AN EPIDEMIOLOGIC MODEL OF THE INCIDENCE OF ACUTE ILLNESS IN PLASMODIUM FALCIPARUM MALARIA

THOMAS SMITH Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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AMANDA ROSS Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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NICOLAS MAIRE Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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CHRISTOPHE ROGIER Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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JEAN-FRANÇOIS TRAPE Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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LOUIS MOLINEAUX Swiss Tropical Institute, Basel, Switzerland; Institut de Médecine Tropicale du Service de Santé des Armées, Marseille-Armées, France; Institut de Recherche pour le Développement, Dakar, Senegal; World Health Organization, Geneva, Switzerland

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We propose a stochastic model for simulating malaria tolerance. The model relates the probability of a clinical attack of malaria to the peripheral parasite densities via a pyrogenic threshold that itself responds dynamically to the parasite load. The parameters of the model have been estimated by fitting it to the relationship between incidence of clinical episodes and the entomologic inoculation rate, using age-specific incidence data from two villages in Senegal and one village in Tanzania. The model reproduces the shifts in age distribution of clinical episodes associated with variation in transmission intensity, and in keeping with the data, predicts a slightly higher lifetime number of episodes in the mesoendemic village of Ndiop than in the holoendemic village of Dielmo. This model provides a parsimonious explanation of counter-intuitive relationships between the overall incidence of clinical malaria and transmission intensity. In contrast to the theory of endemic stability, recently proposed to apply to P. falciparum, it does not assume any intrinsic age dependence in the outcome of infection. This model can be used to explore the consequences for predictions of the effects of different anti-malarial interventions on the incidence of clinical malaria.

Author Notes

Reprints requests: Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, PO Box, CH-4002, Basel, Switzerland.
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