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As part of a large community-based trial on the impact of insecticide (permethrin)-treated bed nets (ITNs) on childhood morbidity and mortality in an area of intense perennial malaria transmission in western Kenya, we assessed the effects of ITNs on malaria-specific humoral responses in young children. The IgG responses to Plasmodium falciparum pre-erythrocytic antigens circumsporozoite protein (CSP) and liver stage antigen-1 (LSA-1) and the blood stage antigen merozoite surface protein-1 (MSP-119 kD) in children less than three years old were investigated during a series of cross-sectional surveys. At 14 and 22 months after the introduction of ITNs, the frequencies and levels of IgG to CSP and LSA-1 were significantly lower in children from ITN villages than in children from control villages (P < 0.001). In contrast, the prevalence of IgG to MSP-1 was significantly higher in children from ITN villages at 14 months (P = 0.0069), but not at 22 months. Our results show that decreased exposure by ITNs reduces IgG responses to pre-erythrocytic antigens, but there was no evidence that two years of ITN use compromises IgG responses to blood stage antigens in these young children in this malaria holoendemic area.
Acknowledgments: We thank the people of Rarieda Division and all the field workers, without whom this study would not have been possible. We are grateful to Philip Onyona, Franklin Komino, Patroba Anyona, Thomas Otieno, Malachi Ogalo, and the late Peter Otieno for technical assistance. We express our gratitude to Dr. David Lanar (Walter Reed Army Institute of Research, Silver Springs, MD) and Dr. David Kaslow (National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD) for the kind donation of recombinant CSP and MSP-1 antigens, respectively. We acknowledge Daniel Colley (Director, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA), Kevin De Cock (Centers for Disease Control and Prevention Country Director in Kenya) and Laurence Slutsker, (Director, Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Kisumu, Kenya) for comments on the manuscript, and Mary Bartlett (Division of Parasitic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention) for editorial assistance. We also thank Dr. Davy Koech (Director, Kenya Medical Research Institute) for his permission to publish this paper.
Financial support: The ITN project was funded by the United States Agency for International Development. The laboratory work was supported by the UNDP/World Bank/World Health Organization/Special Program for Research and Training in Tropical Diseases. Feiko O. ter Kuile and Dianne J. Terlouw were partly supported by a grant from the Netherlands Foundation for the Advancement of Tropical Research (WOTRO) (The Hague, The Netherlands).
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Simon K. Kariuki, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Altaf A. Lal, Dianne J. Terlouw, Feiko O. ter Kuile, Penelope A. Phillips-Howard, Margarette S. Kolczak, William A. Hawley, and Ya Ping Shi, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. John M. O. Ong’echa and Alloys S. S. Orago, Zoology Department, Kenyatta University, PO Box 43844, Nairobi, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
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