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We propose a stochastic model for the relationship between the entomologic inoculation rate (EIR) for Plasmodium falciparum malaria and the force of infection in endemic areas. The model incorporates effects of increased exposure to mosquito bites as a result of the growth in body surface area with the age of the host, naturally acquired pre-erythrocytic immunity, and the reduction in the proportion of entomologically assessed inoculations leading to infection, as the EIR increases. It is fitted to multiple datasets from field studies of the relationship between malaria infection and the EIR. We propose that this model can account for non-monotonic relationships between the age of the host and the parasite prevalence and incidence of disease. It provides a parsimonious explanation for the faster acquisition of natural immunity in adults than in children exposed to high EIRs. This forms one component of a new stochastic model for the entire transmission cycle of P. falciparum that we have derived to estimate the potential epidemiologic impact of malaria vaccines and other malaria control interventions.
Received September 18, 2005. Accepted for publication February 6, 2006.
Acknowledgments: We thank Paulette Rosé for assistance in retrieving the Garki data and Timothy Haley for assistance with statistical analyses. We also thank the members of the Technical Advisory Group (Michael Alpers, Paul Coleman, David Evans, Brian Greenwood, Carol Levin, Kevin Marsh, F. Ellis McKenzie, Mark Miller, and Brian Sharp), the Project Management Team at the Program for Appropriate Technology in Health (PATH) Malaria Vaccine Initiative, and GlaxoSmithKline Biologicals S.A. for their assistance.
Financial support: The mathematical modeling study was supported by the PATH Malaria Vaccine Initiative and GlaxoSmithKline Biologicals S.A.
Disclaimer: Publication of this report and the contents hereof do not necessarily reflect the endorsement, opinion, or viewpoints of the PATH Malaria Vaccine Initiative or GlaxoSmithKline Biologicals S.A.
* Address correspondence to Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002 Basel, Switzerland. E-mail: Thom-as-A.Smith{at}unibas.ch
Authors’ addresses: Thomas Smith, Nicolas Maire, Penelope Vounatsou, and Marcel Tanner, Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002 Basel, Switzerland, Telephone: 41-61-284-8273, Fax: 41-61-284-8105, E-mails: Thomas-A.Smith{at}unibas.ch, nicolas.maire{at}unibas.ch, penelope.vounatsou{at}unibas.ch, and marcel.tanner{at}unibas.ch. Klaus Dietz, Department of Medical Biometry, University of Tübingen, Westbahnhofstrasse 55, 72070 Tübingen, Germany, Telephone: 49-7071-29-78253, Fax: 49-7071-29-5075, E-mail: klaus.dietz{at}uni-tuebingen.de. Gerry F. Killeen, Ifakara Health Research and Development Centre, Ifakara, Kilombero District, Tanzania, Telephone: 255-748-477-118, Fax: 255-23-262-5312, E-mail: gkilleen{at}ihrdc.or.tz. Louis Molineaux, Peney-Dessus, CH-1242 Satigny, Geneva, Switzerland.
Reprint requests: Thomas Smith, Swiss Tropical Institute, Socin-strasse 57, PO Box, CH-4002, Basel, Switzerland.
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