A Malaria-Resistant Phenotype with Immunological Correlates in a Tanzanian Birth Cohort Exposed to Intense Malaria Transmission

Scott D. Nash Laboratory of Malaria Immunology and Vaccinology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.
Epidemiology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

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D. Rebecca Prevots Epidemiology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

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Edward Kabyemela Muheza Designated District Hospital, Muheza, Tanzania.

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Yogender P. Khasa Department of Microbiology, University of Delhi South Campus, New Delhi, India.

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Kun-Lin Lee Laboratory of Malaria Immunology and Vaccinology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.

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Michal Fried Laboratory of Malaria Immunology and Vaccinology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.

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Patrick E. Duffy Laboratory of Malaria Immunology and Vaccinology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.

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Malaria incidence is highly heterogeneous even in areas of high transmission, although no conclusive evidence exists that innate or naturally acquired resistance can prevent infection over an extended period of time. This longitudinal study examined immunoparasitological evidence for a malaria-resistant phenotype in which children do not develop malaria despite an extended period of exposure to parasites. Within a birth cohort followed from 2002 to 2006 in Muheza, Tanzania, an area of intense transmission, children (N = 687) provided blood smears biweekly during infancy and monthly thereafter. Maternal and childhood characteristics were obtained, cord-blood cytokines were measured, and antibody responses were assayed as measures of stage-specific exposure. Sixty-three (9.2%) children had no blood smear–positive slides over 2 years of follow-up (range: 1–3.5 years) and were identified as malaria resistant. Malaria-resistant children were similar to other children with respect to completeness of follow-up and all maternal and childhood characteristics except residence area. Antibody seroprevalence was similar for two sporozoite antigens, but malaria-resistant children had a lower antibody seroprevalence to merozoite antigens merozoite surface protein 1 (5.4% versus 30.2%; P < 0.0001) and apical membrane antigen 1 (7.2% versus 33.3%; P < 0.0001). Malaria-resistant children had higher cytokine levels in cord blood, particularly interleukin-1β. In summary, a subset of children living in an area of intense transmission was exposed to malaria parasites, but never developed patent parasitemia; this phenotype was associated with a distinct cytokine profile at birth and antibody profile during infancy. Further research with malaria-resistant children may identify mechanisms for naturally acquired immunity.

Author Notes

* Address correspondence to Patrick E. Duffy, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Twinbrook I, Room 1111, 5640 Fishers Lane, Bethesda, MD 20892-8132, E-mail: duffype@niaid.nih.gov or Scott D. Nash, The Carter Center, 453 Freedom Parkway, Atlanta, GA 30307, E-mail: scott.nash@cartercenter.org.

Financial support: This research was supported by the Intramural Research Program and an extramural grant (R01AI52059) of the National Institute of Allergy and Infectious Diseases.

Authors' addresses: Scott D. Nash, The Carter Center, Atlanta, GA, E-mail: scott.nash@cartercenter.org. D. Rebecca Prevots, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, E-mail: rprevots@niaid.nih.gov. Edward Kabyemela, Muheza Designated District Hospital, Muheza, Tanzania, E-mail: earkabyemela@yahoo.com. Yogender P. Khasa, Department of Microbiology, University of Delhi South Campus, New Delhi, India, E-mail: yogi110@gmail.com. Kun-Lin Lee, Michal Fried, and Patrick E. Duffy, Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, E-mails: kun-lin.lee@nih.gov, michal.fried@nih.gov, and patrick.duffy@nih.gov.

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