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Intermittent preventive treatment (IPT) and insecticide-treated bed nets are the standard of care for preventing malaria in pregnant women. Since these preventive measures reduce exposure to malaria, their influence on the antibody (Ab) response to the parasite antigen VAR2CSA was evaluated in pregnant Cameroonian women exposed to holoendemic malaria. Ab levels to full-length VAR2CSA (FV2), variants of the six Duffy binding like (DBL) domains, and proportion of high avidity Ab to FV2 were measured longitudinally in 92 women before and 147 women after IPT. As predicted, reduced exposure interfered with acquisition of Ab in primigravidae, with 71% primigravidae being seronegative to FV2 at delivery. Use of IPT for > 13 weeks by multigravidae resulted in 26% of women being seronegative at delivery and a significant reduction in Ab levels to FV2, DBL5, DBL6, proportion of high avidity Ab to FV2, and number of variants recognized. Thus, in women using IPT important immune responses were not acquired by primigravidae and reduced in a portion of multigravidae, especially women with one to two previous pregnancies. Longitudinal data from individual multigravidae on IPT suggest that lower Ab levels most likely resulted from lack of boosting of the VAR2CSA response and not from a short-lived Ab response.
Financial support: The work was supported by grants from NIAID, NIH, UO1AI43888 (pre-intervention samples) and RO1AI071160 (post-intervention samples) (Diane Wallace Taylor, Rose G. F. Leke) and FP7/2007-2013 grant agreement no. 200889 (STOPPAM) (Ali Salanti), IMPM (Rose G. F. Leke).
Authors' addresses: Anna Babakhanyan, Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, E-mail: email@example.com. Yeung L. Tutterrow, Naveen Bobbili, Andrew Wey, and Diane Wallace Taylor, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Ali Salanti, Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark, and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark, E-mail: firstname.lastname@example.org. Josephine Fogako and Rose G. F. Leke, The Biotechnology Center, Faculty of Medicine and Biomedical Research, University of Yaoundé I, Yaoundé, Cameroon, E-mail: email@example.com.