Simulated impact of RTS,S/AS01 vaccination programs in the context of changing malaria transmission.
Simulated impact of RTS,S/AS01 vaccination programs in the context of changing malaria transmission.
复制标题
DOI：
10.1371/journal.pone.0032587
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Smith TA
中科院分区：
文献类型：
--
作者：
Brooks A;Briët OJ;Hardy D;Steketee R;Smith TA
RTS，S/AS01红细胞前疟疾疫苗正在进行III期临床试验。如果试验取得成功，预测在何处以及如何实施是至关重要的。由于疟疾传播水平的变化，这种规划可能会变得复杂。使用基于II期试验结果的疫苗概况，并假设保护作用衰减缓慢，计算机模拟用于检查RTS，S/AS01的影响。模拟的环境中，基线传播（在没有疫苗的情况下）是固定的，或者在十年期间每人每年2至20次传染性蚊子叮咬之间变化。研究了四种交付策略：常规婴儿免疫接种（EPI）、EPI加婴儿追赶、EPI加学校免疫运动、EPI加群众免疫运动。改变传输设置的影响与固定设置的影响相似。假设接种疫苗的效果持续存在，在接种2 ibpa疫苗时，通过大规模接种运动每1000剂疫苗可避免约5-7人死亡，但在传播水平较高的情况下，效益较低。扩大免疫、追赶和学校战略在每1000剂中避免了2 - 3例死亡。在传播正在减少或增加的环境中，扩大免疫、追赶和以学校为基础的战略每1000剂可避免约3-4人死亡。在传播发生变化的情况下，考虑在一系列初始传播水平上模拟红细胞前疫苗的影响似乎就足够了。在20 ibpa时，大规模运动避免了大多数死亡并减少了传播，但这需要进一步研究。如果通过扩大免疫方案提供，RTS、S/AS01可在所有检查环境中每1000名疫苗接种者中避免约6-11人死亡，与非洲婴儿肺炎球菌结合疫苗的估计相似。这些结果支持通过EPI实施RTS，S/AS01，例如与病媒控制干预措施一起实施，提供III期试验支持我们关于功效的假设。
The RTS,S/AS01 pre-erythrocytic malaria vaccine is in phase III clinical trials. It is critical to anticipate where and how it should be implemented if trials are successful. Such planning may be complicated by changing levels of malaria transmission. Computer simulations were used to examine RTS,S/AS01 impact, using a vaccine profile based on phase II trial results, and assuming that protection decays only slowly. Settings were simulated in which baseline transmission (in the absence of vaccine) was fixed or varied between 2 and 20 infectious mosquito bites per person per annum (ibpa) over ten years. Four delivery strategies were studied: routine infant immunization (EPI), EPI plus infant catch-up, EPI plus school-based campaigns, and EPI plus mass campaigns. Impacts in changing transmission settings were similar to those in fixed settings. Assuming a persistent effect of vaccination, at 2 ibpa, the vaccine averted approximately 5–7 deaths per 1000 doses of vaccine when delivered via mass campaigns, but the benefit was less at higher transmission levels. EPI, catch-up and school-based strategies averted 2–3 deaths per 1000 doses in settings with 2 ibpa. In settings where transmission was decreasing or increasing, EPI, catch-up and school-based strategies averted approximately 3–4 deaths per 1000 doses. Where transmission is changing, it appears to be sufficient to consider simulations of pre-erythrocytic vaccine impact at a range of initial transmission levels. At 2 ibpa, mass campaigns averted the most deaths and reduced transmission, but this requires further study. If delivered via EPI, RTS,S/AS01 could avert approximately 6–11 deaths per 1000 vaccinees in all examined settings, similar to estimates for pneumococcal conjugate vaccine in African infants. These results support RTS,S/AS01 implementation via EPI, for example alongside vector control interventions, providing that the phase III trials provide support for our assumptions about efficacy.
登录
查看更多内容
影响因子：
15.8
作者：
Griffin, Jamie T.;Hollingsworth, T. Deirdre;Ghani, Azra C.
通讯作者：
Ghani, Azra C.
影响因子：
3.7
作者：
Ceesay, Serign J.;Casals-Pascual, Climent;Conway, David J.
通讯作者：
Conway, David J.
影响因子：
168.9
作者：
Cutts, FT;Zaman, SMA;Adegbola, RA
通讯作者：
Adegbola, RA
DOI：
10.4269/ajtmh.2006.75.19
发表时间：
2006-08-01
影响因子：
3.3
作者：
Maire, Nicolas;Smith, Thomas;Molineaux, Louis
通讯作者：
Molineaux, Louis
影响因子：
3.7
作者：
Owusu-Agyei, Seth;Ansong, Daniel;Evans, Jennifer
通讯作者：
Evans, Jennifer