Moreover, although changes in the P. falciparum circumsporozoite protein (CSP) were not associated with clinical risk in paired consecutive infections,51 the CSP-based vaccine RTS,S nevertheless did have allele-specific efficacy.6 If the predominant alleles identified in this study are confirmed to predominate in other epidemiological settings, it would be prudent to include both alleles in a vaccine containing PfRH5 to reduce the effect of allele-specific efficacy. This evidence concerns the gene DNAJC5 and infection.