Treatment of chronic asymptomatic plasmodium falciparum infection does not increase the risk of clinical malaria upon reinfection

Silvia Portugal, Tuan  Tran, Aissata Ongoiba, Aboudramane Bathily, Shanping Li, Safiatou Doumbo, Jeff Skinner, Didier Doumtabe, Younoussou Kone, Jules Sangala, Aarti Jain, D. Huw Davies, Christopher Hung, Li Liang, Stacy Ricklefs, Manijeh Vafa Homann, Philip L. Felgner, Stephen F. Porcella, Anna Färnert, Ogobara K. Doumbo & 4 others Kassoum Kayentao, Brian M. Greenwood, Boubacar Traore, Peter D. Crompton

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. 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. Methods. 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. Results. 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. Conclusions. 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.

Original languageEnglish (US)
Pages (from-to)645-653
Number of pages9
JournalClinical Infectious Diseases
Volume64
Issue number5
DOIs
StatePublished - 2017

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Plasmodium falciparum
Malaria
Therapeutics
Polymerase Chain Reaction
Immunity
Mali
Antibodies
Antimalarials
Infection

Keywords

  • Asymptomatic
  • Malaria
  • Malaria/drug therapy
  • Mass drug administration
  • Plasmodium falciparum

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Treatment of chronic asymptomatic plasmodium falciparum infection does not increase the risk of clinical malaria upon reinfection. / Portugal, Silvia; Tran, Tuan ; Ongoiba, Aissata; Bathily, Aboudramane; Li, Shanping; Doumbo, Safiatou; Skinner, Jeff; Doumtabe, Didier; Kone, Younoussou; Sangala, Jules; Jain, Aarti; Davies, D. Huw; Hung, Christopher; Liang, Li; Ricklefs, Stacy; Homann, Manijeh Vafa; Felgner, Philip L.; Porcella, Stephen F.; Färnert, Anna; Doumbo, Ogobara K.; Kayentao, Kassoum; Greenwood, Brian M.; Traore, Boubacar; Crompton, Peter D.

In: Clinical Infectious Diseases, Vol. 64, No. 5, 2017, p. 645-653.

Research output: Contribution to journalArticle

Portugal, S, Tran, T, Ongoiba, A, Bathily, A, Li, S, Doumbo, S, Skinner, J, Doumtabe, D, Kone, Y, Sangala, J, Jain, A, Davies, DH, Hung, C, Liang, L, Ricklefs, S, Homann, MV, Felgner, PL, Porcella, SF, Färnert, A, Doumbo, OK, Kayentao, K, Greenwood, BM, Traore, B & Crompton, PD 2017, 'Treatment of chronic asymptomatic plasmodium falciparum infection does not increase the risk of clinical malaria upon reinfection', Clinical Infectious Diseases, vol. 64, no. 5, pp. 645-653. https://doi.org/10.1093/cid/ciw849
Portugal, Silvia ; Tran, Tuan  ; Ongoiba, Aissata ; Bathily, Aboudramane ; Li, Shanping ; Doumbo, Safiatou ; Skinner, Jeff ; Doumtabe, Didier ; Kone, Younoussou ; Sangala, Jules ; Jain, Aarti ; Davies, D. Huw ; Hung, Christopher ; Liang, Li ; Ricklefs, Stacy ; Homann, Manijeh Vafa ; Felgner, Philip L. ; Porcella, Stephen F. ; Färnert, Anna ; Doumbo, Ogobara K. ; Kayentao, Kassoum ; Greenwood, Brian M. ; Traore, Boubacar ; Crompton, Peter D. / Treatment of chronic asymptomatic plasmodium falciparum infection does not increase the risk of clinical malaria upon reinfection. In: Clinical Infectious Diseases. 2017 ; Vol. 64, No. 5. pp. 645-653.
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abstract = "Background. 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. Methods. 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. Results. 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. Conclusions. 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.",
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T1 - Treatment of chronic asymptomatic plasmodium falciparum infection does not increase the risk of clinical malaria upon reinfection

AU - Portugal, Silvia

AU - Tran, Tuan 

AU - Ongoiba, Aissata

AU - Bathily, Aboudramane

AU - Li, Shanping

AU - Doumbo, Safiatou

AU - Skinner, Jeff

AU - Doumtabe, Didier

AU - Kone, Younoussou

AU - Sangala, Jules

AU - Jain, Aarti

AU - Davies, D. Huw

AU - Hung, Christopher

AU - Liang, Li

AU - Ricklefs, Stacy

AU - Homann, Manijeh Vafa

AU - Felgner, Philip L.

AU - Porcella, Stephen F.

AU - Färnert, Anna

AU - Doumbo, Ogobara K.

AU - Kayentao, Kassoum

AU - Greenwood, Brian M.

AU - Traore, Boubacar

AU - Crompton, Peter D.

PY - 2017

Y1 - 2017

N2 - Background. 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. Methods. 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. Results. 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. Conclusions. 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.

AB - Background. 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. Methods. 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. Results. 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. Conclusions. 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.

KW - Asymptomatic

KW - Malaria

KW - Malaria/drug therapy

KW - Mass drug administration

KW - Plasmodium falciparum

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DO - 10.1093/cid/ciw849

M3 - Article

VL - 64

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EP - 653

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JF - Clinical Infectious Diseases

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