Immunity to non-cerebral severe malaria is acquired after one or two infections (original) (raw)

Nature Medicine volume 5, pages 340–343 (1999)Cite this article

Abstract

In areas of stable transmission, clinical immunity to mild malaria is acquired slowly, so it is not usually effective until early adolescence. Life-threatening disease is, however, restricted to a much younger age group, indicating that resistance to the severe clinical consequences of infection is acquired more quickly. Understanding how rapidly immunity develops to severe malaria is essential, as severe malaria should be the primary target of intervention strategies, and predicting the result of interventions that reduce host exposure will require consideration of these dynamics1,2. Severe disease in childhood is less frequent in areas where transmission is the greatest3. One explanation for this is that infants experience increased exposure to infection4,5,6 while they are protected from disease, possibly by maternal antibody. They therefore emerge from this period of clinical protection with considerably more immunity than those who experience lower transmission intensities. Here we use this data3, assuming a period of clinical protection, to estimate the number of prior infections needed to reduce the risk of severe disease to negligible levels. Contrary to expectations, one or two successful infective bites seem to be all that is necessary across a broad range of transmission intensities.

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Acknowledgements

We are grateful to the Wellcome Trust for financial support.

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Authors and Affiliations

  1. Department of Zoology, Wellcome Trust Centre for Epidemiology of Infectious Disease, University of Oxford, Oxford, UK
    Sunetra Gupta & Christl A. Donnelly
  2. KEMRI/Wellcome Trust Collaborative Programme, Nairobi, Kenya
    Robert W. Snow
  3. Institute of Molecular Medicine, University of Oxford, Oxford, UK
    Robert W. Snow, Kevin Marsh & Chris Newbold
  4. KEMRI Coastal Unit, Kilifi, Kenya
    Kevin Marsh

Authors

  1. Sunetra Gupta
  2. Robert W. Snow
  3. Christl A. Donnelly
  4. Kevin Marsh
  5. Chris Newbold

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Gupta, S., Snow, R., Donnelly, C. et al. Immunity to non-cerebral severe malaria is acquired after one or two infections.Nat Med 5, 340–343 (1999). https://doi.org/10.1038/6560

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