■最近在灭蚊和抗疟治疗方面取得的进展仅在一定程度上降低了疟疾负担。有效的疟疾疫苗仍然是当务之急,但是它的发展有几个挑战。在许多潜在的候选人中,RTS,S/AS01疫苗(MosquirixTM)仍然是主要候选疫苗。
■这篇综述旨在了解RTS的进展,S/AS01疫苗,以及未来关于疫苗在根除疟疾方面的有效性的评论。过去五十年的文献综述是搜索PubMed,EmbaseOvid,和Cochrane图书馆,使用以下搜索项目:(\"疟疾\"或\"世卫组织疟疾\"或\"恶性疟原虫\"或\"RTS,S\"或\"RTS,S/AS01“或”RTS,S/AS02\"或\"红细胞前疟疾\"或\"环子孢子\"或\"Mosquirix\")和(\"疫苗\"或\"疫苗接种\")。
■RTS,S/AS01,一种含有恶性疟原虫表面蛋白(环子孢子)抗原的重组前红细胞疫苗,是安全的,耐受性良好,和免疫原性的儿童。三次剂量,连同助推器,在48个月的随访中,儿童(5-17个月)对临床疟疾的疗效中等,约为36%,婴儿(6-12周)约为26%。然而,在人群亚组之间和寄生虫菌株之间的功效不同,它减少了没有助推器,并提供了一个有限的持续时间的保护。由于其潜在的成本效益和积极的公共卫生效应,该疫苗正在一项针对死亡率获益和更广泛部署的试点计划中进行研究。
■RTS,S/AS01疫苗可预防疟疾;然而,它应该被认为是疟疾控制计划的另一个补充,而不是作为根除工具,因为它的功效相对较低至中等。
BACKGROUND: Recent advances in mosquito eradication and antimalarial treatments have reduced the malaria burden only modestly. An effective malaria vaccine remains a high priority, but its development has several challenges. Among many potential candidates, the RTS,S/AS01 vaccine (MosquirixTM) remains the leading candidate.
OBJECTIVE: This review aims to understand the advances in the RTS,S/AS01 vaccine, and future comments regarding the vaccine\'s effectiveness in malaria eradication. Literature review for the past five decades was performed searching PubMed, EMBASE Ovid, and Cochrane Library, with using the following search items: (\"malaria\" OR \"WHO\'s malaria\" OR \"Plasmodium falciparum\" OR \"RTS,S\" OR \"RTS,S/AS01\" OR \"RTS,S/AS02\" OR \"pre-erythrocytic malaria\" OR \"
circumsporozoite\" OR \"Mosquirix\") AND (\"vaccine\" OR \"vaccination\").
RESULTS: RTS,S/AS01, a recombinant pre-erythrocytic vaccine containing Plasmodium falciparum surface-protein (
circumsporozoite) antigen, is safe, well-tolerated, and immunogenic in children. Three doses, along with a booster, have a modest efficacy of about 36% in children (age 5-17 months) and about 26% in infants (age 6-12 weeks) against clinical malaria during a 48-month follow-up. However, the efficacy varies among population subgroups and with the parasite strain, it reduces without a booster and offers protection for a limited duration. Because of its potential cost-effectiveness and positive public health effect, the vaccine is being investigated in a pilot program for mortality benefits and broader deployment.
CONCLUSIONS: The RTS,S/AS01 vaccine prevents malaria; however, it should be considered another addition to the malaria-control program and not as an eradication tool because of its relatively low to modest efficacy.