title: Adult Javanese migrants to Indonesian Papua at high risk of severe disease caused by malaria.
abstract: Migrants from Java arrive in hyperendemic Papua, Indonesia lacking exposure to endemic malaria. We evaluated records of evacuation to hospital with a diagnosis of severe malaria from a transmigration village in northeastern Papua. During the first 30 months, 198 residents with severe disease were evacuated (7.5 evacuations/100 person-years). During this period the risk of evacuation for adults (> 15 years of age) was 2.8. (95% CI = 2.1-3.8; P < 0.0001) relative to children, despite apparently equal exposure to risk of infection. Relative risk (RR) for adults was greatest during the first 6 months (RR > 16; 95% CI > or = 2.0-129; P = 0.0009), and diminished during the second 6 months (RR = 9.4; 95% CI = 2.7-32.8; P < 0.0001) and the third 6 months (RR = 3.7; 95% CI = 1.7-7.9; P = 0.0004). During the next two 6-month intervals, the RR for adults was 1.6 and 1.5 (95 % CI range 0.8-2.6; P < 0.18). Adults lacking chronic exposure were far more likely to progress to severe disease compared to children during initial exposure, but not after chronic exposure to infection.
authors.affiliation: U.S. Naval Medical Research Unit #2, Jakarta, Indonesia.
authors.forename: J K
authors.initials: JK
authors.lastname: Baird
authors.forename: H
authors.initials: H
authors.lastname: Basri
authors.forename: P
authors.initials: P
authors.lastname: Weina
authors.forename: J D
authors.initials: JD
authors.lastname: MaGuire
authors.forename: M J
authors.initials: MJ
authors.lastname: Barcus
authors.forename: H
authors.initials: H
authors.lastname: Picarema
authors.forename: I R F
authors.initials: IR
authors.lastname: Elyazar
authors.forename: E
authors.initials: E
authors.lastname: Ayomi
authors.lastname: Sekartuti
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007214:Indonesia / Q000208:ethnology; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010219:Papua New Guinea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index