A longitudinal study of seroreactivities to Plasmodium falciparum antigens in infants and children living in a holoendemic area of Liberia.

Investigators studied 348 children age 0-10 years, living in a holoendemic area of Liberia, for parasitological, serological and clinical parameters. The age-specific parasite rate increased towards the 7-10 year-old age group in which it was 86.8%. The geometrical mean parasite density decreased from the 3-4 year-old age group, in which fewer episodes of clinical malaria were observed. Antibodies to crude Plasmodium falciparum parasite antigens were detected in all children. The (EENV)6 seropositive rate was a maximum of 67.9% in the 3-11 month-old age group. It declined to a minimum of 31.7% in the 5-6 years age group after which it increased slowly in the 7-10 years age group. Antibodies to the synthetic peptide (NANP)6 showed a steady seropositive rate after the age of 3 months, between 30.0% and 39.3% in all the age groups up to 10 years. No statistically significant correlation was found between seropositivity to (EENV)6 and malarial parasitemia. In contrast, a statistically significant positive correlation was found between seropositivity to (NANP)6 and parasite rates. The antibody response for the individual child was transient to both Pf155/RESA, measured by immunofluorescence, and to (EENV)6 and (NANP)6, measured by ELISA, especially in the younger age groups of this study population. Parasitological and clinical immunity developed before a stable antibody response to these defined malaria antigens was established. These antibodies may still contribute to the immune protection against malaria, but they were not reliable parameters for protective immunity in the population we studied.

The antibody response to well-defined malaria antigens after acute malaria in individuals living under continuous malaria transmission.

The IgG and IgM antibody responses to the C-terminal 783 amino acids of the P. falciparum glutamate-rich protein, GLURP489-1271, expressed as an E. coli fusion protein, the IgG response to a 18-mer synthetic peptide EDKNEKGQHEIVEVEEIL (GLURP899-916) representing the C-terminal repeats of GLURP, and a synthetic peptide (EENV)6 representing the C-terminal repeats from Pf155/RESA, were investigated longitudinally in 13 children and 7 adults living under conditions of continuous, intense malaria transmission. Some subjects did not recognize the antigens after malaria infection, and in subjects recognizing the antigens, the responses were often short-lived. In adults, the antibody responses to the GLURP489-1271 fusion protein and the (EENV)6 peptide peaked after 2 weeks, and not all individuals responded to all antigens. The antibody response, even against large fragments of conserved antigens, is not uniformly elicited by natural malaria infection in previously primed donors.

Classification of clinical falciparum malaria and its use for the evaluation of chemosuppression in children under six years of age in Liberia, west Africa.

The possible role of malaria as cause of morbidity was assessed during one year in 262 children aged 6 months to 6 years living in two villages in a rural area of Liberia. The study population was followed by weekly clinics and three-monthly surveys and the children were randomly allocated to receive either chloroquine or placebo every 3 weeks. The morbidity of the children was evaluated by criteria based on the history and the clinical condition into four different stages, in order to describe the probability that an observed clinical event could be attributed to malaria infection, based on the presence of detectable parasites in the blood, the history the previous week, and the clinical status of the child. The level of anaemia, splenomegaly and measured body temperature supported that malaria was the major contributor to the overall morbidity observed. Based on the stage classification of clinical illness, children were classified as having 'possible clinical malaria' or 'probable clinical malaria'. Malaria appeared to be an important cause of febrile episodes during both dry and rainy seasons. During the rainy season more than 60% of the children experienced at least one clinical malaria episode, and during the dry season more than 50% of the children experienced at least one clinical attack of malaria. Children receiving chemosuppression had overall fewer clinical malaria attacks, and the effect of the chemosuppression was most pronounced in the dry season, the odds ratio comparing children receiving regular chemosuppression with children receiving presumptive treatment only was estimated to 0.39 (0.25-0.62).