Seasonal vaccination against malaria: a potential use for an imperfect malaria vaccine.
Seasonal vaccination against malaria: a potential use for an imperfect malaria vaccine.
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DOI：
10.1186/s12936-017-1841-9
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发表时间：
2017-05-02
期刊：
影响因子：
3
通讯作者：
Chandramohan D
中科院分区：
文献类型：
--
作者：
Greenwood B;Dicko A;Sagara I;Zongo I;Tinto H;Cairns M;Kuepfer I;Milligan P;Ouedraogo JB;Doumbo O;Chandramohan D
在非洲萨赫勒和萨赫勒以南的许多地区，疟疾仍然是死亡和发病的主要原因，感染的传播具有很强的季节性。季节性疟疾化学预防(SMC)包括在疟疾高发季节每月对幼儿进行一次全程疟疾治疗，事实证明这是这些地区有效的疟疾控制措施。然而，SMC并不提供完全的保护，它要求同时为家庭和医疗保健提供者提供保护。此外，今后有可能出现对目前用于SMC的磺胺多辛-乙胺和阿莫地喹的抗药性。在过去十年中，疟疾疫苗的开发取得了实质性进展，一种名为S/AS01的疟疾疫苗得到了欧洲药品管理局的积极评价，不久将在撒哈拉以南非洲的大规模试点实施项目中部署。这种疫苗的一个特点是，它们在接种疫苗后立即提供高水平的效力，但这种效力迅速减弱，这可能是因为在以前接触疟疾感染的受试者中，很难形成对疟疾抗原的有效免疫记忆。使用初始效力高但保护期短的疟疾疫苗的一个潜在有效方法是在疟疾传播季节前不久开展年度大规模疫苗接种活动，这些地区的疟疾传播主要限于一年中的几个月。
In many parts of the African Sahel and sub-Sahel, where malaria remains a major cause of mortality and morbidity, transmission of the infection is highly seasonal. Seasonal malaria chemoprevention (SMC), which involves administration of a full course of malaria treatment to young children at monthly intervals during the high transmission season, is proving to be an effective malaria control measure in these areas. However, SMC does not provide complete protection and it is demanding to deliver for both families and healthcare givers. Furthermore, there is a risk of the emergence in the future of resistance to the drugs, sulfadoxine–pyrimethamine and amodiaquine, that are currently being used for SMC. Substantial progress has been made in the development of malaria vaccines during the past decade and one malaria vaccine, RTS,S/AS01, has received a positive opinion from the European Medicines Authority and will soon be deployed in large-scale, pilot implementation projects in sub-Saharan Africa. A characteristic feature of this vaccine, and potentially of some of the other malaria vaccines under development, is that they provide a high level of efficacy during the period immediately after vaccination, but that this wanes rapidly, perhaps because it is difficult to develop effective immunological memory to malaria antigens in subjects exposed previously to malaria infection. A potentially effective way of using malaria vaccines with high initial efficacy but which provide only a short period of protection could be annual, mass vaccination campaigns shortly before each malaria transmission season in areas where malaria transmission is confined largely to a few months of the year.