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Gradual acquisition of immunity to severe malaria with increasing exposure

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Griffin, Jamie T., Hollingsworth, T. Déirdre, Reyburn, Hugh, Drakeley, Chris J., Riley, Eleanor and Ghani, Azra C. (2015) Gradual acquisition of immunity to severe malaria with increasing exposure. Proceedings of the Royal Society B : Biological Sciences . pp. 1-8. doi:10.1098/rspb.2014.2657 ISSN 0962-8452.

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Official URL: http://dx.doi.org/10.1098/rspb.2014.2657

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Abstract

Previous analyses have suggested that immunity to non-cerebral severe malaria due to Plasmodium falciparum is acquired after only a few infections, whereas longitudinal studies show that some children experience multiple episodes of severe disease, suggesting that immunity may not be acquired so quickly. We fitted a mathematical model for the acquisition and loss of immunity to severe disease to the age distribution of severe malaria cases stratified by symptoms from a range of transmission settings in Tanzania, combined with data from several African countries on the age distribution and overall incidence of severe malaria. We found that immunity to severe disease was acquired more gradually with exposure than previously thought. The model also suggests that physiological changes, rather than exposure, may alter the symptoms of disease with increasing age, suggesting that a later age at infection would be associated with a higher proportion of cases presenting with cerebral malaria regardless of exposure. This has consequences for the expected pattern of severe disease as transmission changes. Careful monitoring of the decline in immunity associated with reduced transmission will therefore be needed to ensure rebound epidemics of severe and fatal malaria are avoided.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- )
Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH): Malaria -- Immunological aspects, Plasmodium falciparum
Journal or Publication Title: Proceedings of the Royal Society B : Biological Sciences
Publisher: The Royal Society Publishing
ISSN: 0962-8452
Official Date: 7 January 2015
Dates:
DateEvent
7 January 2015Published
4 December 2014Accepted
30 October 2014Submitted
Number of Pages: 8
Page Range: pp. 1-8
DOI: 10.1098/rspb.2014.2657
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 28 December 2015
Date of first compliant Open Access: 28 December 2015
Funder: Medical Research Council (Great Britain) (MRC), Imperial College, London, Wellcome Trust (London, England)
Grant number: G1002284 (MRC), 9901439 (MRC), 097830/ Z/11/A-C (WT)

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