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Development of Clinical Immunity to Malaria in Highland Areas of Low and Unstable Transmission

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  • Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Moi University School of Medicine, Eldoret, Kenya; College of Public Health, University of Arizona, Tucson, Arizona; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Centers for Disease Control and Prevention, Atlanta, Georgia

In highland areas of unstable, low malaria transmission, the extent to which immunity to uncomplicated malaria develops with age and intermittent parasite exposure has not been well characterized. We conducted active surveillance for clinical malaria during April 2003–March 2005 in two highland areas of western Kenya (Kapsisiywa and Kipsamoite). In both sites, annual malaria incidence was significantly lower in persons ≥ 15 years of age than in persons < 5 years of age (Kapsisiywa: incidence = 382.9 cases/1,000 persons among persons < 1–4 years of age versus 135.1 cases/1,000 persons among persons ≥ 15 years of age; Kipsamoite: incidence = 233.0 cases/1,000 persons in persons < 1–4 years of age versus 43.3 cases/1,000 persons in persons ≥ 15 years of age). In Kapsisiywa, among persons with malaria, parasite density and axillary body temperature were also significantly lower in persons ≥ 15 years of age than in persons < 5 years of age. Even in highland areas of unstable and low malaria transmission, age is associated with development of clinical immunity to malaria.

Author Notes

* Address correspondence to Melissa A. Rolfes, Department of Pediatrics, University of Minnesota, 3-410 MTRF, 2001 6th Street SE, Minneapolis, MN 55455. E-mail: riede056@umn.edu

Financial support: This study was supported in part by National Institutes of Allergy and Infectious Diseases grants U01 AI056270, K08 AI01572, and D43 TW0080085 to Chandy C. John.

Authors' addresses: Melissa A. Rolfes and Matthew McCarra, Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mails: riede056@umn.edu and mcca0495@umn.edu. Ng'wena G. Magak, Department of Medical Physiology, School of Medicine, Moi University, Eldoret, Kenya, E-mail: gngwena@hotmail.com. Kacey C. Ernst, College of Public Health, University of Arizona, Tucson, AZ, E-mail: kernst@email.arizona.edu. Arlene E. Dent, Center for Global Health and Diseases, Case Western Reserve School of Medicine, Biomedical Research Building, West Administrative Offices #430, Cleveland, OH, E-mail: arlene.dent@case.edu. Kim A. Lindblade, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: kil2@cdc.gov. Chandy C. John, Center for Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mail: ccj@umn.edu.

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