ArticleTropical medicine and health2026
Accessibility, safety, and early effect of the malaria vaccine in routine immunisation practice among children under 36 months in the Soa Health District, Cameroon.
Article in Tropical medicine and health, 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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Abstract
backgroundMalaria remains a leading cause of child mortality in sub-Saharan Africa. Cameroon introduced the RTS,S/AS01 malaria vaccine in 2024, but real-world evidence on its early effects, coverage, and safety remains limited. This study evaluated these parameters among children under 36 months in the high-transmission Soa Health District.
methodsA community-based analytical cross-sectional study was conducted from February to May 2025. Households were selected by stratified cluster sampling (62 clusters, 622 participants). Children aged < 36 months who had resided in the district for ≥ 3 months were eligible. Vaccination status and malaria episodes (confirmed by rapid diagnostic test or microscopy) during the preceding six months were abstracted from cards. Primary exposure was ≥ 2 doses of RTS,S/AS01; primary outcome was documented malaria episodes. Multivariable modified Poisson regression with robust standard errors was used to estimate risk ratios (RR) adjusted for age, breastfeeding, insecticide-treated net (ITN) use, and intermittent preventive treatment in infancy (IPTi). The effect of the vaccine was measured as (1-adjusted RR) × 100. Coverage and adverse events were also assessed.
resultsAmong 622 children (mean age 17.9 months, 51.4% female), documented coverage of dose 1 was 56·8% (95% CI 53.5-61.7), dropping to 46·6% for dose 2 and 39·0% for dose 3. Perceived free access (aRR 1.97, 95% CI 1.47-2.64) and knowledge of a nearby vaccination facility (aRR 1.86, 95% CI 1.41-2.45) were strongly associated with uptake. In the cross-sectional analysis, children who received ≥ 2 doses were associated with a 50% lower occurrence of malaria episodes (aRR 0.50, 95% CI 0.34-0.73, p = 0.001) compared with those receiving ≤ 1 dose. Minor adverse events occurred in 27% (fever 93%, injection site swelling 10%).
conclusionsIn this high-burden Cameroonian setting, two or more doses of RTS,S/AS01 were associated with a lower occurrence of malaria episodes favourable safety profile. Coverage remains suboptimal, and dropout is high. Ensuring free access and strengthening community awareness are critical for maximising vaccine uptake.
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