• 1.

    Bousema T, Okell L, Felger I, Drakeley C, 2014. Asymptomatic malaria infections: detectability, transmissibility and public health relevance. Nat Rev Microbiol 12: 833840.

    • Search Google Scholar
    • Export Citation
  • 2.

    Shanks GD, Edstein MD, Kereu RK, Spicer PE, Rieckmann KH, 1993. Postexposure administration of halofantrine for the prevention of malaria. Clin Infect Dis 17: 628631.

    • Search Google Scholar
    • Export Citation
  • 3.

    Medzhitov R, Schneider DS, Soares MP, 2012. Disease tolerance as a defense strategy. Science 335: 936941.

  • 4.

    Nguyen TN et al. 2018. The persistence and oscillations of submicroscopic Plasmodium falciparum and Plasmodium vivax infections over time in Vietnam: an open cohort study. Lancet Infect Dis 18: 565572.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bruce-Chwatt LJ, 1985. John Hull Grundy lecture. Mosquitoes, malaria and war; then and now. J R Army Med Corps 131: 8599.

  • 6.

    Findlay GM, 1949. Blackwater fever in West Africa, 1941-45; blackwater fever in African military personnel. Ann Trop Med Parasitol 43: 213224.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hogben L, Johnstone MM, Mullings D, 1947. The medical ethnography of the second World War. Br J Soc Med 1: 251275.

  • 8.

    Findlay GM, 1949. Blackwater fever in West Africa, 1941-45; blackwater fever in European military personnel. Ann Trop Med Parasitol 43: 140154.

    • Search Google Scholar
    • Export Citation
  • 9.

    Deeks WE, James WM, 1911. A Report on Hemoglobinuric Fever in the Canal Zone: A Study of Its Etiology and Treatment. Department of Sanitation. Mount Hope, Canal Zone: ICC Press.

    • Search Google Scholar
    • Export Citation
  • 10.

    Simmons JS, 1939. Malaria in Panama. Baltimore, MD: Johns Hopkins Press.

  • 11.

    Gorgas WC, 1915. Sanitation in Panama. Baltmore, MD: Appleton.

  • 12.

    Gatton ML, Cheng Q, 2002. Evaluation of the pyrogenic threshold for Plasmodium falciparum malaria in naive individuals. Am J Trop Med Hyg 66: 467473.

    • Search Google Scholar
    • Export Citation
  • 13.

    Wright AE, Leishman WB, 1900. Remarks on the results which have been obtained by the antityphoid inoculations and on the methods which have been employed in the preparation of the vaccine. BMJ 1: 122.

    • Search Google Scholar
    • Export Citation
  • 14.

    Boyd MF, Kitchen S, 1943. On attempts to hyperimmunize convalescents from vivax malaria. Am J Trop Med Hyg 1: 209225.

  • 15.

    Perkins DJ, Patel MC, Blanco JC, Vogel SN, 2016. Epigenetic mechanisms governing innate inflammatory responses. J Interferon Cytokine Res 36: 454461.

    • Search Google Scholar
    • Export Citation
  • 16.

    Mandala W, Msefula C, Gondwe E, Drayson M, Molyneux ME, MacLennan C, 2016. Monocyte activation and cytokine production in Malawian children presenting with P. falciparum malaria. Parasite Immunol 38: 317325.

    • Search Google Scholar
    • Export Citation
  • 17.

    Shanks GD, Hay SI, Bradley DJ, 2008. Malaria’s indirect contribution to all-cause mortality in the Andaman Islands during the colonial era. Lancet Infect Dis 8: 564570.

    • Search Google Scholar
    • Export Citation
  • 18.

    Wenyon C, Anderson A, McLay K, Hele T, Waterston J, 1921. Malaria in Macedonia, 1915–1919. J Roy Army Med Corps 37: 83108.

  • 19.

    Shanks GD, White NJ, 2013. The activation of vivax malaria hypnozoites by infectious diseases. Lancet Infect Dis 13: 900906.

  • 20.

    Peto TJ et al. 2016. History of malaria treatment as a predictor of subsequent subclinical parasitaemia: a cross-sectional survey and malaria case records from three villages in Pailin, western Cambodia. Malar J 15: 240.

    • Search Google Scholar
    • Export Citation
  • 21.

    Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 122.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Tolerance May Be More Appropriate Than Immunity When Describing Chronic Malaria Infections

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  • 1 Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia;
  • | 2 School of Public Health, University of Queensland, Brisbane, Australia
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Adults who have not grown up in a malaria-endemic area may experience severe malaria soon after entering a malarious area. Such mortality is usually limited to a short period of time (months), after which they are thought to be “immune.” Such anti-disease immunity may be more accurately considered as tolerance. Malaria rates of British soldiers during the Second World War reflected their time with suppressed infections and the transmission levels. Black workers from non-endemic areas on the Panama Canal experienced higher initial mortality and infection rates than co-located white workers for Plasmodium falciparum, whereas the known genetic resistance of blacks to Plasmodium vivax reversed these rates. The ethnic differences observed in malaria rates may have more to do with acquired tolerance than genetic resistance. Long-term (years) sub-patent infections may maintain host tolerance, and elimination of malaria infections may place these adults at subsequent risk of severe malaria.

Author Notes

Address correspondence to George Dennis Shanks, Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, QLD 4051, Australia. E-mail: dennis.shanks@defence.gov.au

Disclaimer: The opinions expressed are those of the author and do not necessarily reflect those of the Australian Defence Force or the U.S. Department of Defense.

Author’s addresses: George Dennis Shanks, Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia, and School of Public Health, University of Queensland, Brisbane, Australia, E-mail: dennis.shanks@defence.gov.au.

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