季节性 RTS,S/AS01 疫苗接种加季节性疟疾化学预防对布基纳法索和马里儿童营养状况的影响。

Impact of seasonal RTS,S/AS01 vaccination plus seasonal malaria chemoprevention on the nutritional status of children in Burkina Faso and Mali.

机构信息

London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.

Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali.

出版信息

Malar J. 2022 Feb 22;21(1):59. doi: 10.1186/s12936-022-04077-x.

DOI:10.1186/s12936-022-04077-x

PMID:35193608

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8864823/

Abstract

BACKGROUND

A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01 malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition.

METHODS

In Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01 alone, or SMC combined with RTS,S/AS01 for three malaria transmission seasons (2017-2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below - 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression.

RESULTS

In 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01 alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older.

CONCLUSIONS

Despite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas.

TRIAL REGISTRATION

https://www.clinicaltrials.gov/ct2/show/NCT03143218 , registered 8th May 2017.

摘要

背景

最近在布基纳法索和马里进行的一项试验表明，与单独使用季节性 RTS,S/AS01 疟疾疫苗或季节性疟疾化学预防（SMC）相比，将季节性 RTS,S/AS01 疟疾疫苗与季节性疟疾化学预防联合使用可显著降低幼儿的无并发症和严重疟疾发病率。鉴于疟疾可能对营养产生负面影响，该研究调查了这些儿童是否也经历了较低的急性和慢性营养不良患病率。

方法

在布基纳法索和马里，5920 名儿童被随机分配接受 SMC 单独治疗、RTS,S/AS01 单独治疗或 SMC 联合 RTS,S/AS01 治疗三个疟疾传播季节（2017-2019 年）。在每个传播季节后，对所有研究儿童进行横断面调查，收集人体测量学测量值，并用于得出营养状况指标，包括体重不足和发育迟缓的二进制变量（体重与身高比和身高与年龄比的 z 分数分别低于-2）。通过泊松和线性回归比较治疗组之间的二项式和连续结果。

结果

2017 年，与 SMC 单独治疗相比，联合干预措施使体重不足的发生率降低了约 12%[患病率比（PR）= 0.88（95%CI 0.75, 1.03)]，2018 年降低了约 21%[PR = 0.79（95%CI 0.62, 1.01)]。与 RTS,S/AS01 比较的点估计值相似，但差异更明显。2017 年和 2018 年，与其他两组相比，联合组严重体重不足的发生率至少降低了 30%。2019 年，三组之间中度或重度体重不足的发生率没有差异。在三年中的任何一年，各组之间的发育迟缓、低 MUAC 年龄或体重不足的患病率均无差异。2018 年，与其他两组相比，联合组严重发育迟缓的发生率更高，2017 年与 RTS,S/AS01 单独治疗相比，这一观察结果没有明显的解释，可能只是偶然发现。总体而言，该队列中营养不良非常普遍，但随着儿童年龄的增长，研究期间营养不良的情况有所下降。