, University of Nairobi, 00202 Nairobi, Kenya
| | - Andrew R. Leach
- European
Molecular Biology Laboratory, European Bioinformatics
Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SD, United Kingdom
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Bolton JS, MacGill RS, Locke E, Regules JA, Bergmann-Leitner ES. Novel antibody competition binding assay identifies distinct serological profiles associated with protection. Front Immunol 2023; 14:1303446. [PMID: 38152401 PMCID: PMC10752609 DOI: 10.3389/fimmu.2023.1303446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Pre-erythrocytic malaria vaccines hold the promise of inducing sterile protection thereby preventing the morbidity and mortality associated with Plasmodium infection. The main surface antigen of P. falciparum sporozoites, i.e., the circumsporozoite protein (CSP), has been extensively explored as a target of such vaccines with significant success in recent years. Systematic adjuvant selection, refinements of the immunization regimen, and physical properties of the antigen may all contribute to the potential of increasing the efficacy of CSP-based vaccines. Protection appears to be dependent in large part on CSP antibodies. However due to a knowledge gap related to the exact correlates of immunity, there is a critical need to improve our ability to down select candidates preclinically before entering clinical trials including with controlled human malaria infections (CHMI). Methods We developed a novel multiplex competition assay based on well-characterized monoclonal antibodies (mAbs) that target crucial epitopes across the CSP molecule. This new tool assesses both, quality and epitope-specific concentrations of vaccine-induced antibodies by measuring their equivalency with a panel of well-characterized, CSP-epitope-specific mAbs. Results Applying this method to RTS,S-immune sera from a CHMI trial demonstrated a quantitative epitope-specificity profile of antibody responses that can differentiate between protected vs. nonprotected individuals. Aligning vaccine efficacy with quantitation of the epitope fine specificity results of this equivalency assay reveals the importance of epitope specificity. Discussion The newly developed serological equivalence assay will inform future vaccine design and possibly even adjuvant selection. This methodology can be adapted to other antigens and disease models, when a panel of relevant mAbs exists, and could offer a unique tool for comparing and down-selecting vaccine formulations.
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Affiliation(s)
- Jessica S. Bolton
- Biologics Research & Development, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
| | - Randall S. MacGill
- Center for Vaccine Innovation and Access, PATH, Washington, DC, United States
| | - Emily Locke
- Center for Vaccine Innovation and Access, PATH, Washington, DC, United States
| | - Jason A. Regules
- Biologics Research & Development, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
| | - Elke S. Bergmann-Leitner
- Biologics Research & Development, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
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Ranjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. GLOBAL PEDIATRICS 2023; 6:None. [PMID: 38440360 PMCID: PMC10911094 DOI: 10.1016/j.gpeds.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 03/06/2024]
Abstract
Purpose The pediatric population, especially under-five children, is highly susceptible to malaria and accounts for 76 % of global malaria deaths according to the World Malaria Report 2022. The purpose of this manuscript is to discuss the various factors involved in the susceptibility of the pediatric population to Malaria and the importance of this age group for malaria elimination. Methodology Data on pediatric malaria epidemiology that includes prevalence, risk factors, immune factors, socioeconomic factors, control methods, etc. were extracted from published literature using PubMed and Google Scholar. This data was further correlated with malaria incidence data from the World Health Organization (WHO) and the National Center for Vector Borne Diseases Control (NCVBDC). Results The younger age group is vulnerable to severe malaria due to an immature immune system. The risk of infection and clinical disease increases after the waning of maternal immunity. In the initial years of life, the developing brain is more susceptible to malaria infection and its after-effects. The pediatric population may act as a malaria transmission reservoir due to parasite density and asymptomatic infections. WHO recommended RTS,S/AS01 has limitations and may not be applicable in all settings to propel malaria elimination. Conclusion The diagnosis of malaria is based on clinical suspicion and confirmed with microscopy and/or rapid diagnostic testing. The school-age pediatric population serves as a transmission reservoir in the form of asymptomatic malaria since they have acquired some immunity due to exposure in early childhood. Targeting the hidden reservoir in the pediatric population and protecting this vulnerable group will be essential for malaria elimination from the countries targeting elimination.
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Affiliation(s)
- Ritesh Ranjha
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Kuldeep Singh
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | | | - Mradul Mohan
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Anup R Anvikar
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Praveen K. Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India
- Academy of Scientific and Innovative Research, Ghaziabad, India
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Walker IS, Rogerson SJ. Pathogenicity and virulence of malaria: Sticky problems and tricky solutions. Virulence 2023; 14:2150456. [PMID: 36419237 PMCID: PMC9815252 DOI: 10.1080/21505594.2022.2150456] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Infections with Plasmodium falciparum and Plasmodium vivax cause over 600,000 deaths each year, concentrated in Africa and in young children, but much of the world's population remain at risk of infection. In this article, we review the latest developments in the immunogenicity and pathogenesis of malaria, with a particular focus on P. falciparum, the leading malaria killer. Pathogenic factors include parasite-derived toxins and variant surface antigens on infected erythrocytes that mediate sequestration in the deep vasculature. Host response to parasite toxins and to variant antigens is an important determinant of disease severity. Understanding how parasites sequester, and how antibody to variant antigens could prevent sequestration, may lead to new approaches to treat and prevent disease. Difficulties in malaria diagnosis, drug resistance, and specific challenges of treating P. vivax pose challenges to malaria elimination, but vaccines and other preventive strategies may offer improved disease control.
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Affiliation(s)
- Isobel S Walker
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
| | - Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne, The Doherty Institute, Melbourne, Australia
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Wotodjo AN, Oboh MA, Sokhna C, Diagne N, Diène-Sarr F, Trape JF, Doucouré S, Amambua-Ngwa A, D'Alessandro U. Plasmodium falciparum population structure and genetic diversity of cell traversal protein for ookinetes and sporozoites (CelTOS) during malaria resurgences in Dielmo, Senegal. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 116:105535. [PMID: 38030029 DOI: 10.1016/j.meegid.2023.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/01/2023]
Abstract
The ability to accurately measure the intensity of malaria transmission in areas with low transmission is extremely important to guide elimination efforts. Plasmodium falciparum Cell-traversal protein for ookinetes and sporozoites (PfCelTOS) is an important conserved sporozoite antigen reported as one of the promising malaria vaccine candidates, and could be used to estimate malaria transmission intensity. This study aimed at determining whether the diversity of PfCelTOS gene reflects the changes in malaria transmission that occurred between 2007 and 2014 in Dielmo, a Senegalese village, before and after the implementation of insecticide treated bed nets (ITNs). Of the 109 samples positive for PfCelTOS PCR, 96 (88%) were successfully sequenced and analysed for polymorphisms and population diversity. The number of segregating sites was higher during the pre-intervention period (13) and the malaria resurgences (11) than during the intervention period (5). Similarly, the number and diversity of haplotypes were higher during the pre-intervention period (16 and 0.914, respectively) and the malaria resurgences (6 and 0.821, respectively) than during the intervention period (4 and 0.758, respectively). Moreover, the average number of nucleotide differences was higher during the pre-intervention (3.792) and during malaria resurgences (3.467) than during the intervention period (2.189). The 3D7 KSSFNEP haplotype was only observed during the intervention period. Only two haplotypes were shared in both the pre-intervention and intervention periods while four haplotypes were shared between the pre-intervention and the malaria resurgences. The Fst values indicate moderate differentiation between pre-intervention and intervention periods (0.17433), and between intervention and malaria resurgences period (0.19198) as well as between pre-intervention and malaria resurgences periods (0.06607). PfCelTOS genetic diversity reflected changes of malaria transmission, with higher polymorphisms recorded before the large-scale implementation of ITNs and during the malaria resurgences. PfCelTOS is also a candidate vaccine; mapping its diversity across multiple endemic environments will facilitate the design and optimisation of a broad and efficacious vaccine.
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Affiliation(s)
- Amélé Nyedzie Wotodjo
- VITROME, UMR 257 IRD, Campus UCAD-IRD, Dakar, Senegal; Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, Gambia.
| | - Mary Aigbiremo Oboh
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, Gambia; Department of Biological Sciences, University of Medical Sciences, Ondo, Nigeria; Department of Biomedical Sciences, Rochester Institute of Technology, Rochester, NY, United States of America
| | - Cheikh Sokhna
- VITROME, UMR 257 IRD, Campus UCAD-IRD, Dakar, Senegal
| | | | | | - Jean-François Trape
- UMR MIVEGEC, Laboratoire de Paludologie et Zoologie Médicale, IRD, Dakar, Senegal
| | | | - Alfred Amambua-Ngwa
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
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Nicholas J, Kolli SK, Subramani PA, De SL, Ogbondah MM, Barnes SJ, Ntumngia FB, Adams JH. Comparative analyses of functional antibody-mediated inhibition with anti-circumsporozoite monoclonal antibodies against transgenic Plasmodium berghei. Malar J 2023; 22:335. [PMID: 37936181 PMCID: PMC10629016 DOI: 10.1186/s12936-023-04765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Acquired functional inhibitory antibodies are one of several humoral immune mechanisms used to neutralize foreign pathogens. In vitro bioassays are useful tools for quantifying antibody-mediated inhibition and evaluating anti-parasite immune antibodies. However, a gap remains in understanding of how antibody-mediated inhibition in vitro translates to inhibition in vivo. In this study, two well-characterized transgenic Plasmodium berghei parasite lines, PbmCh-luc and Pb-PfCSP(r), and murine monoclonal antibodies (mAbs) specific to P. berghei and Plasmodium falciparum circumsporozoite protein (CSP), 3D11 and 2A10, respectively, were used to evaluate antibody-mediated inhibition of parasite development in both in vitro and in vivo functional assays. METHODS IC50 values of mAbs were determined using an established inhibition of liver-stage development assay (ILSDA). For the in vivo inhibition assay, mice were passively immunized by transfer of the mAbs and subsequently challenged with 5.0 × 103 sporozoites via tail vein injection. The infection burden in both assays was quantified by luminescence and qRT-PCR of P. berghei 18S rRNA normalized to host GAPDH. RESULTS The IC50 values quantified by relative luminescence of mAbs 3D11 and 2A10 were 0.396 µg/ml and 0.093 µg/ml, respectively, against transgenic lines in vitro. Using the highest (> 90%) inhibitory antibody concentrations in a passive transfer, an IC50 of 233.8 µg/ml and 181.5 µg/ml for mAbs 3D11 and 2A10, respectively, was observed in vivo. At 25 µg (250 µg/ml), the 2A10 antibody significantly inhibited liver burden in mice compared to control. Additionally, qRT-PCR of P. berghei 18S rRNA served as a secondary validation of liver burden quantification. CONCLUSIONS Results from both experimental models, ILSDA and in vivo challenge, demonstrated that increased concentrations of the homologous anti-CSP repeat mAbs increased parasite inhibition. However, differences in antibody IC50 values between parasite lines did not allow a direct correlation between the inhibition of sporozoite invasion in vitro by ILSDA and the inhibition of mouse liver stage burden. Further studies are needed to establish the conditions for confident predictions for the in vitro ILSDA to be a predictor of in vivo outcomes using this model system.
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Affiliation(s)
- Justin Nicholas
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Surendra Kumar Kolli
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Pradeep Annamalai Subramani
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Sai Lata De
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
- Department of Infectious Disease & Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Madison M Ogbondah
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Samantha J Barnes
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Francis Babila Ntumngia
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - John H Adams
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA.
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Abstract
Malaria is a mosquito-borne disease caused by protozoan parasites of the genus Plasmodium. Despite significant declines in malaria-attributable morbidity and mortality over the last two decades, it remains a major public health burden in many countries. This underscores the critical need for improved strategies to prevent, treat and control malaria if we are to ultimately progress towards the eradication of this disease. Ideally, this will include the development and deployment of a highly effective malaria vaccine that is able to induce long-lasting protective immunity. There are many malaria vaccine candidates in development, with more than a dozen of these in clinical development. RTS,S/AS01 (also known as Mosquirix) is the most advanced malaria vaccine and was shown to have modest efficacy against clinical malaria in phase III trials in 5- to 17-month-old infants. Following pilot implementation trials, the World Health Organisation has recommended it for use in Africa in young children who are most at risk of infection with P. falciparum, the deadliest of the human malaria parasites. It is well recognised that more effective malaria vaccines are needed. In this review, we discuss malaria vaccine candidates that have progressed into clinical evaluation and highlight the most advanced candidates: Sanaria's irradiated sporozoite vaccine (PfSPZ Vaccine), the chemoattenuated sporozoite vaccine (PfSPZ-CVac), RTS,S/AS01 and the novel malaria vaccine candidate, R21, which displayed promising, high-level efficacy in a recent small phase IIb trial in Africa.
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Affiliation(s)
- Danielle I Stanisic
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
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Hamilton A, Haghpanah F, Hasso-Agopsowicz M, Frost I, Lin G, Schueller E, Klein E, Laxminarayan R. Modeling of malaria vaccine effectiveness on disease burden and drug resistance in 42 African countries. COMMUNICATIONS MEDICINE 2023; 3:144. [PMID: 37833540 PMCID: PMC10576074 DOI: 10.1038/s43856-023-00373-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The emergence of antimalarial drug resistance poses a major threat to effective malaria treatment and control. This study aims to inform policymakers and vaccine developers on the potential of an effective malaria vaccine in reducing drug-resistant infections. METHODS A compartmental model estimating cases, drug-resistant cases, and deaths averted from 2021 to 2030 with a vaccine against Plasmodium falciparum infection administered yearly to 1-year-olds in 42 African countries. Three vaccine efficacy (VE) scenarios and one scenario of rapidly increasing drug resistance are modeled. RESULTS When VE is constant at 40% for 4 years and then drops to 0%, 235.7 (Uncertainty Interval [UI] 187.8-305.9) cases per 1000 children, 0.6 (UI 0.4-1.0) resistant cases per 1000, and 0.6 (UI 0.5-0.9) deaths per 1000 are averted. When VE begins at 80% and drops 20 percentage points each year, 313.9 (UI 249.8-406.6) cases per 1000, 0.9 (UI 0.6-1.3) resistant cases per 1000, and 0.9 (UI 0.6-1.2) deaths per 1000 are averted. When VE remains 40% for 10 years, 384.7 (UI 311.7-496.5) cases per 1000, 1.0 (0.7-1.6) resistant cases per 1000, and 1.1 (UI 0.8-1.5) deaths per 1000 are averted. Assuming an effective vaccine and an increase in current levels of drug resistance to 80% by 2030, 10.4 (UI 7.3-15.8) resistant cases per 1000 children are averted. CONCLUSIONS Widespread deployment of a malaria vaccine could substantially reduce health burden in Africa. Maintaining VE longer may be more impactful than a higher initial VE that falls rapidly.
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Affiliation(s)
| | | | | | - Isabel Frost
- World Health Organization, Geneva, Switzerland
- Imperial College London, London, UK
| | - Gary Lin
- One Health Trust, Washington, D.C., USA
| | | | - Eili Klein
- One Health Trust, Washington, D.C., USA
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, MD, USA
| | - Ramanan Laxminarayan
- One Health Trust, Washington, D.C., USA.
- One Health Trust, New Delhi, India.
- Princeton University, Princeton, NJ, USA.
- University of Washington, Seattle, WA, USA.
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Ohene-Adjei K, Asante KP, Akuffo KO, Tounaikok N, Asiamah M, Owiredu D, Manu AA, Danso-Appiah A. Malaria vaccine-related adverse events among children under 5 in sub-Saharan Africa: systematic review and meta-analysis protocol. BMJ Open 2023; 13:e076985. [PMID: 37793915 PMCID: PMC10551995 DOI: 10.1136/bmjopen-2023-076985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION The RTS,S vaccine has been approved for use in children under 5 living in moderate to high malaria transmission areas. However, clinically important adverse events have been reported in countries in sub-Saharan Africa. This systematic review aims to assess the frequency, severity and clinical importance of vaccine-related adverse events. METHODS AND ANALYSIS This systematic review protocol has been prepared following robust methods and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for protocols guidelines. We will search PubMed, CINAHL, LILACS, Google Scholar, SCOPUS, WEB OF SCIENCE, Cochrane library, HINARI, African Journals Online, Trip Pro and TOXNET from 2000 to 30 September 2023, without language restrictions. We will also search conference proceedings, dissertations, World Bank Open Knowledge Repository, and WHO, PATH, UNICEF, Food and Drugs Authorities and European Medicines Agency databases, preprint repositories and reference lists of relevant studies for additional studies. Experts in the field will be contacted for unpublished or published studies missed by our searches. At least two reviewers will independently select studies and extract data using pretested tools and assess risk of bias in the included studies using the Cochrane risk of bias tool. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically, and statistically using the I2 statistic. We will conduct random-effects meta-analysis when heterogeneity is appreciable, and express dichotomous outcomes (serious adverse events, cerebral malaria and febrile convulsion) as risk ratio (RR) with their 95% CI. We will perform subgroup analysis to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the effect estimates. The overall level of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION Ethical approval is not required for a systematic review. The findings of this study will be disseminated through stakeholder forums, conferences and peer-review publications. PROSPERO REGISTRATION NUMBER CRD42021275155.
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Affiliation(s)
- Kennedy Ohene-Adjei
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Tain District Health Directorate, Ghana Health Service, Tain, Ghana
| | - Kwaku Poku Asante
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Kintampo North Municipality, Bono East Region, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Narcisse Tounaikok
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
- Department of Human and Animal Health, University of Emi Koussi, N'Djamena, Chad
| | - Morrison Asiamah
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
| | - Alexander Ansah Manu
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Accra, Ghana
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Siqueira-Neto JL, Wicht KJ, Chibale K, Burrows JN, Fidock DA, Winzeler EA. Antimalarial drug discovery: progress and approaches. Nat Rev Drug Discov 2023; 22:807-826. [PMID: 37652975 PMCID: PMC10543600 DOI: 10.1038/s41573-023-00772-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
Recent antimalarial drug discovery has been a race to produce new medicines that overcome emerging drug resistance, whilst considering safety and improving dosing convenience. Discovery efforts have yielded a variety of new molecules, many with novel modes of action, and the most advanced are in late-stage clinical development. These discoveries have led to a deeper understanding of how antimalarial drugs act, the identification of a new generation of drug targets, and multiple structure-based chemistry initiatives. The limited pool of funding means it is vital to prioritize new drug candidates. They should exhibit high potency, a low propensity for resistance, a pharmacokinetic profile that favours infrequent dosing, low cost, preclinical results that demonstrate safety and tolerability in women and infants, and preferably the ability to block Plasmodium transmission to Anopheles mosquito vectors. In this Review, we describe the approaches that have been successful, progress in preclinical and clinical development, and existing challenges. We illustrate how antimalarial drug discovery can serve as a model for drug discovery in diseases of poverty.
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Affiliation(s)
| | - Kathryn J Wicht
- Holistic Drug Discovery and Development (H3D) Centre, University of Cape Town, Rondebosch, South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | - Kelly Chibale
- Holistic Drug Discovery and Development (H3D) Centre, University of Cape Town, Rondebosch, South Africa
- South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
| | | | - David A Fidock
- Department of Microbiology and Immunology and Center for Malaria Therapeutics and Antimicrobial Resistance, Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Nicholas J, De SL, Thawornpan P, Brashear AM, Kolli SK, Subramani PA, Barnes SJ, Cui L, Chootong P, Ntumngia FB, Adams JH. Preliminary characterization of Plasmodium vivax sporozoite antigens as pre-erythrocytic vaccine candidates. PLoS Negl Trop Dis 2023; 17:e0011598. [PMID: 37703302 PMCID: PMC10519608 DOI: 10.1371/journal.pntd.0011598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/25/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
Plasmodium vivax pre-erythrocytic (PE) vaccine research has lagged far behind efforts to develop Plasmodium falciparum vaccines. There is a critical gap in our knowledge of PE antigen targets that can induce functionally inhibitory neutralizing antibody responses. To overcome this gap and guide the selection of potential PE vaccine candidates, we considered key characteristics such as surface exposure, essentiality to infectivity and liver stage development, expression as recombinant proteins, and functional immunogenicity. Selected P. vivax sporozoite antigens were surface sporozoite protein 3 (SSP3), sporozoite microneme protein essential for cell traversal (SPECT1), sporozoite surface protein essential for liver-stage development (SPELD), and M2 domain of MAEBL. Sequence analysis revealed little variation occurred in putative B-cell and T-cell epitopes of the PE candidates. Each antigen was tested for expression as refolded recombinant proteins using an established bacterial expression platform and only SPELD failed. The successfully expressed antigens were immunogenic in vaccinated laboratory mice and were positively reactive with serum antibodies of P. vivax-exposed residents living in an endemic region in Thailand. Vaccine immune antisera were tested for reactivity to native sporozoite proteins and for their potential vaccine efficacy using an in vitro inhibition of liver stage development assay in primary human hepatocytes quantified on day 6 post-infection by high content imaging analysis. The anti-PE sera produced significant inhibition of P. vivax sporozoite invasion and liver stage development. This report provides an initial characterization of potential new PE candidates for a future P. vivax vaccine.
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Affiliation(s)
- Justin Nicholas
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Sai Lata De
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Pongsakorn Thawornpan
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Awtum M. Brashear
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Surendra Kumar Kolli
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Pradeep Annamalai Subramani
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Samantha J. Barnes
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Liwang Cui
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Patchanee Chootong
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Francis Babila Ntumngia
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - John H. Adams
- Center for Global Health and Interdisciplinary Research, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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Merle CS. Implementation strategies for the introduction of the RTS,S/AS01 (RTS,S) malaria vaccine in countries with areas of highly seasonal transmission: workshop meeting report. Malar J 2023; 22:242. [PMID: 37612716 PMCID: PMC10464391 DOI: 10.1186/s12936-023-04657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
A workshop on implementation strategies for the introduction of the RTS,S/AS01 (RTS,S) malaria vaccine in countries with areas of highly seasonal transmission, was held as a hybrid meeting in Dakar, Senegal, and online, 23-25 January 2023. Delegates from Expanded Programmes on Immunization (EPI) and National Malaria Control Programmes (NMCPs) from 13 African countries, and representatives from key stakeholders participated. RTS,S is the first malaria vaccine to be recommended by the World Health Organization (WHO). The recommendation followed pilot implementation of the vaccine in Ghana, Kenya and Malawi, which showed that introduction of the vaccine was highly effective at scale, and was associated with a 30% reduction in hospital admissions with severe malaria in age groups eligible to have received the vaccine and no evidence of the safety signals that had been observed in the phase 3 trial. Clinical trials in Mali and Burkina Faso, showed that in children receiving Seasonal Malaria Chemoprevention (SMC), providing the vaccine just prior to high transmission seasons, matching the period of highest efficacy to the peak transmission season, resulted in substantial reduction in the incidence of clinical malaria and of severe malaria. While SMC has been successfully scaled-up despite the challenges of delivery, there is no established platform for seasonal vaccine delivery and no real-world experience. The objectives of this workshop were, therefore, to share experiences from countries that have introduced the RTS,S vaccine in routine child vaccination programmes, with SMC-implementing countries as they consider malaria vaccine introduction, and to explore implementation strategies in countries with seasonal transmission and where EPI coverage may be low especially in the second year of life. Practical implementation challenges, lessons learned for vaccine introduction, and research questions, towards facilitating the introduction of the RTS,S (and other malaria vaccines) in countries with seasonal malaria transmission were discussed.
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Affiliation(s)
- Corinne S Merle
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland.
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Rausch KM, Barnafo EK, Lambert LE, Muratova O, Gorres JP, Anderson C, Narum DL, Wu Y, Morrison RD, Zaidi I, Duffy PE. Preclinical evaluations of Pfs25-EPA and Pfs230D1-EPA in AS01 for a vaccine to reduce malaria transmission. iScience 2023; 26:107192. [PMID: 37485364 PMCID: PMC10359932 DOI: 10.1016/j.isci.2023.107192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/15/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Malaria transmission-blocking vaccine candidates Pfs25-EPA and Pfs230D1-EPA target sexual stage development of Plasmodium falciparum parasites in the mosquito host, thereby reducing mosquito infectivity. When formulated on Alhydrogel, Pfs25-EPA has demonstrated safety and immunogenicity in a phase 1 field trial, while Pfs230D1-EPA has shown superior activity to Pfs25-EPA in a phase 1 US trial and has entered phase 2 field trials. Development continues to enhance immunogenicity of these candidates toward producing a vaccine to reduce malaria transmission (VRMT) with both pre-erythrocytic (i.e., anti-infection) and transmission-blocking components. GSK Adjuvant Systems have demonstrated successful potency in pre-erythrocytic vaccine trials and might offer a common platform for VRMT development. Here, we describe preclinical evaluations of Pfs25-EPA and Pfs230D1-EPA nanoparticles with GSK platforms. Formulations were stable after a series of assessments and induced superior antibody titers and functional activity in CD-1 mice, compared to Alhydrogel formulations of the same antigens.
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Affiliation(s)
- Kelly M. Rausch
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Emma K. Barnafo
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lynn E. Lambert
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Olga Muratova
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - J. Patrick Gorres
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charles Anderson
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David L. Narum
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yimin Wu
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert D. Morrison
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Irfan Zaidi
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Patrick E. Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Challenger JD, van Beek SW, ter Heine R, van der Boor SC, Charles GD, Smit MJ, Ockenhouse C, Aponte JJ, McCall MBB, Jore MM, Churcher TS, Bousema T. Modeling the Impact of a Highly Potent Plasmodium falciparum Transmission-Blocking Monoclonal Antibody in Areas of Seasonal Malaria Transmission. J Infect Dis 2023; 228:212-223. [PMID: 37042518 PMCID: PMC10345482 DOI: 10.1093/infdis/jiad101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/06/2023] [Accepted: 04/11/2023] [Indexed: 04/13/2023] Open
Abstract
Transmission-blocking interventions can play an important role in combating malaria worldwide. Recently, a highly potent Plasmodium falciparum transmission-blocking monoclonal antibody (TB31F) was demonstrated to be safe and efficacious in malaria-naive volunteers. Here we predict the potential public health impact of large-scale implementation of TB31F alongside existing interventions. We developed a pharmaco-epidemiological model, tailored to 2 settings of differing transmission intensity with already established insecticide-treated nets and seasonal malaria chemoprevention interventions. Community-wide annual administration (at 80% coverage) of TB31F over a 3-year period was predicted to reduce clinical incidence by 54% (381 cases averted per 1000 people per year) in a high-transmission seasonal setting, and 74% (157 cases averted per 1000 people per year) in a low-transmission seasonal setting. Targeting school-aged children gave the largest reduction in terms of cases averted per dose. An annual administration of the transmission-blocking monoclonal antibody TB31F may be an effective intervention against malaria in seasonal malaria settings.
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Affiliation(s)
- Joseph D Challenger
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Rob ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences
| | - Saskia C van der Boor
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giovanni D Charles
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Merel J Smit
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris Ockenhouse
- PATH Center for Vaccine Innovation and Access, Washington, District of Columbia, USA
| | - John J Aponte
- PATH Center for Vaccine Innovation and Access, Geneva, Switzerland
| | - Matthew B B McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthijs M Jore
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas S Churcher
- Medical Research Council Centre for Global Infections Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Xu M, Hu YX, Lu SN, Idris MA, Zhou SD, Yang J, Feng XN, Huang YM, Xu X, Chen Y, Wang DQ. Seasonal malaria chemoprevention in Africa and China's upgraded role as a contributor: a scoping review. Infect Dis Poverty 2023; 12:63. [PMID: 37403183 DOI: 10.1186/s40249-023-01115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Children under five are the vulnerable population most at risk of being infected with Plasmodium parasites, especially in the Sahel region. Seasonal malaria chemoprevention (SMC) recommended by World Health Organization (WHO), has proven to be a highly effective intervention to prevent malaria. Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services, it is, therefore, necessary to seek a more coordinated and integrated approach to increasing the pace, coverage and resilience of SMC. Towards this end, fully leverage the resources of major players in the global fight against malaria, such as China could accelerate the SMC process in Africa. METHODS We searched PubMed, MEDLINE, Web of Science, and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC. We used gap analysis to investigate the challenges and gaps of SMC since COVID-19. Through the above methods to explore China's prospective contribution to SMC. RESULTS A total of 68 research articles and reports were found. Through gap analysis, we found that despite the delays in the SMC campaign, 11.8 million children received SMC in 2020. However, there remained some challenges: (1) a shortage of fully covered monthly courses; (2) lack of adherence to the second and third doses of amodiaquine; (3) four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer; (4) additional interventions are needed to consolidate SMC efforts. China was certified malaria-free by WHO in 2021, and its experience and expertise in malaria elimination can be shared with high-burden countries. With the potential to join the multilateral cooperation in SMC, including the supply of quality-assured health commodities, know-how transfer and experience sharing, China is expected to contribute to the ongoing scale-up of SMC. CONCLUSIONS A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run. More actions are entailed to promote the partnership and China can be one of the main contributors with various roles.
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Affiliation(s)
- Ming Xu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yun-Xuan Hu
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shen-Ning Lu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China
| | | | - Shu-Duo Zhou
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jian Yang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xiang-Ning Feng
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yang-Mu Huang
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Ying Chen
- Department of Global Health, School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
- Institute for Global Health and Development, Peking University, Beijing, China.
| | - Duo-Quan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China.
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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González-Sanz M, Berzosa P, Norman FF. Updates on Malaria Epidemiology and Prevention Strategies. Curr Infect Dis Rep 2023; 25:1-9. [PMID: 37361492 PMCID: PMC10248987 DOI: 10.1007/s11908-023-00805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The objective of this review was to provide an update on recent malaria epidemiology, both globally and in non-endemic areas, to identify the current distribution and repercussions of genetically diverse Plasmodium species and summarize recently implemented intervention and prevention tools. Recent Findings Notable changes in malaria epidemiology have occurred in recent years, with an increase in the number of total cases and deaths globally during 2020-2021, in part attributed to the COVID-19 pandemic. The emergence of artemisinin-resistant species in new areas and the expanding distribution of parasites harbouring deletions of the pfhrp2/3 genes have been concerning. New strategies to curb the burden of this infection, such as vaccination, have been implemented in certain endemic areas and their performance is currently being evaluated. Summary Inadequate control of malaria in endemic regions may have an effect on imported malaria and measures to prevent re-establishment of transmission in malaria-free areas are essential. Enhanced surveillance and investigation of Plasmodium spp. genetic variations will contribute to the successful diagnosis and treatment of malaria in future. Novel strategies for an integrated One Health approach to malaria control should also be strengthened.
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Affiliation(s)
- Marta González-Sanz
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre for Tropical Medicine, Carlos III Health Institute, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Francesca F. Norman
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
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Wedderburn CJ, Evans C, Slogrove AL, Rehman AM, Gibb DM, Prendergast AJ, Penazzato M. Co-trimoxazole prophylaxis for children who are HIV-exposed and uninfected: a systematic review. J Int AIDS Soc 2023; 26:e26079. [PMID: 37292018 PMCID: PMC10251133 DOI: 10.1002/jia2.26079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/08/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Co-trimoxazole prophylaxis is recommended for children born to women with HIV to protect those who acquire HIV from opportunistic infections, severe bacterial infections and malaria. With scale-up of maternal antiretroviral therapy, most children remain HIV-exposed uninfected (HEU) and the benefits of universal co-trimoxazole are uncertain. We assessed the effect of co-trimoxazole on mortality and morbidity of children who are HEU. METHODS We performed a systematic review (PROSPERO number: CRD42021215059). We systematically searched MEDLINE, Embase, Cochrane CENTRAL, Global Health, CINAHL Plus, Africa-Wide Information, SciELO and WHO Global Index Medicus for peer-reviewed articles from inception to 4th January 2022 without limits. Ongoing randomized controlled trials (RCTs) were identified through registries. We included RCTs reporting mortality or morbidity in children who are HEU receiving co-trimoxazole versus no prophylaxis/placebo. The risk of bias was assessed using the Cochrane 2.0 tool. Data were summarized using narrative synthesis and findings were stratified by malaria endemicity. RESULTS We screened 1257 records and included seven reports from four RCTs. Two trials from Botswana and South Africa of 4067 children who are HEU found no difference in mortality or infectious morbidity in children randomized to co-trimoxazole prophylaxis started at 2-6 weeks of age compared to those randomized to placebo or no treatment, although event rates were low. Sub-studies found that antimicrobial resistance was higher in infants receiving co-trimoxazole. Two trials in Uganda investigating prolonged co-trimoxazole after breastfeeding cessation showed protection against malaria but no other morbidity or mortality differences. All trials had some concerns or a high risk of bias, which limited the certainty of evidence. DISCUSSION Studies show no clinical benefit of co-trimoxazole prophylaxis in children who are HEU, except to prevent malaria. Potential harms were identified for co-trimoxazole prophylaxis leading to antimicrobial resistance. The trials in non-malarial regions were conducted in populations with low mortality potentially reducing generalizability to other settings. CONCLUSIONS In low-mortality settings with few HIV transmissions and well-performing early infant diagnosis and treatment programmes, universal co-trimoxazole may not be required.
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Affiliation(s)
- Catherine J. Wedderburn
- Department of Paediatrics and Child Health and Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Medical Research Council Clinical Trials Unit at University College LondonLondonUK
- Department of Clinical ResearchLondon School of Hygiene & Tropical MedicineLondonUK
| | - Ceri Evans
- Blizard InstituteQueen Mary University of LondonLondonUK
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
- Department of Clinical InfectionMicrobiology and ImmunologyUniversity of LiverpoolLiverpoolUK
| | - Amy L. Slogrove
- Department of Paediatrics and Child HealthFaculty of Medicine & Health SciencesStellenbosch UniversityWorcesterSouth Africa
| | - Andrea M. Rehman
- MRC International Statistics & Epidemiology GroupDepartment of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Diana M. Gibb
- Medical Research Council Clinical Trials Unit at University College LondonLondonUK
| | - Andrew J. Prendergast
- Blizard InstituteQueen Mary University of LondonLondonUK
- Zvitambo Institute for Maternal and Child Health ResearchHarareZimbabwe
| | - Martina Penazzato
- Department of Global HIVHepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
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Grant J, Diawara H, Traore S, Koita F, Myers J, Sagara I, Chandramohan D, Dicko A, Greenwood B, Webster J. Delivery strategies for malaria vaccination in areas with seasonal malaria transmission. BMJ Glob Health 2023; 8:e011838. [PMID: 37147016 PMCID: PMC10163455 DOI: 10.1136/bmjgh-2023-011838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Seasonal vaccination with the RTS,S/AS01E malaria vaccine given alongside seasonal malaria chemoprevention (SMC) substantially reduces malaria in young children. The WHO has recommended the use of RTS,S/AS01E, including seasonal vaccination, in areas with seasonal malaria transmission. This study aimed to identify potential strategies to deliver RTS,S/AS01E, and assess the considerations and recommendations for delivery of seasonal malaria vaccination in Mali, a country with highly seasonal malaria. METHODS Potential delivery strategies for RTS,S/AS01E in areas with seasonal malaria were identified through a series of high level discussions with the RTS,S/AS01E plus SMC trial investigators, international and national immunisation and malaria experts, and through the development of a theory of change. These were explored through qualitative in-depth interviews with 108 participants, including national-level, regional-level and district-level malaria and immunisation programme managers, health workers, caregivers of children under 5 years of age, and community stakeholders. A national-level workshop was held to confirm the qualitative findings and work towards consensus on an appropriate strategy. RESULTS Four delivery strategies were identified: age-based vaccination delivered via the Essential Programme on Immunisation (EPI); seasonal vaccination via EPI mass vaccination campaigns (MVCs); a combination of age-based priming vaccination doses delivered via the EPI clinics and seasonal booster doses delivered via MVCs; and a combination of age-based priming vaccination doses and seasonal booster doses, all delivered via the EPI clinics, which was the preferred strategy for delivery of RTS,S/AS01E in Mali identified during the national workshop. Participants recommended that supportive interventions, including communications and mobilisation, would be needed for this strategy to achieve required coverage. CONCLUSIONS Four delivery strategies were identified for administration of RTS,S/AS01E alongside SMC in countries with seasonal malaria transmission. Components of these delivery strategies were defined as the vaccination schedule, and the delivery system(s) plus the supportive interventions needed for the strategies to be effective. Further implementation research and evaluation is needed to explore how, where, when and what effective coverage is achievable via these new strategies and their supportive interventions.
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Affiliation(s)
- Jane Grant
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Halimatou Diawara
- Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Seydou Traore
- Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Fatoumata Koita
- Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Jessica Myers
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Issaka Sagara
- Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Alassane Dicko
- Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Runge M, Stahlfeld A, Ambrose M, Toh KB, Rahman S, Omoniwa OF, Bever CA, Oresanya O, Uhomoibhi P, Galatas B, Tibenderana JK, Gerardin J. Perennial malaria chemoprevention with and without malaria vaccination to reduce malaria burden in young children: a modelling analysis. Malar J 2023; 22:133. [PMID: 37095480 PMCID: PMC10124689 DOI: 10.1186/s12936-023-04564-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND A recent WHO recommendation for perennial malaria chemoprevention (PMC) encourages countries to adapt dose timing and number to local conditions. However, knowledge gaps on the epidemiological impact of PMC and possible combination with the malaria vaccine RTS,S hinder informed policy decisions in countries where malaria burden in young children remains high. METHODS The EMOD malaria model was used to predict the impact of PMC with and without RTS,S on clinical and severe malaria cases in children under the age of two years (U2). PMC and RTS,S effect sizes were fit to trial data. PMC was simulated with three to seven doses (PMC-3-7) before the age of eighteen months and RTS,S with three doses, shown to be effective at nine months. Simulations were run for transmission intensities of one to 128 infectious bites per person per year, corresponding to incidences of < 1 to 5500 cases per 1000 population U2. Intervention coverage was either set to 80% or based on 2018 household survey data for Southern Nigeria as a sample use case. The protective efficacy (PE) for clinical and severe cases in children U2 was calculated in comparison to no PMC and no RTS,S. RESULTS The projected impact of PMC or RTS,S was greater at moderate to high transmission than at low or very high transmission. Across the simulated transmission levels, PE estimates of PMC-3 at 80% coverage ranged from 5.7 to 8.8% for clinical, and from 6.1 to 13.6% for severe malaria (PE of RTS,S 10-32% and 24.6-27.5% for clinical and severe malaria, respectively. In children U2, PMC with seven doses nearly averted as many cases as RTS,S, while the combination of both was more impactful than either intervention alone. When operational coverage, as seen in Southern Nigeria, increased to a hypothetical target of 80%, cases were reduced beyond the relative increase in coverage. CONCLUSIONS PMC can substantially reduce clinical and severe cases in the first two years of life in areas with high malaria burden and perennial transmission. A better understanding of the malaria risk profile by age in early childhood and on feasible coverage by age, is needed for selecting an appropriate PMC schedule in a given setting.
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Affiliation(s)
- Manuela Runge
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Anne Stahlfeld
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Monique Ambrose
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, USA
| | - Kok Ben Toh
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
| | - Semiu Rahman
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Omowunmi F. Omoniwa
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Caitlin A. Bever
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, USA
| | - Olusola Oresanya
- Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT Nigeria
| | - Perpetua Uhomoibhi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Beatriz Galatas
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | - Jaline Gerardin
- Department of Preventive Medicine, Institute for Global Health, Northwestern University, Chicago, IL USA
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Topazian HM, Schmit N, Gerard-Ursin I, Charles GD, Thompson H, Ghani AC, Winskill P. Modelling the relative cost-effectiveness of the RTS,S/AS01 malaria vaccine compared to investment in vector control or chemoprophylaxis. Vaccine 2023; 41:3215-3223. [PMID: 37080831 DOI: 10.1016/j.vaccine.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and domestic malaria control programs will need to examine the relative cost-effectiveness of RTS,S and identify target areas for vaccine implementation relative to scale-up of existing interventions. METHODS Using an individual-based mathematical model of P. falciparum, we modelled the cost-effectiveness of RTS,S across a range of settings in sub-Saharan Africa, incorporating various rainfall patterns, insecticide-treated net (ITN) use, treatment coverage, and parasite prevalence bands. We compare age-based and seasonal RTS,S administration to increasing ITN usage, switching to next generation ITNs in settings experiencing insecticide-resistance, and introduction of seasonal malaria chemoprevention (SMC) in areas of seasonal transmission. RESULTS For RTS,S to be the most cost-effective intervention option considered, the maximum cost per dose was less than $9.30 USD in 90.9% of scenarios. Nearly all (89.8%) values at or above $9.30 USD per dose were in settings with 60% established bed net use and / or with established SMC, and 76.3% were in the highest PfPR2-10 band modelled (40%). Addition of RTS,S to strategies involving 60% ITN use, increased ITN usage or a switch to PBO nets, and SMC, if eligible, still led to significant marginal case reductions, with a median of 2,653 (IQR: 1,741 to 3,966) cases averted per 100,000 people annually, and 82,270 (IQR: 54,034 to 123,105) cases averted per 100,000 fully vaccinated children (receiving at least three doses). CONCLUSIONS Use of RTS,S results in reductions in malaria cases and deaths even when layered upon existing interventions. When comparing relative cost-effectiveness, scale up of ITNs, introduction of SMC, and switching to new technology nets should be prioritized in eligible settings.
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Affiliation(s)
- Hillary M Topazian
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Nora Schmit
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Ines Gerard-Ursin
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Giovanni D Charles
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Hayley Thompson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
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50
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Gill R, Hora R, Alam MM, Bansal A, Bhatt TK, Sharma A. Editorial: Frontiers in malaria research. Front Microbiol 2023; 14:1191773. [PMID: 37077247 PMCID: PMC10109456 DOI: 10.3389/fmicb.2023.1191773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Ritu Gill
- Molecular Parasitology Lab, Centre for Biotechnology, MD University, Rohtak, India
- *Correspondence: Ritu Gill ;
| | - Rachna Hora
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Mahmood M. Alam
- School of Infection & Immunity, University Avenue, University of Glasgow, Glasgow, United Kingdom
| | - Abhisheka Bansal
- Molecular Parasitology Lab, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Tarun Kumar Bhatt
- Department of Biotechnology, Central University of Rajasthan, Bandarsindri, Ajmer, India
| | - Ashwani Sharma
- Laboratory of Biomolecular Research, Paul Scherrer Institute, Villigen, Switzerland
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