Public health impact of current and proposed age-expanded perennial malaria chemoprevention: a modelling study

medRxiv - Public and Global Health Pub Date : 2024-08-02 DOI:10.1101/2024.07.31.24311277

Swapnoleena Sen, Braunack-Mayer Lydia, Kelly L. Sherrie, Thiery Masserey, Josephine Malinga, Joerg J. Moehrle, Melissa A. Penny

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Abstract

In 2022, the World Health Organization extended their guidelines for perennial malaria chemoprevention (PMC) from infants to children up to 24 months old. However, evidence for PMC's public health impact is primarily limited to children under 15 months. Further research is needed to assess the public health impact and cost-effectiveness of PMC, and the added benefit of further age-expansion. We integrated an individual-based model of malaria with pharmacological models of drug action to address these questions for PMC and a proposed age-expanded schedule (PMC+, for children 03-36 months). Across prevalence settings of 5-70% and different drug sensitivity assumptions, we predicted PMC and PMC+'s median efficacy of 18.6%(12.2-25.0%) and 21.9%(14.3-29.5%) against clinical disease and 9.0%(2.0-16.0%) and 10.8%(3.2-18.4%) against severe malaria, respectively, in children under three years. PMC's total impact outweighed risk of delayed malaria in children up to age five and remained cost-effective when delivered through the Expanded Program on Immunization.

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当前和拟议的扩大年龄常年疟疾化学预防的公共卫生影响：模型研究

2022 年，世界卫生组织将常年疟疾化学预防（PMC）指南的适用范围从婴儿扩大到 24 个月以下的儿童。然而，有关常年疟疾化学预防对公共卫生影响的证据主要局限于 15 个月以下的儿童。我们需要开展进一步的研究，以评估常年疟疾化学预防对公共卫生的影响和成本效益，以及进一步扩大年龄的额外益处。我们将基于个体的疟疾模型与药物作用的药理学模型相结合，以解决 PMC 和拟议的年龄扩展计划（PMC+，针对 03-36 个月的儿童）的这些问题。在疟疾流行率为 5-70% 的情况下，根据不同的药物敏感性假设，我们预测 PMC 和 PMC+ 对三岁以下儿童临床疾病的疗效中位数分别为 18.6%（12.2-25.0%）和 21.9%（14.3-29.5%），对重症疟疾的疗效中位数分别为 9.0%（2.0-16.0%）和 10.8%（3.2-18.4%）。在五岁以下儿童中，PMC的总体影响超过了延迟疟疾的风险，并且在通过扩大免疫计划提供时仍具有成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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medRxiv - Public and Global Health

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