{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:56:39Z","timestamp":1787021799978,"version":"build-2736575974"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV047-048"],"award-info":[{"award-number":["INV047-048"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    Malaria constitutes a major public health burden in sub-Saharan Africa. It remains a key health concern and the leading cause of death in children under five in Benin. Since October 2021, the World Health Organization has recommended the use of malaria vaccines for the prevention of\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    malaria in children living in malaria endemic areas, prioritizing areas of moderate and high transmission in sub-Saharan Africa. However, with the exception of Ghana, there is a scarcity of studies modelling the potential impact of the RTS,S\/AS01 vaccine in the context of West Africa. A compartmental mathematical model was developed to estimate clinical and severe malaria cases averted in children under five with the primary series of the RTS,S\/AS01 malaria vaccine in Benin. Over a period of 10 years, scenarios involving vaccine introduction at different coverage levels alongside the use of long-lasting insecticidal nets were modelled to assess the impact of the RTS,S\/AS01 vaccine on malaria transmission. The combination of childhood malaria vaccination at a coverage similar to that of the third dose of diphtheria, tetanus, and pertussis (DTP3) vaccine, along with the current use of nets, is projected to result in a 40% reduction in malaria clinical cases and deaths among children under five years old, compared to using nets alone, from 2025 to 2034. However, if the introduction of a malaria vaccine has the unintended consequence of decreased net use, cumulative benefits may be offset. A 1.5-fold decrease in the use of nets is projected to result in an increase in malaria burden. This modelling exercise concludes that childhood vaccination is expected to avert clinical and severe cases of malaria and is an additional tool to advance malaria control efforts in Benin but potential unintended consequences of a reduction in net usage may reduce these gains.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0005543","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:11:30Z","timestamp":1778281890000},"page":"e0005543","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Estimating the impact of the RTS,S\/AS01 malaria vaccine in Benin: A mathematical modelling study"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7432-6359","authenticated-orcid":true,"given":"Sena V.","family":"Alohoutade","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Hounsell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Codjo","family":"Dandonougbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rock","family":"Aikpon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jules","family":"Degila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheetal","family":"Silal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"pgph.0005543.ref001","volume-title":"World malaria report 2024","author":"World Health Organization"},{"key":"pgph.0005543.ref002","unstructured":"World Health Organization. World malaria report. 2022. https:\/\/www.who.int\/teams\/global-malaria-programme\/reports\/world-malaria-report-2022"},{"key":"pgph.0005543.ref003","volume-title":"Benin Malaria Operational Plan FY 2023","author":"U.S. President\u2019s Malaria Initiative","year":"2023"},{"key":"pgph.0005543.ref004","volume-title":"Free and open access to global development data","author":"The World Bank Data"},{"key":"pgph.0005543.ref005","volume-title":"WHO policy recommendation: seasonal malaria chemoprevention (SMC) for plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa","author":"World Health Organization","year":"2012"},{"key":"pgph.0005543.ref006","unstructured":"World Health Organization. Malaria vaccine: WHO position paper \u2013 March 2022. 2022. https:\/\/www.who.int\/publications-detail-redirect\/who-wer9709-61\u201380"},{"issue":"1","key":"pgph.0005543.ref007","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1038\/s43856-023-00373-y","article-title":"Modeling of malaria vaccine effectiveness on disease burden and drug resistance in 42 African countries","volume":"3","author":"A Hamilton","year":"2023","journal-title":"Commun Med (Lond)"},{"issue":"10","key":"pgph.0005543.ref008","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1080\/21645515.2019.1586040","article-title":"Safety profile of the RTS,S\/AS01 malaria vaccine in infants and children: additional data from a phase III randomized controlled trial in sub-Saharan Africa","volume":"15","author":"Y Guerra Mendoza","year":"2019","journal-title":"Hum Vaccin Immunother"},{"key":"pgph.0005543.ref009","volume-title":"Full Evidence Report on the RTS,S\/AS01 Malaria Vaccine","author":"Strategic Advisory Group of Experts on Immunization (SAGE), Malaria Policy Advisory Group","year":"2021"},{"key":"pgph.0005543.ref010","author":"World Health Organization","year":"2024"},{"key":"pgph.0005543.ref011","volume-title":"Mathematical modelling to support malaria control and elimination","author":"N Chitnis","year":"2010"},{"key":"pgph.0005543.ref012","doi-asserted-by":"crossref","first-page":"260","DOI":"10.12688\/wellcomeopenres.16224.2","article-title":"Cost-effectiveness and public health impact of RTS,S\/AS01 E malaria vaccine in Malawi, using a Markov static model","volume":"5","author":"L Ndeketa","year":"2021","journal-title":"Wellcome Open Res"},{"issue":"1","key":"pgph.0005543.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000090","article-title":"Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa","volume":"2","author":"P Winskill","year":"2017","journal-title":"BMJ Glob Health"},{"key":"pgph.0005543.ref014","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1475-2875-14-6","article-title":"Calibration of an intrahost malaria model and parameter ensemble evaluation of a pre-erythrocytic vaccine","volume":"14","author":"KA McCarthy","year":"2015","journal-title":"Malar J"},{"key":"pgph.0005543.ref015","unstructured":"Sauboin C. Cost-effectiveness of RTS,S malaria vaccine candidate in children estimated using a Markov cohort model and Phase 3 trial results. In: Afhea, 2014. https:\/\/afhea.confex.com\/afhea\/intl14\/webprogram\/Paper1266.html"},{"key":"pgph.0005543.ref016","doi-asserted-by":"crossref","first-page":"3136","DOI":"10.1038\/ncomms4136","article-title":"Estimates of the changing age-burden of Plasmodium falciparum malaria disease in sub-Saharan Africa","volume":"5","author":"JT Griffin","year":"2014","journal-title":"Nat Commun"},{"issue":"1","key":"pgph.0005543.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001157","article-title":"Ensemble modeling of the likely public health impact of a pre-erythrocytic malaria vaccine","volume":"9","author":"T Smith","year":"2012","journal-title":"PLoS Med"},{"issue":"10016","key":"pgph.0005543.ref018","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0140-6736(15)00725-4","article-title":"Public health impact and cost-effectiveness of the RTS,S\/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models","volume":"387","author":"MA Penny","year":"2016","journal-title":"Lancet"},{"issue":"11","key":"pgph.0005543.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003377","article-title":"Estimated impact of RTS,S\/AS01 malaria vaccine allocation strategies in sub-Saharan Africa: A modelling study","volume":"17","author":"AB Hogan","year":"2020","journal-title":"PLoS Med"},{"key":"pgph.0005543.ref020","doi-asserted-by":"crossref","first-page":"2381468319861346","DOI":"10.1177\/2381468319861346","article-title":"Reducing malaria mortality at the lowest budget: An optimization tool for selecting malaria preventative interventions applied to Ghana","volume":"4","author":"C Sauboin","year":"2019","journal-title":"MDM Policy Pract"},{"issue":"20","key":"pgph.0005543.ref021","doi-asserted-by":"crossref","first-page":"3215","DOI":"10.1016\/j.vaccine.2023.04.011","article-title":"Modelling the relative cost-effectiveness of the RTS,S\/AS01 malaria vaccine compared to investment in vector control or chemoprophylaxis","volume":"41","author":"HM Topazian","year":"2023","journal-title":"Vaccine"},{"key":"pgph.0005543.ref022","volume-title":"World malaria report 2020","author":"World Health Organization"},{"issue":"5","key":"pgph.0005543.ref023","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.4269\/ajtmh.19-0062","article-title":"Climate Variability and Malaria over West Africa","volume":"102","author":"I Diouf","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0005543.ref024","volume-title":"DHS Final Report 2017-18","author":"DHS Benin","year":"2017"},{"key":"pgph.0005543.ref025","first-page":"1310","article-title":"Use of the Long-Lasting Insecticide-treat Nets (LLINs) against malaria in Benin: impact of washing practices in the community on their effectiveness","volume":"7","author":"R Kelani","year":"2014","journal-title":"Int J Innov Appl Stud"},{"key":"pgph.0005543.ref026","first-page":"137","article-title":"Improving the Use of Insecticide-Treated Nets among Children under Five Years Old in Benin, West Africa","volume":"13","author":"E Houessou","year":"2023","journal-title":"Adv Infect Dis"},{"key":"pgph.0005543.ref027","article-title":"Impact de l\u2019introduction de l\u2019identifiant unique sur les indicateurs de couverture globale en chimiopr\u00e9vention du paludisme saisonnier au B\u00e9nin","volume":"25","author":"C Affoukou","year":"2024","journal-title":"Health Sci Dis"},{"key":"pgph.0005543.ref028","unstructured":"Global Health Observatory. Diphtheria tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%). 2023. https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/diphtheria-tetanus-toxoid-and-pertussis-(dtp3)-immunization-coverage-among-1-year-olds-(-)"},{"issue":"9988","key":"pgph.0005543.ref029","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(15)60721-8","article-title":"Efficacy and safety of RTS,S\/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial","volume":"386","author":"RTS,S Clinical Trials Partnership","year":"2015","journal-title":"Lancet"},{"issue":"10437","key":"pgph.0005543.ref030","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/S0140-6736(24)00004-7","article-title":"Feasibility, safety, and impact of the RTS,S\/AS01E malaria vaccine when implemented through national immunisation programmes: evaluation of 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