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C-terminus IgG are more durable than NANP-repeats in RTS,S/AS01 malaria vaccine recipientsNew data shows how malaria vaccine antibodies last longer

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Key Takeaway
Note that C-terminus IgG are more durable than NANP-repeats and remain independently protective against malaria risk.

This observational ancillary study evaluated the immunological profile of 1292 children aged 5 to 17 months across six African countries who received the RTS,S/AS01 vaccine. The study focused on IgG responses to various circumsporozoite protein constructs over a 17-month follow-up period.

Results showed that C-terminus IgG declined more slowly than NANP-repeat IgG (0.099 vs 0.055; p<0.0001). Following a booster, C-terminal IgG significantly increased to 1.98 (95% CI 1.77-2.21), exceeding post-primary peak levels. In contrast, NANP-repeat responses were restored to 0.57 (95% CI 0.51-0.63) but remained below post-primary levels.

Furthermore, C-terminus IgG remained independently protective against malaria risk after adjustment for NANP-repeat antibodies (hazard ratio 0.60, 95% CI 0.43-0.83; p=0.0021). Higher circumsporozoite protein IgG levels were associated with reduced malaria risk.

Safety data were not reported. As an observational study, the results are associated with outcomes rather than proven as causal. The findings suggest that C-terminus IgG may offer more durable protection than NANP-repeats, though the evidence is based on an ancillary study of a Phase 3 trial.

How this fits prior evidence

How this fits prior evidence: This study addresses a gap in understanding the specific mechanisms of vaccine durability in the RTS,S/AS01 vaccine. While previous coverage noted that malaria presence at vaccination reduces HPV16 and HPV18 antibody levels, this study provides specific data on the durability of circumsporozoite protein IgG constructs. It confirms that C-terminus IgG are more durable than NANP-repeats, providing a more nuanced understanding of the immunological components of the RTS,S/AS01 vaccine compared to general malaria risk factors.

Protecting children from malaria is a major challenge in many parts of the world. Researchers looked at how the RTS,S/AS01 vaccine works in children aged 5 to 17 months across six African countries. They wanted to see how long the body keeps the specific antibodies needed to fight off the parasite.

The study found that one specific type of antibody, called C-terminus, lasted longer in the body than another type called NANP-repeat. While both types were important, the C-terminus antibodies stayed steady over a 17-month period. When children received a booster shot, these C-terminus levels jumped significantly, even higher than they were after the first dose.

Importantly, the researchers found that having these long-lasting antibodies was linked to a lower risk of getting malaria. While this was an observational study, it suggests that the ability to maintain these antibodies over time is a key part of how the vaccine works. Because this was an ancillary study of a phase 3 trial, it provides a deeper look at the immune response rather than a new clinical trial result.

What this means for you:
Long-lasting antibodies from the RTS,S/AS01 vaccine are linked to a lower risk of malaria in children.

Common questions

How long do the vaccine antibodies last?

The study followed children for 17 months. They found that C-terminus antibodies declined more slowly than NANP-repeat antibodies over that time. This suggests that maintaining these antibodies is a key part of how the vaccine provides protection against malaria.

Does the booster shot help?

Yes, the booster shot significantly increased C-terminus antibodies. These levels actually exceeded the peak levels seen after the first dose. For the other type of antibody, the booster restored levels, but they stayed below the initial peak.

Is this vaccine safe for children?

The study focused on the immune response of 1,292 children aged 5 to 17 months. While the study did not report specific adverse events or safety data, it was part of a phase 3 trial. Talk to a healthcare provider for specific medical advice.

Study Details

Study typePhase3
EvidenceLevel 2
Follow-up17.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND: The RTS,S/AS01 malaria vaccine provides partial protection against Plasmodium falciparum, largely mediated by antibodies targeting the circumsporozoite protein. Correlates of protection remain incompletely defined and have focused mainly on peak IgG responses to the immunodominant NANP-repeats, with less known about antibody durability or responses to the C-terminus of circumsporozoite protein. METHODS: In this observational study, we evaluated IgG responses to NANP-repeat, C-terminus, and full-length circumsporozoite protein constructs at five timepoints before and after primary and booster vaccination, in children aged 5-17 months from six African countries enrolled in the RTS,S/AS01 phase 3 trial (NCT00866619, 2009-11). Antibody kinetics were analysed with linear regressions, and associations with clinical malaria risk over 1 year with Cox models. FINDINGS: Between May 25, 2009, to March 5, 2010, 1292 children were recruited and included for analysis in this study. IgG levels declined more slowly for C-terminus than for NANP-repeat over 17 months after primary vaccination (geometric mean fold change 0·099 [95% CI 0·089-0·110] vs 0·055 [0·048-0·062]; p<0·0001). The booster significantly enhanced C-terminal IgG, exceeding post-primary peak levels (geometric mean fold change 1·98 [95% CI 1·77-2·21]), whereas NANP-repeat responses were restored but remained below post-primary levels (geometric mean fold changes 0·57 [95% CI 0·51-0·63]). Higher circumsporozoite protein IgG levels correlated with reduced malaria risk, particularly during maintenance phases, with stronger associations for C-terminus, which remained independently protective after adjustment for NANP-repeat antibodies (hazard ratio 0·60, 95% CI 0·43-0·83; p=0·0021). After boosting, maintenance but not peak IgG levels correlated with reduced malaria risk. INTERPRETATION: IgG to circumsporozoite protein C-terminus are more durable than those to the NANP-repeats. Antibody maintenance emerges as a stronger predictor of RTS,S/AS01 vaccine efficacy than peak responses. FUNDING: USA National Institute of Allergy and Infectious Diseases, National Institutes of Health; PATH and Malaria Vaccine Initiative; Spanish Ministerio de Economía y Competitividad; Instituto de Salud Carlos III; CERCA programme; and Secretaria d'Universitats i Recerca del Departament d'Empresa i Coneixement, Generalitat de Catalunya.
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