PREDICTIONS OF THE EPIDEMIOLOGIC IMPACT OF INTRODUCING A PRE-ERYTHROCYTIC VACCINE INTO THE EXPANDED PROGRAM ON IMMUNIZATION IN SUB-SAHARAN AFRICA

NICOLAS MAIRE Swiss Tropical Institute, Basel, Switzerland

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FABRIZIO TEDIOSI Swiss Tropical Institute, Basel, Switzerland

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AMANDA ROSS Swiss Tropical Institute, Basel, Switzerland

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THOMAS SMITH Swiss Tropical Institute, Basel, Switzerland

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We predict the effects of introduction of a pre-erythrocytic vaccine against Plasmodium falciparum into a malaria-endemic population in Africa. We use a stochastic simulation model that includes components of transmission, parasitology, and clinical epidemiology of malaria and was validated using the results of field trials of the RTS,S/AS02A vaccine. The results suggest that vaccines with efficacy similar to that of RTS,S/AS02A have a substantial impact on malaria morbidity and mortality during the first decade after their introduction, but have negligible effects on malaria transmission at levels of endemicity typical for sub-Saharan Africa. The main benefits result from prevention of morbidity and mortality in the first years of life. Vaccines with very short half-life or low efficacy may have little overall effect on incidence of severe malaria. A similar approach can be used to make predictions for other strategies for deployment of the vaccine and to other types of malaria vaccines and interventions.

Author Notes

Reprint requests: Thomas Smith, Swiss Tropical Institute, PO Box, CH-4002, Basel, Switzerland.
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