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Elife. 2018 Jul 25;7. pii: e35832. doi: 10.7554/eLife.35832.

Quantification of anti-parasite and anti-disease immunity to malaria as a function of age and exposure.

Author information

1
Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, United States.
2
Infectious Diseases Research Collaboration, Kampala, Uganda.
3
Department of Medicine, Stanford University, Stanford, United States.
4
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
5
London School of Hygiene and Tropical Medicine, London, United Kingdom.
6
Institute of Health Metrics and Evaluation, University of Washington, Seattle, United States.

Abstract

Fundamental gaps remain in our understanding of how immunity to malaria develops. We used detailed clinical and entomological data from parallel cohort studies conducted across the malaria transmission spectrum in Uganda to quantify the development of immunity against symptomatic P. falciparum as a function of age and transmission intensity. We focus on: anti-parasite immunity (i.e. ability to control parasite densities) and anti-disease immunity (i.e. ability to tolerate higher parasite densities without fever). Our findings suggest a strong effect of age on both types of immunity, not explained by cumulative-exposure. They also show an independent effect of exposure, where children living in moderate/high transmission settings develop immunity faster as transmission increases. Surprisingly, children in the lowest transmission setting appear to develop immunity more efficiently than those living in moderate transmission settings. Anti-parasite and anti-disease immunity develop in parallel, reducing the probability of experiencing symptomatic malaria upon each subsequent P. falciparum infection.

KEYWORDS:

P. falciparum; anti-disease immunity; anti-parasite immunity; epidemiology; global health; immunity; malaria

Comment in

PMID:
30044224
PMCID:
PMC6103767
DOI:
10.7554/eLife.35832
[Indexed for MEDLINE]
Free PMC Article

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