The risk of malarial infections and disease in Papua New Guinean children.
In a treatment re-infection study of 206 Papua New Guinean school children, we examined risk of reinfection and symptomatic malaria caused by different Plasmodium species. Although children acquired a similar number of polymerase chain reaction-detectable Plasmodium falciparum and P. vivax infections in six months of active follow-up (P. falciparum = 5.00, P. vivax = 5.28), they were 21 times more likely to develop symptomatic P. falciparum malaria (1.17/year) than P. vivax malaria (0.06/year). Children greater than nine years of age had a reduced risk of acquiring P. vivax infections of low-to-moderate (>150/microL) density (adjusted hazard rate [AHR] = 0.65 and 0.42), whereas similar reductions in risk with age of P. falciparum infection was only seen for parasitemias > 5,000/microL (AHR = 0.49) and symptomatic episodes (AHR = 0.51). Infection and symptomatic episodes with P. malariae and P. ovale were rare. By nine years of age, children have thus acquired almost complete clinical immunity to P. vivax characterized by a very tight control of parasite density, whereas the acquisition of immunity to symptomatic P. falciparum malaria remained incomplete. These observations suggest that different mechanisms of immunity may be important for protection from these malaria species.
Michon
Pascal
P
Papua New Guinea Institute of Medical Research, PO Box 378, Madang, MAD 511, Papua New Guinea.
Cole-Tobian
Jennifer L
JL
Dabod
Elijah
E
Schoepflin
Sonja
S
Igu
Jennifer
J
Susapu
Melinda
M
Tarongka
Nandao
N
Zimmerman
Peter A
PA
Reeder
John C
JC
Beeson
James G
JG
Schofield
Louis
L
King
Christopher L
CL
Mueller
Ivo
I
D000293:Adolescent; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D016780:Malaria, Vivax / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D008297:Male; D010219:Papua New Guinea / Q000453:epidemiology; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D010963:Plasmodium falciparum / Q000235:genetics / Q000276:immunology*; D010966:Plasmodium vivax / Q000235:genetics / Q000276:immunology*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012424:Rural Population; D012717:Sesquiterpenes / Q000627:therapeutic use
D000913:Antibodies, Protozoan; D000962:Antimalarials; D037621:Artemisinins; D016054:DNA, Protozoan; D012717:Sesquiterpenes; D000077332:Artesunate