Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Malar J. 2023 Sep 19;22(1):278. doi: 10.1186/s12936-023-04714-z.
After a period of unprecedented progress against malaria in the 2000s, halving the global disease burden by 2015, gains overall in sub-Saharan Africa have slowed and even reversed in some places, beginning well before the COVID-19 pandemic. The highly effective drugs, treated nets, and diagnostics that fueled the initial progress all face some threats to their effectiveness, and global funding to maintain and increase their use over the long term is not guaranteed. Malaria vaccines are among the most promising new interventions that could accelerate the elimination of malaria. Vaccines are still in early stages of rollout in children, the age group (along with pregnant women) that has been the focus of malaria strategies for a century. At the same time, over the past decade, a case has been made, based largely on evidence from verbal autopsies in at least a few high-transmission areas, that the malaria death rate among adults has been greatly underestimated. Could vaccinating adults help to bring down the adult malaria mortality rate, contribute to reduced transmission, or both? A randomized trial of a malaria vaccine is proposed in Sierra Leone, a highly endemic setting, to shed light on this proposition.
在 21 世纪，疟疾防治取得了前所未有的进展，到 2015 年将全球疾病负担减少了一半。然而，整个撒哈拉以南非洲地区的进展总体上已经放缓，甚至在 COVID-19 大流行之前就在一些地方出现了逆转。推动最初进展的高效药物、驱虫蚊帐和诊断方法都面临着有效性的一些威胁，而确保长期维持和增加其使用的全球资金也没有得到保证。疟疾疫苗是最有前途的新干预措施之一，它可以加速消除疟疾。疫苗在儿童中仍处于早期推广阶段，儿童（以及孕妇）是一个世纪以来疟疾防控工作的重点关注群体。与此同时，在过去十年中，基于至少在一些高传播地区的口头尸检证据，人们提出了一个观点，即成年人的疟疾死亡率被大大低估了。接种疫苗能否帮助降低成年人的疟疾死亡率，有助于减少传播，或者两者兼而有之？在塞拉利昂这个高度流行地区，正在提出一项疟疾疫苗的随机试验，以探讨这一观点。
