title: Temporal association of acute hepatitis A and Plasmodium falciparum malaria in children.
abstract: BACKGROUND
  In sub-Saharan Africa, Plasmodium falciparum and hepatitis A (HAV) infections are common, especially in children. Co-infections with these two pathogens may therefore occur, but it is unknown if temporal clustering exists.
  
  
  METHODS
  We studied the pattern of co-infection of P. falciparum malaria and acute HAV in Kenyan children under the age of 5 years in a cohort of children presenting with uncomplicated P. falciparum malaria. HAV status was determined during a 3-month follow-up period.
  
  
  CONCLUSIONS
  Among 222 cases of uncomplicated malaria, 10 patients were anti-HAV IgM positive. The incidence of HAV infections during P. falciparum malaria was 1.7 (95% CI 0.81-3.1) infections/person-year while the cumulative incidence of HAV over the 3-month follow-up period was 0.27 (95% CI 0.14-0.50) infections/person-year. Children with or without HAV co-infections had similar mean P. falciparum asexual parasite densities at presentation (31,000/µL vs. 34,000/µL, respectively), largely exceeding the pyrogenic threshold of 2,500 parasites/µL in this population and minimizing risk of over-diagnosis of malaria as an explanation.
  
  
  CONCLUSIONS
  The observed temporal association between acute HAV and P. falciparum malaria suggests that co-infections of these two hepatotrophic human pathogens may result from changes in host susceptibility. Testing this hypothesis will require larger prospective studies.
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Klein Klouwenberg
authors.forename: Philip
authors.initials: P
authors.lastname: Sasi
authors.forename: Mahfudh
authors.initials: M
authors.lastname: Bashraheil
authors.forename: Ken
authors.initials: K
authors.lastname: Awuondo
authors.forename: Marc
authors.initials: M
authors.lastname: Bonten
authors.forename: James
authors.initials: J
authors.lastname: Berkley
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Steffen
authors.initials: S
authors.lastname: Borrmann
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D035922:Hepatitis A Antibodies / Q000276:immunology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D013997:Time Factors
chemical_list: D035922:Hepatitis A Antibodies