title: Malaria preventive therapy in pregnancy and its potential impact on immunity to malaria in an area of declining transmission.
abstract: BACKGROUND
  Regular anti-malarial therapy in pregnancy, a pillar of malaria control, may affect malaria immunity, with therapeutic implications in regions of reducing transmission.
  
  
  METHODS
  Plasma antibodies to leading vaccine candidate merozoite antigens and opsonizing antibodies to endothelial-binding and placental-binding infected erythrocytes were quantified in pregnant Melanesian women receiving sulfadoxine-pyrimethamine (SP) with chloroquine taken once, or three courses of SP with azithromycin.
  
  
  RESULTS
  Malaria prevalence was low. Between enrolment and delivery, antibodies to recombinant antigens declined in both groups (p<0.0001). In contrast, median levels of opsonizing antibodies did not change, although levels for some individuals changed significantly. In multivariate analysis, the malaria prevention regimen did not influence antibody levels.
  
  
  CONCLUSIONS
  Different preventive anti-malarial chemotherapy regimens used during pregnancy had limited impact on malarial-immunity in a low-transmission region of Papua New Guinea.
  
  
  BACKGROUND
  NCT01136850.
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. andrew.teo@uqconnect.edu.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teo
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. whasang@unimelb.edu.au.|Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia. whasang@unimelb.edu.au.
authors.forename: Wina
authors.initials: W
authors.lastname: Hasang
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. louise.randall@unimelb.edu.au.|Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia. louise.randall@unimelb.edu.au.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Randall
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. hwunger@doctors.org.uk.
authors.forename: Holger W
authors.initials: HW
authors.lastname: Unger
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. peter.siba@pngimr.org.pg.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Siba
authors.affiliation: The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia. mueller@wehi.edu.au.|Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain. mueller@wehi.edu.au.
authors.forename: Ivo
authors.initials: I
authors.lastname: Mueller
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. g.brown@unimelb.edu.au.|Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia. g.brown@unimelb.edu.au.|The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia. g.brown@unimelb.edu.au.
authors.forename: Graham V
authors.initials: GV
authors.lastname: Brown
authors.affiliation: University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. sroger@unimelb.edu.au.|Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia. sroger@unimelb.edu.au.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
mesh_terms: D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood*; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D017963:Azithromycin / Q000008:administration & dosage / Q000009:adverse effects*; D002738:Chloroquine / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D004912:Erythrocytes; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000517:prevention & control*; D010219:Papua New Guinea; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000139:chemically induced / Q000276:immunology*; D011739:Pyrimethamine / Q000008:administration & dosage / Q000009:adverse effects*; D013413:Sulfadoxine / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D017963:Azithromycin; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine