ArticleMalaria journal2026
Timing of the fourth dose of RTS,S/AS01 malaria vaccine in perennial settings: a modelling study.
Article in Malaria journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundThe recommendation of the RTS,S/AS01 malaria vaccine for use in children in moderate to high transmission areas by the WHO in 2021 provided another crucial tool in reducing malaria morbidity and mortality. As countries introduce the RTS,S/AS01 vaccine, there is an interest in exploring vaccination schedules that align with existing routine health touchpoints and to optimize vaccine coverage.
methodsThis study used OpenMalaria, an individual-based, stochastic model of malaria transmission and disease progression, to assess the impact of different vaccination timing schedules and coverage on uncomplicated malaria cases, severe malaria cases, and malaria-related deaths across different archetypal transmission settings. We ran simulations comparing fourth dose protection against infection and timings at 6-, 9-, 12-, 15- and 18-month intervals following the primary series, including exploring ranges of plausible protection assumptions for many of the dose timings.
resultsThe primary series substantially reduces the malaria burden across transmission settings, regardless of timing of the fourth vaccine dose. For example, at a baseline Plasmodium falciparum prevalence in 2-10 year olds (PfPR
conclusionsA fourth dose delivered between 15- and 21-months of age (corresponding to a 6-12 month interval after the third dose) with high population coverage will likely avert the largest proportion of cases of uncomplicated malaria, severe malaria, and deaths in perennial settings, across transmission intensities. Therefore, the delivery of the fourth dose of the RTS,S/AS01 vaccine can be tailored to country-specific context and linked to existing health touchpoints to ensure adequate coverage of this dose to optimize its impact.
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