Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Malaria Research and Training Center (MRTC), Universite des Sciences des Techniques et des Technologies de Bamako, Bamako, Mali.
BMJ Glob Health. 2023 May;8(5). doi: 10.1136/bmjgh-2023-011838.
Seasonal vaccination with the RTS,S/AS01 malaria vaccine given alongside seasonal malaria chemoprevention (SMC) substantially reduces malaria in young children. The WHO has recommended the use of RTS,S/AS01, including seasonal vaccination, in areas with seasonal malaria transmission. This study aimed to identify potential strategies to deliver RTS,S/AS01, and assess the considerations and recommendations for delivery of seasonal malaria vaccination in Mali, a country with highly seasonal malaria.
Potential delivery strategies for RTS,S/AS01 in areas with seasonal malaria were identified through a series of high level discussions with the RTS,S/AS01 plus SMC trial investigators, international and national immunisation and malaria experts, and through the development of a theory of change. These were explored through qualitative in-depth interviews with 108 participants, including national-level, regional-level and district-level malaria and immunisation programme managers, health workers, caregivers of children under 5 years of age, and community stakeholders. A national-level workshop was held to confirm the qualitative findings and work towards consensus on an appropriate strategy.
Four delivery strategies were identified: age-based vaccination delivered via the Essential Programme on Immunisation (EPI); seasonal vaccination via EPI mass vaccination campaigns (MVCs); a combination of age-based priming vaccination doses delivered via the EPI clinics and seasonal booster doses delivered via MVCs; and a combination of age-based priming vaccination doses and seasonal booster doses, all delivered via the EPI clinics, which was the preferred strategy for delivery of RTS,S/AS01 in Mali identified during the national workshop. Participants recommended that supportive interventions, including communications and mobilisation, would be needed for this strategy to achieve required coverage.
Four delivery strategies were identified for administration of RTS,S/AS01 alongside SMC in countries with seasonal malaria transmission. Components of these delivery strategies were defined as the vaccination schedule, and the delivery system(s) plus the supportive interventions needed for the strategies to be effective. Further implementation research and evaluation is needed to explore how, where, when and what effective coverage is achievable via these new strategies and their supportive interventions.
在季节性疟疾传播地区，与季节性疟疾化学预防（SMC）联合使用 RTS,S/AS01 疟疾疫苗进行季节性接种，可显著降低儿童疟疾发病率。世界卫生组织（WHO）建议在季节性疟疾传播地区使用 RTS,S/AS01，包括季节性接种。本研究旨在确定在疟疾高度季节性流行的马里提供 RTS,S/AS01 的潜在策略，并评估在马里提供季节性疟疾疫苗接种的考虑因素和建议。
通过与 RTS,S/AS01+SMC 试验研究人员、国际和国家免疫与疟疾专家进行一系列高级别讨论，并通过制定变革理论，确定了季节性疟疾地区 RTS,S/AS01 的潜在提供策略。通过对 108 名参与者进行深入的定性访谈，包括国家、地区和地区级疟疾和免疫规划管理人员、卫生工作者、5 岁以下儿童的照顾者和社区利益攸关方，探讨了这些策略。举办了一次国家级研讨会，以确认定性研究结果，并就适当策略达成共识。
确定了四种提供策略：通过免疫规划基本方案（EPI）进行基于年龄的接种；通过 EPI 大规模疫苗接种运动（MVC）进行季节性接种；EPI 诊所提供基于年龄的初级免疫接种剂量和 MVC 提供季节性加强剂量的组合；EPI 诊所提供基于年龄的初级免疫接种剂量和季节性加强剂量的组合，这是在国家研讨会期间确定的马里 RTS,S/AS01 接种的首选策略。参与者建议，为了实现所需的覆盖率，需要提供支持性干预措施，包括沟通和动员。
在季节性疟疾传播地区，与 SMC 联合使用 RTS,S/AS01 时，确定了四种提供策略。这些提供策略的组成部分被定义为疫苗接种时间表以及实现策略有效的接种系统（多个）和支持性干预措施。需要进一步开展实施研究和评估，以探讨通过这些新策略及其支持性干预措施，如何、何地、何时以及如何实现有效的覆盖率。
