# Impact of early childhood malaria prevention on malaria risk at school entry (ERASE)

> **NIH NIH R01** · UNIVERSITY OF MARYLAND BALTIMORE · 2024 · $685,104

## Abstract

Project Summary
The World Health Organization (WHO) recommends two key interventions to protect young children in
sub-Saharan Africa from Plasmodium falciparum (Pf) malaria morbidity and mortality. Seasonal
malaria chemoprevention (SMC) provides a full course of antimalarial drugs every month of the high
transmission period in seasonal transmission areas. More recently, RTS,S vaccination to prevent malaria in
young children in areas of moderate to high transmission has also been recommended following the promising
results of large-scale pilot study. Ghana is one of three countries in this pilot study and is the only country in
the world where both SMC and RTS,S have been implemented in a broad population. SMC has been
implemented at the regional level and RTS,S vaccine administration has been randomized by district through
the implementation pilot program. This means that in a small geographic area, we can evaluate children
who have received SMC and/or RTS,S or neither of these interventions.
In our on-going surveillance of malaria in sub-Saharan Africa, we identified school-age children (ages five
to fifteen years) as the population with the highest prevalence of malaria infection. These infections typically do
not cause severe disease. However, because immunity to malaria is acquired through repeated exposures,
children who receive SMC and/or RTS,S vaccine may have delayed immune development and experience
increased malaria disease burden and more frequent severe disease after the interventions end at five
years of age. Alternatively, decreasing exposure to malaria in early life may allow children to develop a more
robust immune response to Pf and thus lead to a reduced risk of infection and disease as they reach school-
age. Finally, vaccine antibodies, especially in children who completed the primary series plus the
recommended booster, may continue to protect children beyond five years of age.
Thus, the opportunity to study children who received various combinations of RTS,S and/or SMC is unique
in Ghana and timely for all high malaria burden countries. We propose a longitudinal cohort study of four
groups of children ages five to seven years with a history of different combinations of exposures to early
childhood interventions: SMC alone, RTS,S alone, SMC plus RTS,S, or none of these interventions. We
designed the study to understand the epidemiological impact of vaccination and SMC on the burden of malaria
infection and disease at five to seven years of age through a longitudinal study assessing Pf prevalence and
the incidence of clinical disease. We have also proposed innovative serological profiling, fine epitope mapping,
and genomic approaches to understanding the immunological and parasitological basis of our observations to
inform the next generation of interventions.

## Key facts

- **NIH application ID:** 10995441
- **Project number:** 1R01AI181383-01A1
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Kwaku Poku Asante
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $685,104
- **Award type:** 1
- **Project period:** 2024-07-10 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10995441

## Citation

> US National Institutes of Health, RePORTER application 10995441, Impact of early childhood malaria prevention on malaria risk at school entry (ERASE) (1R01AI181383-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10995441. Licensed CC0.

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