title: Plasmodium falciparum infection patterns since birth and risk of severe malaria: a nested case-control study in children on the coast of Kenya.
abstract: Children in malaria endemic areas acquire immunity to severe malaria faster than to mild malaria. Only a minority of children suffers from severe malaria and it is not known what determines this. The aim of this study was to establish how P. falciparum infections during the first years of life affect the risk of severe malaria. A matched case-control study was nested within a large birth cohort set up to study the immunoepidemiology of pneumococci on the Kenyan coast. Infection patterns in three-monthly blood samples in cohort children admitted to hospital with severe malaria were compared to controls matched on age, residential location and time of sampling. P. falciparum detected at least once from birth conferred an increased risk of severe malaria and particularly if multiclonal infections, as characterized by genotyping of a polymorphic antigen gene, were ever detected. The results show for the first time that children with severe malaria have more infections early in life compared to community controls. These findings provide important insights on the immunity to severe disease, knowledge essential for the development of a vaccine against severe malaria.
authors: Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden. klara.lundblom@ki.se
authors: Klara
authors: K
authors: Lundblom
authors: Linda
authors: L
authors: Murungi
authors: Victoria
authors: V
authors: Nyaga
authors: Daniel
authors: D
authors: Olsson
authors: Josea
authors: J
authors: Rono
authors: Faith
authors: F
authors: Osier
authors: Edna
authors: E
authors: Ogada
authors: Scott
authors: S
authors: Montgomery
authors: J Anthony G
authors: JA
authors: Scott
authors: Kevin
authors: K
authors: Marsh
authors: Anna
authors: A
authors: Färnert
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D012306:Risk; D012720:Severity of Illness Index