Combatting seasonal malaria transmission using a highly potent Plasmodium falciparum transmission-blocking monoclonal antibody

Abstract

Transmission-blocking interventions can play an important role in combatting malaria worldwide. Recently, a highly potent Plasmodium falciparum transmission-blocking monoclonal antibody (TB31F) was demonstrated to be safe and efficacious in malaria-naive volunteers. Here we determine what dose would be required to obtain effective transmission reduction throughout the malaria season and predict the potential public health impact of large-scale implementation of TB31F alongside existing interventions. To this purpose, we developed a pharmaco-epidemiological model, tailored to two settings of differing transmission intensity with already established insecticide-treated nets and seasonal malaria chemoprevention interventions. We found that a simple weight-based TB31F dosing strategy achieved >80% transmission-reducing activity for over 5 months. With this approach, community-wide annual administration (at 80% coverage) of TB31F over a three-year period was predicted to reduce clinical incidence by 54% (381 cases averted per 1000 people per year) in a high-transmission seasonal setting, and 74% (157 cases averted per 1000 people per year) in a low-transmission seasonal setting. Targeting school-aged children gave the largest reduction in terms of cases averted per dose. We conclude that annual administration of transmission-blocking mAb TB31F may be an effective intervention against malaria in seasonal malaria settings.