title: Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection.
abstract: Chronic asymptomatic Plasmodium falciparum infections are common in endemic areas and are thought to contribute to the maintenance of malaria immunity. Whether treatment of these infections increases the subsequent risk of clinical episodes of malaria is unclear.
  
  
  
  In a 3-year study in Mali, asymptomatic individuals with or without P. falciparum infection at the end of the 6-month dry season were identified by polymerase chain reaction (PCR), and clinical malaria risk was compared during the ensuing 6-month malaria transmission season. At the end of the second dry season, 3 groups of asymptomatic children were identified: (1) children infected with P. falciparum as detected by rapid diagnostic testing (RDT) who were treated with antimalarials (n = 104), (2) RDT-negative children whose untreated P. falciparum infections were detected retrospectively by PCR (n = 55), and (3) uninfected children (RDT/PCR negative) (n = 434). Clinical malaria risk during 2 subsequent malaria seasons was compared. Plasmodium falciparum-specific antibody kinetics during the dry season were compared in children who did or did not harbor asymptomatic P. falciparum infections.
  
  
  
  Chronic asymptomatic P. falciparum infection predicted decreased clinical malaria risk during the subsequent malaria season(s); treatment of these infections did not alter this reduced risk. Plasmodium falciparum-specific antibodies declined similarly in children who did or did not harbor chronic asymptomatic P. falciparum infection during the dry season.
  
  
  
  These findings challenge the notion that chronic asymptomatic P. falciparum infection maintains malaria immunity and suggest that mass drug administration during the dry season should not increase the subsequent risk of clinical malaria.
authors.affiliation: Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Portugal
authors.affiliation: Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.|Division of Infectious Diseases, Department of Medicine, Indianapolis University School of Medicine, Indiana.
authors.forename: Tuan M
authors.initials: TM
authors.lastname: Tran
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Aissata
authors.initials: A
authors.lastname: Ongoiba
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Aboudramane
authors.initials: A
authors.lastname: Bathily
authors.affiliation: Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Shanping
authors.initials: S
authors.lastname: Li
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Safiatou
authors.initials: S
authors.lastname: Doumbo
authors.affiliation: Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Skinner
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Didier
authors.initials: D
authors.lastname: Doumtabe
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Younoussou
authors.initials: Y
authors.lastname: Kone
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Jules
authors.initials: J
authors.lastname: Sangala
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Aarti
authors.initials: A
authors.lastname: Jain
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: D Huw
authors.initials: DH
authors.lastname: Davies
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hung
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: Rocky Mountain Laboratory Research Technologies Section, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Ricklefs
authors.affiliation: Department of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
authors.forename: Manijeh Vafa
authors.initials: MV
authors.lastname: Homann
authors.affiliation: University of California, Irvine, California, USA.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Felgner
authors.affiliation: Rocky Mountain Laboratory Research Technologies Section, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Porcella
authors.affiliation: Department of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Färnert
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Kassoum
authors.initials: K
authors.lastname: Kayentao
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.affiliation: Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, International Center of Excellence in Research, University of Sciences, Technique and Technology of Bamako, Mali.
authors.forename: Boubacar
authors.initials: B
authors.lastname: Traore
authors.affiliation: Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Crompton
mesh_terms: D000293:Adolescent; D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood / Q000276:immunology; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use; D058345:Asymptomatic Infections; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D008297:Male; D008302:Mali / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D011159:Population Surveillance; D012306:Risk; D012621:Seasons; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000962:Antimalarials; D007074:Immunoglobulin G
keywords: Plasmodium falciparum; asymptomatic; malaria; malaria/drug therapy; mass drug administration.