Combination treatment reduces malaria by 70% among African children – Study
This was published in a new study in the New England Journal of Medicine.
It said that giving young children the world’s first malaria vaccine and antimalarial drugs before the rainy season could substantially reduce cases of the life-threatening disease in the Sahel region, where the randomised trial took place.
It was coordinated by the London School of Hygiene and Tropical Medicine (LSHTM) with partners Institut de Recherche en Sciences de la Santé (IRSS) in Burkina Faso and the Malaria Research and Training Centre (MRTC) at the University of Science, Technology and Techniques in Mali.
The researchers followed nearly 6,000 children aged between five and 17 months in Burkina Faso and Mali, two countries with a very high rate of malaria.
After three years, the combination of Seasonal Malaria Chemoprevention (SMC) and vaccination lowered clinical cases of malaria, hospital admissions with World Health Organisation (WHO)-defined severe malaria, and deaths from malaria by about 70 per cent compared to SMC use alone, which is currently the case in both countries, according to the study.
The researchers said the new combination had the potential to prevent malaria in large parts of Africa where cases of the disease remain high and where malaria is transmitted seasonally.
Seasonal vaccination with the new antimalarial drug was also found to be as effective as four annual courses of SMC in protecting against clinical malaria.
After nearly two decades of progress, the decline in malaria cases and deaths has stalled in recent years in a number of countries, according to the WHO.
Its 2020 World Malaria Report said there were 229 million malaria cases and an estimated 409,000 malaria deaths in 2019, with most occurring in children under five years old.
Professor Jean-Bosco Ouedraogo of the IRSS said: “I am really proud of the contribution of our African research teams to these fantastic results.
“I hope that this evidence will be taken into account by decision-makers as a new additional strategy for saving children’s lives in Africa.
“A collaboration among malaria endemic countries and with northern partners is essential to succeeding against malaria, including in the Sahel countries.”
Prof Alassane Dicko of the MRTC said: “Our results showed that seasonal vaccination with RTS,S/AS01E [the new malaria vaccine] is as effective as seasonal malaria chemoprevention.
“This new malaria tackling tool could mean the disease is no longer the primary cause of death or hospital admissions in our settings for the very first time.
“We look forward to a quick policy decision and addition of this new tool to reduce the intolerable burden of malaria in our region.”
Prof Brian Greenwood from the LSHTM said: “The world has made great strides in tackling malaria but the pace of progress has slowed considerably in recent years.
“We urgently need new interventions, particularly in many parts of the Sahel and sub-Sahel where the burden of malaria remains very high.”
He said that the aim was to find out whether the new malaria vaccine could be more effective in areas with seasonal transmission by giving children three doses of the vaccine before the malaria transmission season, and then a booster dose before the rainy season over subsequent years.
“The results are very striking and could pave the way for a potential new approach to malaria control,” Prof. Greenwood added.
In 2018, the WHO and RBM Partnership to End Malaria joined with countries to launch a “High burden – High impact” programme focusing on the countries where malaria remains high and where new approaches to its control are needed.
Six of the 10 African countries in this programme are in the African Sahel and sub-Sahel, including Burkina Faso and Mali.
In these countries, malaria occurs predominantly during just a few months of the year.
SMC, which involves giving anti-malarial drugs to young children every month during the rainy season, is highly effective in preventing malaria, the study found.
Despite this, malaria is still the main cause of death and hospital admissions among the more than 20 million children under the age of five in most areas where SMC is deployed.
Prof Daniel Chandramohan from the LSHTM noted: “Further research is now needed to examine how seasonal malaria vaccination could be delivered most effectively at scale.”
In welcoming the new malaria vaccine, Dr Pedro Alonso, Director of the WHO Global Malaria Programme, said it had already reached more than 740,000 children through routine childhood vaccination in Ghana, Kenya and Malawi in a landmark pilot programme through which more than 2.1 million malaria vaccine doses had been delivered.
“The level of vaccine uptake by families over a relatively short period shows strong community demand for the vaccine and the capacity of childhood vaccination programmes to deliver it.”
The researchers acknowledge that there are limitations of the study, including that both antimalarials and the vaccine were given under trial conditions, thus achieving very high levels of coverage.