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Holla P, Bhardwaj J, Tran TM. Mature beyond their years: young children who escape detection of parasitemia despite living in settings of intense malaria transmission. Biochem Soc Trans 2024; 52:1025-1034. [PMID: 38752830 PMCID: PMC11209762 DOI: 10.1042/bst20230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Despite having the highest risk of progressing to severe disease due to lack of acquired immunity, the youngest children living in areas of highly intense malaria transmission have long been observed to be infected at lower rates than older children. Whether this observation is due to reduced exposure to infectious mosquito bites from behavioral and biological factors, maternally transferred immunity, genetic factors, or enhanced innate immunity in the young child has intrigued malaria researchers for over half a century. Recent evidence suggests that maternally transferred immunity may be limited to early infancy and that the young child's own immune system may contribute to control of malarial symptoms early in life and prior to the development of more effective adaptive immunity. Prospective studies of active and passive detection of Plasmodium falciparum blood-stage infections have identified young children (<5 years old) who remain uninfected through a defined surveillance period despite living in settings of highly intense malaria transmission. Yet, little is known about the potential immunological basis for this 'aparasitemic' phenotype. In this review, we summarize the observational evidence for this phenotype in field studies and examine potential reasons why these children escape detection of parasitemia, covering factors that are either extrinsic or intrinsic to their developing immune system. We discuss the challenges of distinguishing malaria protection from lack of malaria exposure in field studies. We also identify gaps in our knowledge regarding cellular immunity in the youngest age group and propose directions that researchers may take to address these gaps.
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Affiliation(s)
- Prasida Holla
- Ryan White Center for Global Health and Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
| | - Jyoti Bhardwaj
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
| | - Tuan M. Tran
- Ryan White Center for Global Health and Pediatric Infectious Diseases, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN 46202, U.S.A
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Okek EJ, Ocan M, Obondo SJ, Kiyimba A, Arinaitwe E, Nankabirwa J, Ssewanyana I, Kamya MR. Effects of anti-malarial prophylaxes on maternal transfer of Immunoglobulin-G (IgG) and association to immunity against Plasmodium falciparum infections among children in a Ugandan birth cohort. PLoS One 2023; 18:e0277789. [PMID: 36812236 PMCID: PMC9946240 DOI: 10.1371/journal.pone.0277789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/10/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The in-utero transfer of malaria specific IgG to the fetus in Plasmodium falciparum infected pregnant women potentially plays a role in provision of immune protection against malaria in the first birth year. However, the effect of Intermittent Prophylactic Treatment in Pregnancy (IPTp) and placental malaria on the extent of in-utero antibody transfer in malaria endemic regions like Uganda remain unknown. The aim of this study was thus to establish the effect of IPTp on in-utero transfer of malaria specific IgG to the fetus and the associated immune protection against malaria in the first birth year of children born to mothers who had P. falciparum infection during pregnancy in Uganda. METHODS We screened a total of 637 cord blood samples from a double blinded randomized clinical trial on Sulfadoxine-Pyrimethamine (SP) and Dihydroartemisinin-Piperaquine (DP) IPTp in a Ugandan birth cohort; study conducted from Busia, Eastern Uganda. Luminex assay was used to measure the cord levels of IgG sub-types (IgG1, IgG2, IgG3 and IgG4) against 15 different P. falciparum specific antigens, with tetanus toxoid (t.t) as a control antigen. Man-Whitney U test (non-parametric) in STATA (ver15) was used in statistical analysis of the samples. In addition, Multivariate cox regression analysis was used to determine the effect of maternal transfer of IgG on the incidence of malaria in the first birth year of children under study. RESULTS Mothers on SP expressed higher levels of cord IgG4 against erythrocyte binding antigens (EBA140, EBA175 and EBA181) (p<0.05). Placental malaria did not affect cord levels of IgG sub-types against selected P. falciparum specific antigens (p>0.05). Children who expressed higher levels (75th percentile) of total IgG against the six key P. falciparum antigens (Pf SEA, Rh4.2, AMA1, GLURP, Etramp5Ag1 and EBA 175) had higher risk of malaria in the first birth year; AHRs: 1.092, 95% CI: 1.02-1.17 (Rh4.2); 1.32, 95% CI: 1.00-1.74 (PfSEA); 1.21, 95%CI: 0.97-1.52 (Etramp5Ag1); 1.25, 95%CI: 0.98-1.60 (AMA1); 1.83, 95%CI: 1.15-2.93 (GLURP) (GLURP), and 1.35,; 95%CI: 1.03-1.78 (EBA175). Children born to mothers categorized as poorest had the highest risk of malaria infections in the first birth year (AHR: 1.79, 95% CI: 1.31-2.4). Children born to mothers who had malaria infections during gestation had higher risk of getting malaria in the first birth year (AHR 1.30; 95%CI: 0.97-1.7). CONCLUSION Malaria prophylaxis in pregnant mothers using either DP or SP does not affect expression of antibodies against P. falciparum specific antigens in the cord blood. Poverty and malaria infections during pregnancy are key risk factors of malaria infections in the first birth year of growth of children. Antibodies against P. falciparum specific antigens does not protect against parasitemia and malaria infections in the first birth year of children born in malaria endemic areas.
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Affiliation(s)
- Erick Jacob Okek
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Malaria Research Training Program, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Moses Ocan
- Department of Medicine, Malaria Research Training Program, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sande James Obondo
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anthony Kiyimba
- San Francisco Infectious Disease Research Collaboration, Makerere University-University of California, Kampala, Uganda
| | - Emmanuel Arinaitwe
- Department of Medicine, Malaria Research Training Program, College of Health Sciences, Makerere University, Kampala, Uganda
- San Francisco Infectious Disease Research Collaboration, Makerere University-University of California, Kampala, Uganda
| | - Joaniter Nankabirwa
- Department of Medicine, Malaria Research Training Program, College of Health Sciences, Makerere University, Kampala, Uganda
- San Francisco Infectious Disease Research Collaboration, Makerere University-University of California, Kampala, Uganda
| | - Isaac Ssewanyana
- San Francisco Infectious Disease Research Collaboration, Makerere University-University of California, Kampala, Uganda
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Moses Robert Kamya
- Department of Medicine, Malaria Research Training Program, College of Health Sciences, Makerere University, Kampala, Uganda
- San Francisco Infectious Disease Research Collaboration, Makerere University-University of California, Kampala, Uganda
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3
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Briggs J, Murray M, Nideffer J, Jagannathan P. Sex-Linked Differences in Malaria Risk Across the Lifespan. Curr Top Microbiol Immunol 2023; 441:185-208. [PMID: 37695429 DOI: 10.1007/978-3-031-35139-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Despite the high burden of malaria worldwide, there is surprisingly scarce research on sex-based differences in malaria outside of pregnancy. A more thorough understanding of sexual dimorphism in malaria, and what underlies these sex-based differences, could elucidate the underlying mechanisms driving malaria pathogenesis and has the potential to inform malaria control efforts, including new vaccines. This review summarizes our current understanding of sex-based differences in the epidemiology of malaria across the lifespan, potential sex- or gender-based mechanisms driving these differences, and the knowledge gaps that need to be addressed.
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Affiliation(s)
- Jessica Briggs
- Department of Medicine, University of California, San Francisco, California, United States
| | - Margaret Murray
- Department of Medicine, University of California, San Francisco, California, United States
| | - Jason Nideffer
- Department of Medicine, Stanford University, Stanford, California, United States
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States.
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4
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Dechavanne C, Nouatin O, Adamou R, Edslev S, Hansen A, Meurisse F, Sadissou I, Gbaguidi E, Milet J, Cottrell G, Gineau L, Sabbagh A, Massougbodji A, Moutairou K, Donadi EA, Carosella ED, Moreau P, Remarque E, Theisen M, Rouas-Freiss N, Garcia A, Favier B, Courtin D. Placental Malaria is Associated with Higher LILRB2 Expression in Monocyte Subsets and Lower Anti-Malarial IgG Antibodies During Infancy. Front Immunol 2022; 13:909831. [PMID: 35911674 PMCID: PMC9326509 DOI: 10.3389/fimmu.2022.909831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background Placental malaria (PM) is associated with a higher susceptibility of infants to Plasmodium falciparum (Pf) malaria. A hypothesis of immune tolerance has been suggested but no clear explanation has been provided so far. Our goal was to investigate the involvement of inhibitory receptors LILRB1 and LILRB2, known to drive immune evasion upon ligation with pathogen and/or host ligands, in PM-induced immune tolerance. Method Infants of women with or without PM were enrolled in Allada, southern Benin, and followed-up for 24 months. Antibodies with specificity for five blood stage parasite antigens were quantified by ELISA, and the frequency of immune cell subsets was quantified by flow cytometry. LILRB1 or LILRB2 expression was assessed on cells collected at 18 and 24 months of age. Findings Infants born to women with PM had a higher risk of developing symptomatic malaria than those born to women without PM (IRR=1.53, p=0.040), and such infants displayed a lower frequency of non-classical monocytes (OR=0.74, p=0.01) that overexpressed LILRB2 (OR=1.36, p=0.002). Moreover, infants born to women with PM had lower levels of cytophilic IgG and higher levels of IL-10 during active infection. Interpretation Modulation of IgG and IL-10 levels could impair monocyte functions (opsonisation/phagocytosis) in infants born to women with PM, possibly contributing to their higher susceptibility to malaria. The long-lasting effect of PM on infants’ monocytes was notable, raising questions about the capacity of ligands such as Rifins or HLA-I molecules to bind to LILRB1 and LILRB2 and to modulate immune responses, and about the reprogramming of neonatal monocytes/macrophages.
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Affiliation(s)
- Celia Dechavanne
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Odilon Nouatin
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Rafiou Adamou
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Sofie Edslev
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Anita Hansen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Florian Meurisse
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Université Paris-Saclay, Inserm, CEA, Fontenay-aux-Roses, France
| | - Ibrahim Sadissou
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Erasme Gbaguidi
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Jacqueline Milet
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Gilles Cottrell
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Laure Gineau
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Audrey Sabbagh
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Cotonou, Benin
| | - Kabirou Moutairou
- Laboratoire de Biologie et Physiologie Cellulaires, Faculté des Sciences et Techniques, Université d’Abomey-Calavi, Cotonou, Benin
| | - Eduardo A. Donadi
- Laboratory of Clinical Immunology, Ribeirão Preto Medicine School, University of São Paulo, Ribeirão Preto, Brazil
| | - Edgardo D. Carosella
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - Philippe Moreau
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - Ed Remarque
- Department of Parasitology, Biomedical Primate Research Centre, Rijswijk, Netherlands
| | - Michael Theisen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Nathalie Rouas-Freiss
- CEAA, DRF-Institut François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
- U976 HIPI Unit, IRSL, Université Paris, Paris, France
| | - André Garcia
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
| | - Benoit Favier
- Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Université Paris-Saclay, Inserm, CEA, Fontenay-aux-Roses, France
| | - David Courtin
- UMR 261 MERIT, Université Paris Cité, Institut de Recherche pour le Développement (IRD), Paris, France
- *Correspondence: David Courtin,
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Kakuru A, Roh ME, Kajubi R, Ochieng T, Ategeka J, Ochokoru H, Nakalembe M, Clark TD, Ruel T, Staedke SG, Chandramohan D, Havlir DV, Kamya MR, Dorsey G, Jagannathan P. Infant sex modifies associations between placental malaria and risk of malaria in infancy. Malar J 2020; 19:449. [PMID: 33272281 PMCID: PMC7713316 DOI: 10.1186/s12936-020-03522-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023] Open
Abstract
Background Placental malaria (PM) has been associated with a higher risk of malaria during infancy. However, it is unclear whether this association is causal, and is modified by infant sex, and whether intermittent preventive treatment in pregnancy (IPTp) can reduce infant malaria by preventing PM. Methods Data from a birth cohort of 656 infants born to HIV-uninfected mothers randomised to IPTp with dihydroartemisinin–piperaquine (DP) or Sulfadoxine–pyrimethamine (SP) was analysed. PM was categorized as no PM, active PM (presence of parasites), mild-moderate past PM (> 0–20% high powered fields [HPFs] with pigment), or severe past PM (> 20% HPFs with pigment). The association between PM and incidence of malaria in infants stratified by infant sex was examined. Causal mediation analysis was used to test whether IPTp can impact infant malaria incidence via preventing PM. Results There were 1088 malaria episodes diagnosed among infants during 596.6 person years of follow-up. Compared to infants born to mothers with no PM, the incidence of malaria was higher among infants born to mothers with active PM (adjusted incidence rate ratio [aIRR] 1.30, 95% CI 1.00–1.71, p = 0.05) and those born to mothers with severe past PM (aIRR 1.28, 95% CI 0.89–1.83, p = 0.18), but the differences were not statistically significant. However, when stratifying by infant sex, compared to no PM, severe past PM was associated a higher malaria incidence in male (aIRR 2.17, 95% CI 1.45–3.25, p < 0.001), but not female infants (aIRR 0.74, 95% CI 0.46–1.20, p = 0.22). There were no significant associations between active PM or mild-moderate past PM and malaria incidence in male or female infants. Male infants born to mothers given IPTp with DP had significantly less malaria in infancy than males born to mothers given SP, and 89.7% of this effect was mediated through prevention of PM. Conclusion PM may have more severe consequences for male infants, and interventions which reduce PM could mitigate these sex-specific adverse outcomes. More research is needed to better understand this sex-bias between PM and infant malaria risk. Trial registration ClinicalTrials.gov, NCT02793622. Registered 8 June 2016, https://clinicaltrials.gov/ct2/show/NCT02793622
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Affiliation(s)
- Abel Kakuru
- London School of Hygiene and Tropical Medicine, London, UK. .,Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda.
| | - Michelle E Roh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Teddy Ochieng
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - John Ategeka
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Harriet Ochokoru
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Miriam Nakalembe
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Tamara D Clark
- Department of Medicine, University of California, San Francisco, USA
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, USA
| | | | | | - Diane V Havlir
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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6
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Gies S, Roberts SA, Diallo S, Lompo OM, Tinto H, Brabin BJ. Risk of malaria in young children after periconceptional iron supplementation. MATERNAL AND CHILD NUTRITION 2020; 17:e13106. [PMID: 33236840 PMCID: PMC7988873 DOI: 10.1111/mcn.13106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 01/13/2023]
Abstract
This study in Burkina Faso investigated whether offspring of young mothers who had received weekly periconceptional iron supplementation in a randomised controlled trial were at increased risk of malaria. A child safety survey was undertaken in the peak month of malaria transmission towards the end of the trial to assess child iron biomarkers, nutritional status, anaemia and malaria outcomes. Antenatal iron biomarkers, preterm birth, fetal growth restriction and placental pathology for malaria and chorioamnionitis were assessed. Data were available for 180 babies surviving to the time of the survey when their median age was 9 months. Prevalence of maternal iron deficiency in the last trimester based on low body iron stores was 16%. Prevalence of active placental malaria infection was 24.8%, past infection 59% and chorioamnionitis 55.6%. Babies of iron supplemented women had lower median gestational age. Four out of five children ≥ 6 months were iron deficient, and 98% were anaemic. At 4 months malaria prevalence was 45%. Child iron biomarkers, anaemia and malaria outcomes did not differ by trial arm. Factors associated with childhood parasitaemia were third trimester C-reactive protein level (OR 2.1; 95% CI 1.1-3.9), active placental malaria (OR 5.8; 1.0-32.5, P = 0.042) and child body iron stores (OR 1.13; 1.04-1.23, P = 0.002). Chorioamnionitis was associated with reduced risk of child parasitaemia (OR 0.4; 0.1-1.0, P = 0.038). Periconceptional iron supplementation of young women did not alter body iron stores of their children. Higher child body iron stores and placental malaria increased risk of childhood parasitaemia.
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Affiliation(s)
- Sabine Gies
- Department of Biomedical Sciences, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.,Medical Mission Institute, Wurzburg, Germany
| | - Stephen A Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Salou Diallo
- Institute for Research in Health Sciences-Clinical Research Unit of Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Olga M Lompo
- Service d'Anatomocytopathologie et de Médicine Légale, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Halidou Tinto
- Institute for Research in Health Sciences-Clinical Research Unit of Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Bernard J Brabin
- Clinical Division, Liverpool School of Tropical Medicine, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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7
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Park S, Nixon CE, Miller O, Choi NK, Kurtis JD, Friedman JF, Michelow IC. Impact of Malaria in Pregnancy on Risk of Malaria in Young Children: Systematic Review and Meta-Analyses. J Infect Dis 2020; 222:538-550. [PMID: 32219317 PMCID: PMC7377293 DOI: 10.1093/infdis/jiaa139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Our objective was to quantify the risk of acquiring malaria among progeny of women with malaria during pregnancy. METHODS We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for eligible prospective studies. The primary predictor was malaria during pregnancy defined as placental malaria, parasitemia, clinical malaria, or pregnancy-associated malaria. Primary outcomes were parasitemia or clinically defined malaria of young children. We performed meta-analyses to pool adjusted risk estimates using a random-effects model. RESULTS Nineteen of 2053 eligible studies met inclusion criteria for the systemic review. Eleven of these studies were quantitative and were included in the meta-analyses. The pooled adjusted odds ratio (aOR) or adjusted hazard ratio (aHR) of malaria during pregnancy for detection of parasitemia in young children were 1.94 (95% confidence interval [CI], 0.93-4.07; P = .08) and 1.46 (95% CI, 1.07-2.00; P < .001), respectively. The pooled aOR or aHR for clinically defined malaria in young children were 2.82 (95% CI, 1.82-4.38; P < .001) and 1.31 (95% CI, 0.96-1.79; P = .09), respectively. CONCLUSIONS Our results confirmed that malaria during pregnancy significantly increased the overall risk of malaria in young children via indeterminate mechanisms and emphasize the urgent need to implement safe and highly effective strategies to prevent malaria during pregnancy.
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Affiliation(s)
- Sangshin Park
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea
| | - Christina E Nixon
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Olivia Miller
- Department of Global Health, DePauw University, Greencastle, Indiana, USA
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Jonathan D Kurtis
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jennifer F Friedman
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ian C Michelow
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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8
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Moncunill G, Dobaño C, González R, Smolen KK, Manaca MN, Balcells R, Jairoce C, Cisteró P, Vala A, Sevene E, Rupérez M, Aponte JJ, Macete E, Menéndez C, Kollmann TR, Mayor A. Association of Maternal Factors and HIV Infection With Innate Cytokine Responses of Delivering Mothers and Newborns in Mozambique. Front Microbiol 2020; 11:1452. [PMID: 32765436 PMCID: PMC7381182 DOI: 10.3389/fmicb.2020.01452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
Maternal factors and exposure to pathogens have an impact on infant health. For instance, HIV exposed but uninfected infants have higher morbidity and mortality than HIV unexposed infants. Innate responses are the first line of defense and orchestrate the subsequent adaptive immune response and are especially relevant in newborns. To determine the association of maternal HIV infection with maternal and newborn innate immunity we analyzed the cytokine responses upon pattern recognition receptor (PRR) stimulations in the triad of maternal peripheral and placental blood as well as in cord blood in a cohort of mother-infant pairs from southern Mozambique. A total of 48 women (35 HIV-uninfected and 13 HIV-infected) were included. Women and infant innate responses positively correlated with each other. Age, gravidity and sex of the fetus had some associations with spontaneous production of cytokines in the maternal peripheral blood. HIV-infected women not receiving antiretroviral therapy (ART) before pregnancy showed decreased IL-8 and IL-6 PRR responses in peripheral blood compared to those HIV-uninfected, and PRR hyporesponsiveness for IL-8 was also found in the corresponding infant’s cord blood. HIV infection had a greater impact on placental blood responses, with significantly increased pro-inflammatory, TH1 and TH17 PRR responses in HIV-infected women not receiving ART before pregnancy compared to HIV-uninfected women. In conclusion, innate response of the mother and her newborn was altered by HIV infection in the women who did not receive ART before pregnancy. As these responses could be related to birth outcomes, targeted innate immune modulation could improve maternal and newborn health.
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Affiliation(s)
- Gemma Moncunill
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Kinga K Smolen
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Maria N Manaca
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Reyes Balcells
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anifa Vala
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - María Rupérez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - John J Aponte
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Tobias R Kollmann
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.,Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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9
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Bouaziz O, Courtin D, Cottrell G, Milet J, Nuel G, Garcia A. Is Placental Malaria a Long-term Risk Factor for Mild Malaria Attack in Infancy? Revisiting a Paradigm. Clin Infect Dis 2019; 66:930-935. [PMID: 29069339 DOI: 10.1093/cid/cix899] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/18/2017] [Indexed: 11/12/2022] Open
Abstract
Background Children born to mothers with placental malaria (PM) have been described as more susceptible to the occurrence of a first malaria infection. However, whether or not these children remain more at risk during infancy has never been explored. We aimed to determine if children born to mothers with PM are more susceptible to malaria and remain at higher risk between birth and 18 months. Methods Five hundred fifty children were followed up weekly with control of temperature and, if >37.5°C, both a rapid diagnostic test for malaria and a thick blood smear were performed. Taking into account environmental risk of infection, the relationship between occurrences of malaria attacks from birth to 18 months was modeled using Cox models for recurrent events. Results PM is not associated with an overall susceptibility to malaria but only with the delay of occurrence of the first malaria attack. Children born from mothers with PM tend to have an increased risk for the first malaria attack (hazard ratio [HR] = 1.33; P = .048) but not for subsequent ones (HR = 0.9; P = .46). Children who experienced 1 malaria attack were strongly at risk to develop subsequent infections independent of placental infection and environmental exposure. Conclusions These results are consistent with the existence of an individual susceptibility to malaria unrelated to PM. From a public health point of view, protecting children born to infected placenta remains a priority, but seems insufficient to account for other frail children for whom a biomarker of frailty needs to be found.
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Affiliation(s)
- Olivier Bouaziz
- Laboratoire MAP5, Université Paris Descartes et CNRS, Sorbonne Paris Cité, France
| | - David Courtin
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gilles Cottrell
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France.,IRD, UMR 216, Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Bénin
| | - Jacqueline Milet
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gregory Nuel
- Laboratoire de Probabilités et Modèles Aléatoires/Université Pierre et Marie Curie, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement, UMR216 MERIT, Mère et enfant face aux infections tropicales, France.,Faculté de Pharmacie, Université Paris Descartes, Sorbonne Paris Cité, France.,IRD, UMR 216, Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Bénin
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10
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Feeney ME. The immune response to malaria in utero. Immunol Rev 2019; 293:216-229. [PMID: 31553066 DOI: 10.1111/imr.12806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
Malaria causes tremendous early childhood morbidity and mortality, providing an urgent impetus for the development of a vaccine that is effective in neonates. However, the infant immune response to malaria may be influenced by events that occur well before birth. Placental malaria infection complicates one quarter of all pregnancies in Africa and frequently results in exposure of the fetus to malaria antigens in utero, while the immune system is still developing. Some data suggest that in utero exposure to malaria may induce immunologic tolerance that interferes with the development of protective immunity during childhood. More recently, however, a growing body of evidence suggests that fetal malaria exposure can prime highly functional malaria-specific T- and B-cells, which may contribute to postnatal protection from malaria. In utero exposure to malaria also impacts the activation and maturation of fetal antigen presenting cells and innate lymphocytes, which could have implications for global immunity in the infant. Here, we review recent advances in our understanding of how various components of the fetal immune system are altered by in utero exposure to malaria, discuss factors that may tilt the critical balance between tolerance and adaptive immunity, and consider the implications of these findings for malaria prevention strategies.
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Affiliation(s)
- Margaret E Feeney
- Departments of Pediatrics and Medicine, University of California, San Francisco, San Francisco, CA, USA
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11
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Natama HM, Rovira-Vallbona E, Sorgho H, Somé MA, Traoré-Coulibaly M, Scott S, Zango SH, Sawadogo O, Zongo SC, Valéa I, Mens PF, Schallig HDFH, Kestens L, Tinto H, Rosanas-Urgell A. Additional Screening and Treatment of Malaria During Pregnancy Provides Further Protection Against Malaria and Nonmalarial Fevers During the First Year of Life. J Infect Dis 2019; 217:1967-1976. [PMID: 29659897 DOI: 10.1093/infdis/jiy140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background Although consensus exists that malaria in pregnancy (MiP) increases the risk of malaria in infancy, and eventually nonmalarial fevers (NMFs), there is a lack of conclusive evidence of benefits of MiP preventive strategies in infants. Methods In Burkina Faso, a birth cohort study was nested to a clinical trial assessing the effectiveness of a community-based scheduled screening and treatment of malaria in combination with intermittent preventive treatment with sulfadoxine-pyrimethamine (CSST/IPTp-SP) to prevent placental malaria. Clinical episodes and asymptomatic infections were monitored over 1 year of follow-up to compare the effect of CSST/IPTp-SP and standard IPTp-SP on malaria and NMFs. Results Infants born during low-transmission season from mothers receiving CSST/IPTp-SP had a 26% decreased risk of experiencing a first clinical episode (hazard ratio, 0.74 [95% confidence interval, .55-0.99]; P = .047). CSST/IPTp-SP interacted with birth season and gravidity to reduce the incidence of NMFs. No significant effects of CSST/IPTp-SP on the incidence of clinical episodes, parasite density, and Plasmodium falciparum infections were observed. Conclusions Our findings indicate that CSST/IPTp-SP strategy may provide additional protection against both malaria and NMFs in infants during the first year of life, and suggest that malaria control interventions during pregnancy could have long-term benefits in infants.
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Affiliation(s)
- Hamtandi Magloire Natama
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Department of Biomedical Sciences, University of Antwerp, Belgium
| | | | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Maminata Traoré-Coulibaly
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Susana Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Serge Henri Zango
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Ousséni Sawadogo
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Sibiri Claude Zongo
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Innocent Valéa
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology, Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology, Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Belgium
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.,Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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12
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Kakuru A, Staedke SG, Dorsey G, Rogerson S, Chandramohan D. Impact of Plasmodium falciparum malaria and intermittent preventive treatment of malaria in pregnancy on the risk of malaria in infants: a systematic review. Malar J 2019; 18:304. [PMID: 31481075 PMCID: PMC6724246 DOI: 10.1186/s12936-019-2943-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/28/2019] [Indexed: 09/16/2023] Open
Abstract
Background Studies of the association between malaria in pregnancy (MiP) and malaria during infancy have provided mixed results. A systematic review was conducted to evaluate available evidence on the impact of Plasmodium falciparum malaria infection during pregnancy, and intermittent preventive treatment of malaria during pregnancy (IPTp), on the risk of clinical malaria or parasitaemia during infancy. Methods MEDLINE, EMBASE, Global Health, and Malaria in Pregnancy Library databases were searched from inception to 22 May 2018 for articles published in English that reported on associations between MiP and malaria risk in infancy. Search terms included malaria, Plasmodium falciparum, pregnancy, placenta, maternal, prenatal, foetal, newborn, infant, child or offspring or preschool. Randomized controlled trials and prospective cohort studies, which followed infants for at least 6 months, were included if any of the following outcomes were reported: incidence of clinical malaria, prevalence of parasitaemia, and time to first episode of parasitaemia or clinical malaria. Substantial heterogeneity between studies precluded meta-analysis. Thus, a narrative synthesis of included studies was conducted. Results The search yielded 14 published studies, 10 prospective cohort studies and four randomized trials; all were conducted in sub-Saharan Africa. Infants born to mothers with parasitaemia during pregnancy were at higher risk of malaria in three of four studies that assessed this association. Placental malaria detected by microscopy or histology was associated with a higher risk of malaria during infancy in nine of 12 studies, but only one study adjusted for malaria transmission intensity. No statistically significant associations between the use of IPTp or different IPTp regimens and the risk of malaria during infancy were identified. Conclusion Evidence of an association between MiP and IPTp and risk of malaria in infancy is limited and of variable quality. Most studies did not adequately adjust for malaria transmission intensity shared by mothers and their infants. Further research is needed to confirm or exclude an association between MiP and malaria in infancy. Randomized trials evaluating highly effective interventions aimed at preventing MiP, such as IPTp with dihydroartemisinin–piperaquine, may help to establish a causal association between MiP and malaria in infancy.
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Affiliation(s)
- Abel Kakuru
- Infectious Diseases Research Collaboration, P.O Box 7475, Kampala, Uganda. .,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Grant Dorsey
- University of California San Francisco, San Francisco, CA, USA
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, University of Melbourne, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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13
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Avokpaho E, d'Almeida TC, Sadissou I, Tokplonou L, Adamou R, Sonon P, Milet J, Cottrell G, Mondière A, Massougbodji A, Moutairou K, Donadi EA, Teixeira Mendes Junior C, Favier B, Carosella E, Moreau P, Rouas-Freiss N, Garcia A, Courtin D. HLA-G expression during hookworm infection in pregnant women. Acta Trop 2019; 196:52-59. [PMID: 31078470 DOI: 10.1016/j.actatropica.2019.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION HLA-G plays a key role on immune tolerance. Pathogens can induce soluble HLA-G (sHLA-G) production to down-regulate the host immune response, creating a tolerogenic environment favorable for their dissemination. To our knowledge, no study has yet been conducted to assess the relationship between sHLA-G and geohelminth infections. METHODS The study was conducted in Allada, Southeastern Benin, from 2011-2014. The study population encompassed 400 pregnant women, included before the end of the 28th week of gestation and followed-up until delivery. At two antenatal care visits and at delivery, stool and blood samples were collected. Helminths were diagnosed by means of the Kato-Katz concentration technique. We used quantile regression to analyze the association between helminth infections and sHLA-G levels during pregnancy. RESULTS sHLA-G levels gradually increased during pregnancy and reached maximal levels at delivery. Prevalence of helminth infections was low, with a majority of hookworm infections. We found significantly more hookworm-infected women above the 80th quantile (Q80) of the distribution of the mean sHLA-G level (p < 0.03, multivariate quantile regression). Considering only women above the Q80 percentile, the mean sHLA-G level was significantly higher in hookworm-infected compared to uninfected women (p = 0.04). CONCLUSION High levels of sHLA-G were associated with hookworm infection in pregnant women. This result is consistent with the potential involvement of sHLA-G in immune tolerance induced by helminths during pregnancy.
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Affiliation(s)
- Euripide Avokpaho
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Tania C d'Almeida
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Ibrahim Sadissou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin; Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Léonidas Tokplonou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin
| | - Rafiou Adamou
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin
| | - Paulin Sonon
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France; Université d'Abomey-Calavi, Cotonou, Benin; Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Jacqueline Milet
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Gilles Cottrell
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - Amandine Mondière
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | | | | | - Eduardo A Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Celso Teixeira Mendes Junior
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Brazil
| | - Benoit Favier
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Edgardo Carosella
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Philippe Moreau
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherche en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, IUH, Hôpital Saint-Louis, UMRE5, IUH, Paris, France
| | - André Garcia
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France
| | - David Courtin
- MERIT, Institut de Recherche pour le Développement (IRD), Université Sorbonne Paris Cité, Université Paris Descartes, France.
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14
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d'Almeida TC, Sadissou I, Sagbohan M, Milet J, Avokpaho E, Gineau L, Sabbagh A, Moutairou K, Donadi EA, Favier B, Pennetier C, Baldet T, Moiroux N, Carosella E, Moreau P, Rouas-Freiss N, Cottrell G, Courtin D, Garcia A. High level of soluble human leukocyte antigen (HLA)-G at beginning of pregnancy as predictor of risk of malaria during infancy. Sci Rep 2019; 9:9160. [PMID: 31235762 PMCID: PMC6591392 DOI: 10.1038/s41598-019-45688-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/11/2019] [Indexed: 12/14/2022] Open
Abstract
Placental malaria has been associated with an immune tolerance phenomenon and a higher susceptibility to malaria infection during infancy. HLA-G is involved in fetal maternal immune tolerance by inhibiting maternal immunity. During infections HLA-G can be involved in immune escape of pathogens by creating a tolerogenic environment. Recent studies have shown an association between the risk of malaria and HLA-G at both genetic and protein levels. Moreover, women with placental malaria have a higher probability of giving birth to children exhibiting high sHLA-G, independently of their own level during pregnancy. Our aim was to explore the association between the level of maternal soluble HLA-G and the risk of malaria infection in their newborns. Here, 400 pregnant women and their children were actively followed-up during 24 months. The results show a significant association between the level of sHLA-G at the first antenatal visit and the time to first malaria infection during infancy adjusted to the risk of exposure to vector bites (aHR = 1.02, 95%CI [1.01–1.03], p = 0.014). The level of sHLA-G is a significant predictor of the occurrence of malaria infection during infancy consistent with the hypothesis that mother sHLA-G could be a biomarker of malaria susceptibility in children.
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Affiliation(s)
- Tania C d'Almeida
- Université Pierre et Marie Curie, Paris VI, France.,MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - Ibrahim Sadissou
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.,Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,Université d'Abomey-Calavi, Cotonou, Benin
| | - Mermoz Sagbohan
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.,Université d'Abomey-Calavi, Cotonou, Benin
| | | | - Euripide Avokpaho
- IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin
| | - Laure Gineau
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - Audrey Sabbagh
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | | | - Eduardo A Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Benoit Favier
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Cédric Pennetier
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Thierry Baldet
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Nicolas Moiroux
- UMR MIVEGEC (IRD-CNRS-UM), Montpellier, France.,Centre de Recherche Entomologiques de Cotonou (CREC), Cotonou, Benin
| | - Edgardo Carosella
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Philippe Moreau
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives, Direction de la Recherche Fondamentale, Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, IUH, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Gilles Cottrell
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France.,IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin
| | - David Courtin
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France
| | - André Garcia
- MERIT, IRD, Université Paris Descartes, Paris, 75006, France. .,IRD, UMR 261, Centre d'Étude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Cotonou, Benin.
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15
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Lawford HLS, Lee AC, Kumar S, Liley HG, Bora S. Establishing a conceptual framework of the impact of placental malaria on infant neurodevelopment. Int J Infect Dis 2019; 84:54-65. [PMID: 31028878 DOI: 10.1016/j.ijid.2019.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 01/11/2023] Open
Abstract
A novel conceptual framework to describe the relationship between placental malaria and adverse infant neurodevelopmental outcomes is proposed. This conceptual framework includes three distinct stages: (1) maternal and environmental risk factors for the development of placental malaria; (2) placental pathology and inflammation associated with placental malaria infection; and (3) postnatal impacts of placental malaria. The direct, indirect, and bidirectional effects of these risk factors on infant neurodevelopment across the three stages were critically examined. These factors ultimately culminate in an infant phenotype that not only leads to adverse birth outcomes, but also to increased risks of neurological, cognitive, and behavioural deficits that may impact the quality of life in this high-risk population. Multiple risk factors were identified in this conceptual framework; nonetheless, based on current evidence, a key knowledge gap is the uncertainty regarding which are the most important and how exactly they interact.
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Affiliation(s)
- Harriet L S Lawford
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sailesh Kumar
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Helen G Liley
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia.
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16
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Abstract
Malaria in pregnancy not only exerts profound negative consequences on the health of the mother and developing fetus, but may also alter the risk of malaria during infancy. Although mechanisms driving this altered risk remain unclear, in utero exposure to malaria antigens may impact the development of fetal and infant innate immunity. In an article in BMC Medicine, Natama et al. describe an ambitious analysis of basal and TLR-stimulated cord blood responses among a birth cohort in Burkina Faso. Basal levels of several cytokines, chemokines, and growth factors were shown to be significantly lower in cord blood with histopathologic evidence of placental malaria. Additionally, following TLR7/8 stimulation, samples obtained from infants of mothers with placental malaria were hyper-responsive compared to those without evidence of prenatal malaria exposure. Furthermore, several responses impacted by placental malaria were associated with differential malaria risk in infancy. Understanding how malaria in pregnancy shapes immune responses in infants will provide critical insight into the rational design of malaria control strategies during pregnancy, including intermittent preventative treatment in pregnancy and vaccines.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1187-3.
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17
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González R, Pons‐Duran C, Piqueras M, Aponte JJ, ter Kuile FO, Menéndez C. Mefloquine for preventing malaria in pregnant women. Cochrane Database Syst Rev 2018; 11:CD011444. [PMID: 30480761 PMCID: PMC6517148 DOI: 10.1002/14651858.cd011444.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine for malaria for all women who live in moderate to high malaria transmission areas in Africa. However, parasite resistance to sulfadoxine-pyrimethamine has been increasing steadily in some areas of the region. Moreover, HIV-infected women on cotrimoxazole prophylaxis cannot receive sulfadoxine-pyrimethamine because of potential drug interactions. Thus, there is an urgent need to identify alternative drugs for prevention of malaria in pregnancy. One such candidate is mefloquine. OBJECTIVES To assess the effects of mefloquine for preventing malaria in pregnant women, specifically, to evaluate:• the efficacy, safety, and tolerability of mefloquine for preventing malaria in pregnant women; and• the impact of HIV status, gravidity, and use of insecticide-treated nets on the effects of mefloquine. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS), the Malaria in Pregnancy Library, and two trial registers up to 31 January 2018. In addition, we checked references and contacted study authors to identify additional studies, unpublished data, confidential reports, and raw data from published trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing mefloquine IPT or mefloquine prophylaxis against placebo, no treatment, or an alternative drug regimen. DATA COLLECTION AND ANALYSIS Two review authors independently screened all records identified by the search strategy, applied inclusion criteria, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when required. Dichotomous outcomes were compared using risk ratios (RRs), count outcomes as incidence rate ratios (IRRs), and continuous outcomes using mean differences (MDs). We have presented all measures of effect with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach for the following main outcomes of analysis: maternal peripheral parasitaemia at delivery, clinical malaria episodes during pregnancy, placental malaria, maternal anaemia at delivery, low birth weight, spontaneous abortions and stillbirths, dizziness, and vomiting. MAIN RESULTS Six trials conducted between 1987 and 2013 from Thailand (1), Benin (3), Gabon (1), Tanzania (1), Mozambique (2), and Kenya (1) that included 8192 pregnant women met our inclusion criteria.Two trials (with 6350 HIV-uninfected pregnant women) compared two IPTp doses of mefloquine with two IPTp doses of sulfadoxine-pyrimethamine. Two other trials involving 1363 HIV-infected women compared three IPTp doses of mefloquine plus cotrimoxazole with cotrimoxazole. One trial in 140 HIV-infected women compared three doses of IPTp-mefloquine with cotrimoxazole. Finally, one trial enrolling 339 of unknown HIV status compared mefloquine prophylaxis with placebo.Study participants included women of all gravidities and of all ages (four trials) or > 18 years (two trials). Gestational age at recruitment was > 20 weeks (one trial), between 16 and 28 weeks (three trials), or ≤ 28 weeks (two trials). Two of the six trials blinded participants and personnel, and only one had low risk of detection bias for safety outcomes.When compared with sulfadoxine-pyrimethamine, IPTp-mefloquine results in a 35% reduction in maternal peripheral parasitaemia at delivery (RR 0.65, 95% CI 0.48 to 0.86; 5455 participants, 2 studies; high-certainty evidence) but may have little or no effect on placental malaria infections (RR 1.04, 95% CI 0.58 to 1.86; 4668 participants, 2 studies; low-certainty evidence). Mefloquine results in little or no difference in the incidence of clinical malaria episodes during pregnancy (incidence rate ratio (IRR) 0.83, 95% CI 0.65 to 1.05, 2 studies; high-certainty evidence). Mefloquine decreased maternal anaemia at delivery (RR 0.84, 95% CI 0.76 to 0.94; 5469 participants, 2 studies; moderate-certainty evidence). Data show little or no difference in the proportions of low birth weight infants (RR 0.95, 95% CI 0.78 to 1.17; 5641 participants, 2 studies; high-certainty evidence) and in stillbirth and spontaneous abortion rates (RR 1.20, 95% CI 0.91 to 1.58; 6219 participants, 2 studies; I2 statistic = 0%; moderate-certainty evidence). IPTp-mefloquine increased drug-related vomiting (RR 4.76, 95% CI 4.13 to 5.49; 6272 participants, 2 studies; high-certainty evidence) and dizziness (RR 4.21, 95% CI 3.36 to 5.27; participants = 6272, 2 studies; moderate-certainty evidence).When compared with cotrimoxazole, IPTp-mefloquine plus cotrimoxazole probably results in a 48% reduction in maternal peripheral parasitaemia at delivery (RR 0.52, 95% CI 0.30 to 0.93; 989 participants, 2 studies; moderate-certainty evidence) and a 72% reduction in placental malaria (RR 0.28, 95% CI 0.14 to 0.57; 977 participants, 2 studies; moderate-certainty evidence) but has little or no effect on the incidence of clinical malaria episodes during pregnancy (IRR 0.76, 95% CI 0.33 to 1.76, 1 study; high-certainty evidence) and probably no effect on maternal anaemia at delivery (RR 0.94, 95% CI 0.73 to 1.20; 1197 participants, 2 studies; moderate-certainty evidence), low birth weight rates (RR 1.20, 95% CI 0.89 to 1.60; 1220 participants, 2 studies; moderate-certainty evidence), and rates of spontaneous abortion and stillbirth (RR 1.12, 95% CI 0.42 to 2.98; 1347 participants, 2 studies; very low-certainty evidence). Mefloquine was associated with higher risks of drug-related vomiting (RR 7.95, 95% CI 4.79 to 13.18; 1055 participants, one study; high-certainty evidence) and dizziness (RR 3.94, 95% CI 2.85 to 5.46; 1055 participants, 1 study; high-certainty evidence). AUTHORS' CONCLUSIONS Mefloquine was more efficacious than sulfadoxine-pyrimethamine in HIV-uninfected women or daily cotrimoxazole prophylaxis in HIV-infected pregnant women for prevention of malaria infection and was associated with lower risk of maternal anaemia, no adverse effects on pregnancy outcomes (such as stillbirths and abortions), and no effects on low birth weight and prematurity. However, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women.
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Affiliation(s)
- Raquel González
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Clara Pons‐Duran
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Mireia Piqueras
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - John J Aponte
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Feiko O ter Kuile
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
| | - Clara Menéndez
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
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18
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Natama HM, Moncunill G, Rovira-Vallbona E, Sanz H, Sorgho H, Aguilar R, Coulibaly-Traoré M, Somé MA, Scott S, Valéa I, Mens PF, Schallig HDFH, Kestens L, Tinto H, Dobaño C, Rosanas-Urgell A. Modulation of innate immune responses at birth by prenatal malaria exposure and association with malaria risk during the first year of life. BMC Med 2018; 16:198. [PMID: 30384846 PMCID: PMC6214168 DOI: 10.1186/s12916-018-1187-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/05/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Factors driving inter-individual differences in immune responses upon different types of prenatal malaria exposure (PME) and subsequent risk of malaria in infancy remain poorly understood. In this study, we examined the impact of four types of PME (i.e., maternal peripheral infection and placental acute, chronic, and past infections) on both spontaneous and toll-like receptors (TLRs)-mediated cytokine production in cord blood and how these innate immune responses modulate the risk of malaria during the first year of life. METHODS We conducted a birth cohort study of 313 mother-child pairs nested within the COSMIC clinical trial (NCT01941264), which was assessing malaria preventive interventions during pregnancy in Burkina Faso. Malaria infections during pregnancy and infants' clinical malaria episodes detected during the first year of life were recorded. Supernatant concentrations of 30 cytokines, chemokines, and growth factors induced by stimulation of cord blood with agonists of TLRs 3, 7/8, and 9 were measured by quantitative suspension array technology. Crude concentrations and ratios of TLR-mediated cytokine responses relative to background control were analyzed. RESULTS Spontaneous production of innate immune biomarkers was significantly reduced in cord blood of infants exposed to malaria, with variation among PME groups, as compared to those from the non-exposed control group. However, following TLR7/8 stimulation, which showed higher induction of cytokines/chemokines/growth factors than TLRs 3 and 9, cord blood cells of infants with evidence of past placental malaria were hyper-responsive in comparison to those of infants not-exposed. In addition, certain biomarkers, which levels were significantly modified depending on the PME category, were independent predictors of either malaria risk (GM-CSF TLR7/8 crude) or protection (IL-12 TLR7/8 ratio and IP-10 TLR3 crude, IL-1RA TLR7/8 ratio) during the first year of life. CONCLUSIONS These findings indicate that past placental malaria has a profound effect on fetal immune system and that the differential alterations of innate immune responses by PME categories might drive heterogeneity between individuals to clinical malaria susceptibility during the first year of life.
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Affiliation(s)
- Hamtandi Magloire Natama
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.,Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso.,Department of Biomedical Sciences, University of Antwerp, B 2610, Antwerp, Belgium
| | - Gemma Moncunill
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Eduard Rovira-Vallbona
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium
| | - Héctor Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Hermann Sorgho
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Ruth Aguilar
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Maminata Coulibaly-Traoré
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - M Athanase Somé
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Susana Scott
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | - Innocent Valéa
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso
| | - Petra F Mens
- Department of Medical Microbiology - Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology - Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Luc Kestens
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, B 2610, Antwerp, Belgium
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, BP218, Nanoro, Burkina Faso.,Centre Muraz, BP390, Bobo Dioulasso, Burkina Faso
| | - Carlota Dobaño
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic - Universitat de Barcelona, Carrer Rossello 132, E-08036, Barcelona, Catalonia, Spain
| | - Anna Rosanas-Urgell
- Department of Biomedical Sciences, Institute of Tropical Medicine, B 2000, Antwerp, Belgium.
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19
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Harrington WE, Kakuru A, Jagannathan P. Malaria in pregnancy shapes the development of foetal and infant immunity. Parasite Immunol 2018; 41:e12573. [PMID: 30019470 DOI: 10.1111/pim.12573] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/21/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
Abstract
Malaria, particularly Plasmodium falciparum, continues to disproportionately affect pregnant women. In addition to the profoundly deleterious impact of maternal malaria on the health of the mother and foetus, malaria infection in pregnancy has been shown to affect the development of the foetal and infant immune system and may alter the risk of malaria and nonmalarial outcomes during infancy. This review summarizes our current understanding of how malaria infection in pregnancy shapes the protective components of the maternal immune system transferred to the foetus and how foetal exposure to parasite antigens impacts the development of foetal and infant immunity. It also reviews existing evidence linking malaria infection in pregnancy to malaria and nonmalarial outcomes in infancy and how preventing malaria in pregnancy may alter these outcomes. A better understanding of the consequences of malaria infection in pregnancy on the development of foetal and infant immunity will inform control strategies, including intermittent preventive treatment in pregnancy and vaccine development.
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Affiliation(s)
- Whitney E Harrington
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
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20
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Song Y, Aguilar R, Guo J, Manaca MN, Nhabomba A, Berthoud TK, Khoo SK, Wiertsema S, Barbosa A, Quintó L, Laing IA, Mayor A, Guinovart C, Alonso PL, LeSouëf PN, Dobaño C, Zhang GB. Cord Blood IL-12 Confers Protection to Clinical Malaria in Early Childhood Life. Sci Rep 2018; 8:10860. [PMID: 30022038 PMCID: PMC6052074 DOI: 10.1038/s41598-018-29179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022] Open
Abstract
Using a well-designed longitudinal cohort, we aimed to identify cytokines that were protective against malaria and to explore how they were influenced by genetic and immunological factors. 349 Mozambican pregnant women and their newborn babies were recruited and followed up for malaria outcomes until 24 months of age. Six Th1 cytokines in cord blood were screened for correlation with malaria incidence, of which IL-12 was selected for further analyses. We genotyped IL-12 polymorphisms in children/mothers and evaluated the genotype-phenotype associations and genetic effects on IL-12 levels. Maternal IL-12 concentrations were also investigated in relation to Plasmodium infections and cord blood IL-12 levels. Our data showed that high background IL-12 levels were prospectively associated with a low incidence of clinical malaria, while IL-12 production after parasite stimulation had the opposite effect on malaria incidence. IL-12 genotypes (IL-12b rs2288831/rs17860508) and the haplotype CGTTAGAG distribution were related to malaria susceptibility and background IL-12 levels. Maternal genotypes also exhibited an evident impact on host genotype-phenotype associations. Finally, a positive correlation in background IL-12 levels between maternal and cord blood was identified. Thus, cord blood background IL-12 concentrations are important for protecting children from clinical malaria, likely mediated by both genotypes (children&mothers) and maternal immunity.
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Affiliation(s)
- Yong Song
- School of Public Health, Curtin University, Perth, 6102, Western Australia, Australia.,Centre for Genetic Origins of Health and Disease, The University of Western Australia and Curtin University, Perth, 6009, Western Australia, Australia
| | - Ruth Aguilar
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique.,ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Jing Guo
- School of Public Health, Curtin University, Perth, 6102, Western Australia, Australia.,Centre for Genetic Origins of Health and Disease, The University of Western Australia and Curtin University, Perth, 6009, Western Australia, Australia
| | - Maria Nelia Manaca
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique
| | - Tamara Katherine Berthoud
- ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Siew-Kim Khoo
- School of Paediatrics and Child Health, The University of Western Australia, Perth, 6009, Western Australia, Australia
| | - Selma Wiertsema
- School of Paediatrics and Child Health, The University of Western Australia, Perth, 6009, Western Australia, Australia
| | - Arnoldo Barbosa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Ingrid A Laing
- School of Paediatrics and Child Health, The University of Western Australia, Perth, 6009, Western Australia, Australia
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Caterina Guinovart
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique.,ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Pedro L Alonso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique.,ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain
| | - Peter N LeSouëf
- School of Paediatrics and Child Health, The University of Western Australia, Perth, 6009, Western Australia, Australia
| | - Carlota Dobaño
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, CP1929, Mozambique. .,ISGlobal, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Catalonia, 08036, Spain.
| | - Guicheng Brad Zhang
- School of Public Health, Curtin University, Perth, 6102, Western Australia, Australia. .,Centre for Genetic Origins of Health and Disease, The University of Western Australia and Curtin University, Perth, 6009, Western Australia, Australia. .,Curtin Health Innovation Research Institute, Curtin University, Perth, 6102, Western Australia, Australia.
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21
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Jagannathan P, Kakuru A, Okiring J, Muhindo MK, Natureeba P, Nakalembe M, Opira B, Olwoch P, Nankya F, Ssewanyana I, Tetteh K, Drakeley C, Beeson J, Reiling L, Clark TD, Rodriguez-Barraquer I, Greenhouse B, Wallender E, Aweeka F, Prahl M, Charlebois ED, Feeney ME, Havlir DV, Kamya MR, Dorsey G. Dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria during pregnancy and risk of malaria in early childhood: A randomized controlled trial. PLoS Med 2018; 15:e1002606. [PMID: 30016328 PMCID: PMC6049882 DOI: 10.1371/journal.pmed.1002606] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment of malaria in pregnancy (IPTp) with dihydroartemisinin-piperaquine (IPTp-DP) has been shown to reduce the burden of malaria during pregnancy compared to sulfadoxine-pyrimethamine (IPTp-SP). However, limited data exist on how IPTp regimens impact malaria risk during infancy. We conducted a double-blinded randomized controlled trial (RCT) to test the hypothesis that children born to mothers given IPTp-DP would have a lower incidence of malaria during infancy compared to children born to mothers who received IPTp-SP. METHODS AND FINDINGS We compared malaria metrics among children in Tororo, Uganda, born to women randomized to IPTp-SP given every 8 weeks (SP8w, n = 100), IPTp-DP every 8 weeks (DP8w, n = 44), or IPTp-DP every 4 weeks (DP4w, n = 47). After birth, children were given chemoprevention with DP every 12 weeks from 8 weeks to 2 years of age. The primary outcome was incidence of malaria during the first 2 years of life. Secondary outcomes included time to malaria from birth and time to parasitemia following each dose of DP given during infancy. Results are reported after adjustment for clustering (twin gestation) and potential confounders (maternal age, gravidity, and maternal parasitemia status at enrolment).The study took place between June 2014 and May 2017. Compared to children whose mothers were randomized to IPTp-SP8w (0.24 episodes per person year [PPY]), the incidence of malaria was higher in children born to mothers who received IPTp-DP4w (0.42 episodes PPY, adjusted incidence rate ratio [aIRR] 1.92; 95% CI 1.00-3.65, p = 0.049) and nonsignificantly higher in children born to mothers who received IPT-DP8w (0.30 episodes PPY, aIRR 1.44; 95% CI 0.68-3.05, p = 0.34). However, these associations were modified by infant sex. Female children whose mothers were randomized to IPTp-DP4w had an apparently 4-fold higher incidence of malaria compared to female children whose mothers were randomized to IPTp-SP8w (0.65 versus 0.20 episodes PPY, aIRR 4.39, 95% CI 1.87-10.3, p = 0.001), but no significant association was observed in male children (0.20 versus 0.28 episodes PPY, aIRR 0.66, 95% CI 0.25-1.75, p = 0.42). Nonsignificant increases in malaria incidence were observed among female, but not male, children born to mothers who received DP8w versus SP8w. In exploratory analyses, levels of malaria-specific antibodies in cord blood were similar between IPTp groups and sex. However, female children whose mothers were randomized to IPTp-DP4w had lower mean piperaquine (PQ) levels during infancy compared to female children whose mothers received IPTp-SP8w (coef 0.81, 95% CI 0.65-1.00, p = 0.048) and male children whose mothers received IPTp-DP4w (coef 0.72, 95% CI 0.57-0.91, p = 0.006). There were no significant sex-specific differences in PQ levels among children whose mothers were randomized to IPTp-SP8w or IPTp-DP8w. The main limitations were small sample size and childhood provision of DP every 12 weeks in infancy. CONCLUSIONS Contrary to our hypothesis, preventing malaria in pregnancy with IPTp-DP in the context of chemoprevention with DP during infancy does not lead to a reduced incidence of malaria in childhood; in this setting, it may be associated with an increased incidence of malaria in females. Future studies are needed to better understand the biological mechanisms of in utero drug exposure on drug metabolism and how this may affect the dosing of antimalarial drugs for treatment and prevention during infancy. TRIAL REGISTRATION ClinicalTrials.gov number NCT02163447.
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MESH Headings
- Adolescent
- Adult
- Antimalarials/administration & dosage
- Antimalarials/adverse effects
- Artemisinins/administration & dosage
- Artemisinins/adverse effects
- Child, Preschool
- Double-Blind Method
- Drug Administration Schedule
- Drug Combinations
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/prevention & control
- Malaria, Falciparum/transmission
- Pregnancy
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Complications, Parasitic/prevention & control
- Pyrimethamine/administration & dosage
- Pyrimethamine/adverse effects
- Quinolines/administration & dosage
- Quinolines/adverse effects
- Sulfadoxine/administration & dosage
- Sulfadoxine/adverse effects
- Time Factors
- Treatment Outcome
- Uganda/epidemiology
- Young Adult
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Affiliation(s)
- Prasanna Jagannathan
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Paul Natureeba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Miriam Nakalembe
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bishop Opira
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Olwoch
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Kevin Tetteh
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Tamara D. Clark
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Isabel Rodriguez-Barraquer
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Erika Wallender
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Francesca Aweeka
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
| | - Mary Prahl
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Margaret E. Feeney
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Diane V. Havlir
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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22
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Akinyotu O, Bello F, Abdus-Salam R, Arowojolu A. Comparative study of mefloquine and sulphadoxine-pyrimethamine for malaria prevention among pregnant women with HIV in southwest Nigeria. Int J Gynaecol Obstet 2018; 142:194-200. [PMID: 29719927 DOI: 10.1002/ijgo.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the effectiveness of mefloquine and sulphadoxine-pyrimethamine as intermittent preventive therapy for malaria among pregnant women with HIV. METHODS The present randomized, controlled, prospective, open-label study enrolled women with HIV who had reached at least 16 weeks of pregnancy attending prenatal clinics at secondary and tertiary health facilities in South West Nigeria between January 1 and August 31, 2016. Block randomization was used to assign patients to treatment with mefloquine or sulphadoxine-pyrimethamine for malaria prophylaxis. The primary outcome was malaria parasitemia at delivery. Data were compared with the χ2 and t tests on a per-protocol basis. RESULTS Of 142 women enrolled and randomized equally to each group, 131 (92.3%) completed the study (64 in the mefloquine group and 67 in the sulphadoxine-pyrimethamine group). Blood-sample malaria parasites were isolated from 6 (9%) and 5 (7%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at enrolment, and 6 (9%) and 9 (13%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at delivery; the differences between the groups was not significant at enrolment (P=0.693) or delivery (P=0.466). CONCLUSION Outcomes following prophylactic use of mefloquine for intermittent preventive therapy for malaria among pregnant women with HIV were comparable to sulphadoxine-pyrimethamine treatment; mefloquine is a feasible alternative therapy. ClinicalTrials.gov: NCT02524444.
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Affiliation(s)
- Oriyomi Akinyotu
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
| | - Folasade Bello
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
| | | | - Ayodele Arowojolu
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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23
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González R, Pons‐Duran C, Piqueras M, Aponte JJ, ter Kuile FO, Menéndez C. Mefloquine for preventing malaria in pregnant women. Cochrane Database Syst Rev 2018; 3:CD011444. [PMID: 29561063 PMCID: PMC5875065 DOI: 10.1002/14651858.cd011444.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine for malaria for all women who live in moderate to high malaria transmission areas in Africa. However, parasite resistance to sulfadoxine-pyrimethamine has been increasing steadily in some areas of the region. Moreover, HIV-infected women on cotrimoxazole prophylaxis cannot receive sulfadoxine-pyrimethamine because of potential drug interactions. Thus, there is an urgent need to identify alternative drugs for prevention of malaria in pregnancy. One such candidate is mefloquine. OBJECTIVES To assess the effects of mefloquine for preventing malaria in pregnant women, specifically, to evaluate:• the efficacy, safety, and tolerability of mefloquine for preventing malaria in pregnant women; and• the impact of HIV status, gravidity, and use of insecticide-treated nets on the effects of mefloquine. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS), the Malaria in Pregnancy Library, and two trial registers up to 31 January 2018. In addition, we checked references and contacted study authors to identify additional studies, unpublished data, confidential reports, and raw data from published trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing mefloquine IPT or mefloquine prophylaxis against placebo, no treatment, or an alternative drug regimen. DATA COLLECTION AND ANALYSIS Two review authors independently screened all records identified by the search strategy, applied inclusion criteria, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when required. Dichotomous outcomes were compared using risk ratios (RRs), count outcomes as incidence rate ratios (IRRs), and continuous outcomes using mean differences (MDs). We have presented all measures of effect with 95% confidence intervals (CIs). We assessed the certainty of evidence using the GRADE approach for the following main outcomes of analysis: maternal peripheral parasitaemia at delivery, clinical malaria episodes during pregnancy, placental malaria, maternal anaemia at delivery, low birth weight, spontaneous abortions and stillbirths, dizziness, and vomiting. MAIN RESULTS Six trials conducted between 1987 and 2013 from Thailand (1), Benin (3), Gabon (1), Tanzania (1), Mozambique (2), and Kenya (1) that included 8192 pregnant women met our inclusion criteria.Two trials (with 6350 HIV-uninfected pregnant women) compared two IPTp doses of mefloquine with two IPTp doses of sulfadoxine-pyrimethamine. Two other trials involving 1363 HIV-infected women compared three IPTp doses of mefloquine plus cotrimoxazole with cotrimoxazole. One trial in 140 HIV-infected women compared three doses of IPTp-mefloquine with cotrimoxazole. Finally, one trial enrolling 339 of unknown HIV status compared mefloquine prophylaxis with placebo.Study participants included women of all gravidities and of all ages (four trials) or > 18 years (two trials). Gestational age at recruitment was > 20 weeks (one trial), between 16 and 28 weeks (three trials), or ≤ 28 weeks (two trials). Two of the six trials blinded participants and personnel, and only one had low risk of detection bias for safety outcomes.When compared with sulfadoxine-pyrimethamine, IPTp-mefloquine results in a 35% reduction in maternal peripheral parasitaemia at delivery (RR 0.65, 95% CI 0.48 to 0.86; 5455 participants, 2 studies; high-certainty evidence) but may have little or no effect on placental malaria infections (RR 1.04, 95% CI 0.58 to 1.86; 4668 participants, 2 studies; low-certainty evidence). Mefloquine results in little or no difference in the incidence of clinical malaria episodes during pregnancy (incidence rate ratio (IRR) 0.83, 95% CI 0.65 to 1.05, 2 studies; high-certainty evidence). Mefloquine decreased maternal anaemia at delivery (RR 0.84, 95% CI 0.76 to 0.94; 5469 participants, 2 studies; moderate-certainty evidence). Data show little or no difference in the proportions of low birth weight infants (RR 0.95, 95% CI 0.78 to 1.17; 5641 participants, 2 studies; high-certainty evidence) and in stillbirth and spontaneous abortion rates (RR 1.20, 95% CI 0.91 to 1.58; 6219 participants, 2 studies; I2 statistic = 0%; high-certainty evidence). IPTp-mefloquine increased drug-related vomiting (RR 4.76, 95% CI 4.13 to 5.49; 6272 participants, 2 studies; high-certainty evidence) and dizziness (RR 4.21, 95% CI 3.36 to 5.27; participants = 6272, 2 studies; high-certainty evidence).When compared with cotrimoxazole, IPTp-mefloquine plus cotrimoxazole probably results in a 48% reduction in maternal peripheral parasitaemia at delivery (RR 0.52, 95% CI 0.30 to 0.93; 989 participants, 2 studies; moderate-certainty evidence) and a 72% reduction in placental malaria (RR 0.28, 95% CI 0.14 to 0.57; 977 participants, 2 studies; high-certainty evidence) but has little or no effect on the incidence of clinical malaria episodes during pregnancy (IRR 0.76, 95% CI 0.33 to 1.76, 1 study; high-certainty evidence) and probably no effect on maternal anaemia at delivery (RR 0.94, 95% CI 0.73 to 1.20; 1197 participants, 2 studies; moderate-certainty evidence), low birth weight rates (RR 1.20, 95% CI 0.89 to 1.60; 1220 participants, 2 studies; moderate-certainty evidence), and rates of spontaneous abortion and stillbirth (RR 1.12, 95% CI 0.42 to 2.98; 1347 participants, 2 studies; very low-certainty evidence). Mefloquine was associated with higher risks of drug-related vomiting (RR 7.95, 95% CI 4.79 to 13.18; 1055 participants, one study; high-certainty evidence) and dizziness (RR 3.94, 95% CI 2.85 to 5.46; 1055 participants, 1 study; high-certainty evidence). AUTHORS' CONCLUSIONS Mefloquine was more efficacious than sulfadoxine-pyrimethamine in HIV-uninfected women or daily cotrimoxazole prophylaxis in HIV-infected pregnant women for prevention of malaria infection and was associated with lower risk of maternal anaemia, no adverse effects on pregnancy outcomes (such as stillbirths and abortions), and no effects on low birth weight and prematurity. However, the high proportion of mefloquine-related adverse events constitutes an important barrier to its effectiveness for malaria preventive treatment in pregnant women.
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Key Words
- female
- humans
- pregnancy
- insecticide‐treated bednets
- abortion, spontaneous
- abortion, spontaneous/chemically induced
- abortion, spontaneous/epidemiology
- africa south of the sahara
- africa south of the sahara/epidemiology
- antimalarials
- antimalarials/adverse effects
- antimalarials/therapeutic use
- dizziness
- dizziness/chemically induced
- dizziness/epidemiology
- drug combinations
- drug therapy, combination
- hiv infections
- hiv infections/complications
- infant, low birth weight
- malaria
- malaria/epidemiology
- malaria/prevention & control
- mefloquine
- mefloquine/adverse effects
- mefloquine/therapeutic use
- parasitemia
- parasitemia/epidemiology
- pregnancy complications, parasitic
- pregnancy complications, parasitic/epidemiology
- pregnancy complications, parasitic/prevention & control
- pyrimethamine
- pyrimethamine/adverse effects
- pyrimethamine/therapeutic use
- randomized controlled trials as topic
- sulfadoxine
- sulfadoxine/adverse effects
- sulfadoxine/therapeutic use
- thailand
- thailand/epidemiology
- trimethoprim, sulfamethoxazole drug combination
- trimethoprim, sulfamethoxazole drug combination/therapeutic use
- vomiting
- vomiting/chemically induced
- vomiting/epidemiology
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Affiliation(s)
- Raquel González
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Clara Pons‐Duran
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Mireia Piqueras
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - John J Aponte
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
| | - Feiko O ter Kuile
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Clara Menéndez
- Hospital Clínic ‐ Universitat de BarcelonaISGlobalBarcelonaSpain
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24
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Tassi Yunga S, Fouda GG, Sama G, Ngu JB, Leke RGF, Taylor DW. Increased Susceptibility to Plasmodium falciparum in Infants is associated with Low, not High, Placental Malaria Parasitemia. Sci Rep 2018; 8:169. [PMID: 29317740 PMCID: PMC5760570 DOI: 10.1038/s41598-017-18574-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/12/2017] [Indexed: 01/19/2023] Open
Abstract
Risk of malaria in infants can be influenced by prenatal factors. In this study, the potential for placental parasitemia at delivery in predicting susceptibility of infants to Plasmodium falciparum (Pf) infections was evaluated. Seventy-two newborns of mothers who were placental malaria negative (PM-) and of mothers who were PM+ with below (PM+ Lo) and above (PM + Hi) median placental parasitemia, were actively monitored during their first year of life. Median time to first PCR-detected Pf infection was shorter in PM + Lo infants (2.8 months) than in both PM- infants (4.0 months, p = 0.002) and PM + Hi infants (4.1 months, p = 0.01). Total number of new infections was also highest in the PM + Lo group. Only 24% of infants experienced clinical malaria episodes but these episodes occurred earlier in PM + Lo infants than in PM + Hi infants (p = 0.05). The adjusted hazard ratio (95% CI) of having Pf infection was 3.9 (1.8-8.4) and 1.5 (0.7-3.4) for infants in the PM + Lo and PM + Hi groups, respectively. Collectively, low placental parasitemia was associated with increased susceptibility to malaria during infancy. Therefore, malaria in pregnancy preventive regimens, such as sulfadoxine-pyremethamine, that reduce but do not eliminate placental Pf in areas of drug resistance may increase the risk of malaria in infants.
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Affiliation(s)
- Samuel Tassi Yunga
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, BSB320, Honolulu, HI, 96813, USA
| | - Genevieve G Fouda
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA and Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Grace Sama
- The Biotechnology Center, University of Yaoundé 1, BP 3851 Messa, Yaoundé, Cameroon
| | - Julia B Ngu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, BP 1364, Yaoundé, Cameroon
| | - Rose G F Leke
- The Biotechnology Center, University of Yaoundé 1, BP 3851 Messa, Yaoundé, Cameroon
| | - Diane W Taylor
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, BSB320, Honolulu, HI, 96813, USA.
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25
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Boudová S, Divala T, Mungwira R, Mawindo P, Tomoka T, Laufer MK. Placental but Not Peripheral Plasmodium falciparum Infection During Pregnancy Is Associated With Increased Risk of Malaria in Infancy. J Infect Dis 2017; 216:732-735. [PMID: 28934438 DOI: 10.1093/infdis/jix372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/27/2017] [Indexed: 11/14/2022] Open
Abstract
Pregnancy-associated Plasmodium falciparum infection impacts the health of mothers and newborns, but little is known about the effects of these infections on infant susceptibility to malaria. We followed 473 mother-infant pairs during pregnancy and through 2 years of age. We observed that children born to mothers with placental malaria, but not those born to mothers with peripheral infection without evidence of placental sequestration, had increased risk of malaria during the first year of life compared with children born to mothers with no malaria during pregnancy. Malaria infections with placental sequestration have long-lasting impact on infant susceptibility to malaria infection.
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Affiliation(s)
- Sarah Boudová
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore
| | | | | | | | - Tamiwe Tomoka
- Department of Histopathology, University of Malawi College of Medicine, Blantyre
| | - Miriam K Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore
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26
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Harrington WE, Kanaan SB, Muehlenbachs A, Morrison R, Stevenson P, Fried M, Duffy PE, Nelson JL. Maternal Microchimerism Predicts Increased Infection but Decreased Disease due to Plasmodium falciparum During Early Childhood. J Infect Dis 2017; 215:1445-1451. [PMID: 28329160 DOI: 10.1093/infdis/jix129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background A mother's infection with placental malaria (PM) can affect her child's susceptibility to malaria, although the mechanism remains unclear. The fetus acquires a small amount of maternal cells and DNA known as maternal microchimerism (MMc), and we hypothesized that PM increases MMc and that MMc alters risk of Plasmodium falciparum malaria during infancy. Methods In a nested cohort from Muheza, Tanzania, we evaluated the presence and level of cord blood MMc in offspring of women with and without PM. A maternal-specific polymorphism was identified for each maternal-infant pair, and MMc was assayed by quantitative polymerase chain reaction. The ability of MMc to predict malaria outcomes during early childhood was evaluated in longitudinal models. Results Inflammatory PM increased the detection rate of MMc among offspring of primigravidae and secundigravidae, and both noninflammatory and inflammatory PM increased the level of MMc. Detectable MMc predicted increased risk of positive blood smear but, interestingly, decreased risk of symptomatic malaria and malaria hospitalization. Conclusions The acquisition of MMc may result in increased malaria infection but protection from malaria disease. Future studies should be directed at the cellular component of MMc, with attention to its ability to directly or indirectly coordinate anti-malarial immune responses in the offspring.
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Affiliation(s)
- Whitney E Harrington
- Department of Pediatrics, University of Washington School of Medicine/Seattle Children's Hospital, Washington
| | - Sami B Kanaan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Atis Muehlenbachs
- Department of Pathology, University of Washington, Seattle, Washington
| | - Robert Morrison
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Philip Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - J Lee Nelson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Rheumatology, University of Washington, Seattle
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27
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Abstract
One hundred and twenty-five million women in malaria-endemic areas become pregnant each year (see Dellicour et al. PLoS Med7: e1000221 [2010]) and require protection from infection to avoid disease and death for themselves and their offspring. Chloroquine prophylaxis was once a safe approach to prevention but has been abandoned because of drug-resistant parasites, and intermittent presumptive treatment with sulfadoxine-pyrimethamine, which is currently used to protect pregnant women throughout Africa, is rapidly losing its benefits for the same reason. No other drugs have yet been shown to be safe, tolerable, and effective as prevention for pregnant women, although monthly dihydroartemisinin-piperaquine has shown promise for reducing poor pregnancy outcomes. Insecticide-treated nets provide some benefits, such as reducing placental malaria and low birth weight. However, this leaves a heavy burden of maternal, fetal, and infant morbidity and mortality that could be avoided. Women naturally acquire resistance to Plasmodium falciparum over successive pregnancies as they acquire antibodies against parasitized red cells that bind chondroitin sulfate A in the placenta, suggesting that a vaccine is feasible. Pregnant women are an important reservoir of parasites in the community, and women of reproductive age must be included in any elimination effort, but several features of malaria during pregnancy will require special consideration during the implementation of elimination programs.
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Affiliation(s)
- Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, MD 20892
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, NIAID, NIH, Bethesda, MD 20892
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28
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Gbédandé K, Fievet N, Viwami F, Ezinmegnon S, Issifou S, Chippaux JP, Dossou Y, Moutairou K, Massougbodji A, Ndam N, de Jongh WA, Søgaard TMM, Salanti A, Nielsen MA, Esen M, Mordmüller B, Deloron P, Luty AJF. Clinical development of a VAR2CSA-based placental malaria vaccine PAMVAC: Quantifying vaccine antigen-specific memory B & T cell activity in Beninese primigravidae. Vaccine 2017; 35:3474-3481. [PMID: 28527688 DOI: 10.1016/j.vaccine.2017.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The antigen VAR2CSA plays a pivotal role in the pathophysiology of pregnancy-associated malaria (PAM) caused by Plasmodium falciparum. A VAR2CSA-based vaccine candidate, PAMVAC, is under development by an EU-funded multi-country consortium (PlacMalVac project). As part of PAMVAC's clinical development, we quantified naturally acquired vaccine antigen-specific memory B and T cell responses in Beninese primigravidae recruited at the beginning of pregnancy and followed up to delivery and beyond. METHODS Clinical and parasitological histories were compiled from monthly clinic visits. On 4 occasions (first and fifth month of pregnancy, delivery, 6months post-delivery) peripheral blood mononuclear cells were isolated for in vitro assays. PAMVAC-specific memory B cells as well as those specific for a PAM unrelated P. falciparum antigen (PfEMP1-CIDR1a) and for tetanus toxoid were quantified by ELISpot. Memory T cell responses were assessed by quantifying cytokines (IL-5, IL-6, IL-10, IL-13, IFN-γ, TNF-α) in supernatants of cells stimulated in vitro either with PAMVAC, or mitogen (PHA). RESULTS Both tetanus toxoid- and PAMVAC-specific memory B cell frequencies increased to reach peak levels in the 5th month and at delivery, respectively and persisted post-delivery. The frequency of CIDR1a-specific memory B cells was stable during pregnancy, but declined post-delivery. The cumulated prevalence of infection with P. falciparum during pregnancy was 61% by microscopy. In women with a history of such infections, a significantly higher frequency of PAMVAC-specific memory B cells was observed at delivery. PAMVAC-specific pro-inflammatory (IFN-γ, TNF) responses tended to be higher at delivery in those with a history of infection. Mitogen-induced IL-5/IL-13 responses were significantly enhanced in the same women. CONCLUSIONS PAMVAC-specific memory B cells are induced during first pregnancies and are maintained post-delivery. Women with a T helper cell profile biased towards production of Th2-type cytokines have a greater risk of infection with P. falciparum.
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Affiliation(s)
- Komi Gbédandé
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin; Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Benin; MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
| | - Nadine Fievet
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin; MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
| | - Firmine Viwami
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin.
| | - Sem Ezinmegnon
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin.
| | - Saadou Issifou
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin.
| | - Jean-Philippe Chippaux
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin; MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
| | - Yannelle Dossou
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin.
| | - Kabirou Moutairou
- Département de Biochimie et de Biologie Cellulaire, Faculté des Sciences et Techniques, Université d'Abomey-Calavi, Benin.
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin.
| | - Nicaise Ndam
- MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
| | | | - T Max M Søgaard
- ExpreS(2)ion Biotechnologies SCION-DTU Science Park DK-2970, Hoersholm, Denmark.
| | - Ali Salanti
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
| | - Morten A Nielsen
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
| | - Meral Esen
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.
| | - Benjamin Mordmüller
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.
| | - Philippe Deloron
- MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
| | - Adrian J F Luty
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Benin; MERIT UMR D216, Institut de Recherche pour le Développement, Université Paris Descartes, COMUE Sorbonne Paris Cité, 75006 Paris, France.
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29
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The impact of prenatal exposure to parasitic infections and to anthelminthic treatment on antibody responses to routine immunisations given in infancy: Secondary analysis of a randomised controlled trial. PLoS Negl Trop Dis 2017; 11:e0005213. [PMID: 28178298 PMCID: PMC5298230 DOI: 10.1371/journal.pntd.0005213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background Chronic parasitic infections are associated with active immunomodulation which may include by-stander effects on unrelated antigens. It has been suggested that pre-natal exposure to parasitic infections in the mother impacts immunological development in the fetus and hence the offspring’s response to vaccines, and that control of parasitic infection among pregnant women will therefore be beneficial. Methodology/Principal findings We used new data from the Entebbe Mother and Baby Study, a trial of anthelminthic treatment during pregnancy conducted in Uganda, to further investigate this hypothesis. 2705 mothers were investigated for parasitic infections and then randomised to albendazole (400mg) versus placebo and praziquantel (40mg/kg) during pregnancy in a factorial design. All mothers received sulfadoxine/pyrimethamine for presumptive treatment of malaria. Offspring received Expanded Programme on Immunisation vaccines at birth, six, 10 and 14 weeks. New data on antibody levels to diphtheria toxin, three pertussis antigens, Haemophilus influenzae type B (HiB) and Hepatitis B, measured at one year (April 2004 –May 2007) from 1379 infants were analysed for this report. Additional observational analyses relating maternal infections to infant vaccine responses were also conducted. Helminth infections were highly prevalent amongst mothers (hookworm 43.1%, Mansonella 20.9%, Schistosoma mansoni 17.3%, Strongyloides 11.7%, Trichuris 8.1%) and 9.4% had malaria at enrolment. In the trial analysis we found no overall effect of either anthelminthic intervention on the measured infant vaccine responses. In observational analyses, no species was associated with suppressed responses. Strongyloidiasis was associated with enhanced responses to pertussis toxin, HiB and Hep B vaccine antigens. Conclusions/Significance Our results do not support the hypothesis that routine anthelminthic treatment during pregnancy has a benefit for the infant’s vaccine response, or that maternal helminth infection has a net suppressive effect on the offspring’s response to vaccines. Trial Registration ISRCTN.com ISRCTN32849447 Parasitic infections, such as worms and malaria, have potent effects on the human immune system. These effects include modification of immune responses in the fetus and infant if a mother has a parasitic infection during pregnancy. These immunological changes can influence the way a child responds to the same infection when exposed in later life. It has been suggested that the immunological changes might also influence how the child responds to the vaccines given in infancy, and that treating mothers for parasitic infections when they are pregnant might be helpful. In this study we compared responses to vaccines between infants of mothers who had, or had not, been treated for worms while they were pregnant. We found no overall differences. We also compared vaccine responses between groups of mothers with and without parasitic infections. We found no evidence that the parasitic infections were associated with reduced responses in the children. This means that, although treating worms during pregnancy may have some benefits, improvements in the children’s responses to vaccines are not likely to be among them.
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d’Almeida TC, Sadissou I, Milet J, Cottrell G, Mondière A, Avokpaho E, Gineau L, Sabbagh A, Massougbodji A, Moutairou K, Donadi EA, Favier B, Carosella E, Moreau P, Rouas-Freiss N, Courtin D, Garcia A. Soluble human leukocyte antigen -G during pregnancy and infancy in Benin: Mother/child resemblance and association with the risk of malaria infection and low birth weight. PLoS One 2017; 12:e0171117. [PMID: 28166246 PMCID: PMC5293225 DOI: 10.1371/journal.pone.0171117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022] Open
Abstract
Human leukocyte antigen (HLA) G is a tolerogenic molecule involved in the maternal-fetal immune tolerance phenomenon. Its expression during some infectious diseases leading to immune evasion has been established. A first study conducted in Benin has shown that the production of soluble HLA-G (sHLA-G) during the first months of life is strongly correlated with the maternal level at delivery and associated with low birth weight and malaria. However sHLA-G measurements during pregnancy were not available for mothers and furthermore, to date the evolution of sHLA-G in pregnancy is not documented in African populations. To extend these previous findings, between January 2010 and June 2013, 400 pregnant women of a malaria preventive trial and their newborns were followed up in Benin until the age of 2 years. Soluble HLA-G was measured 3 times during pregnancy and repeatedly during the 2 years follow-up to explore how sHLA-G evolved and the factors associated. During pregnancy, plasma levels of sHLA-G remained stable and increased significantly at delivery (p<0.001). Multigravid women seemed to have the highest levels (p = 0.039). In infants, the level was highest in cord blood and decreased before stabilizing after 18 months (p<0.001). For children, a high level of sHLA-G was associated with malaria infection during the follow-up (p = 0.02) and low birth weight (p = 0.06). The mean level of sHLA-G during infancy was strongly correlated with the mother’s level during pregnancy (<0.001), and not only at delivery. Moreover, mothers with placental malaria infection had a higher probability of giving birth to a child with a high level of sHLA-g (p = 0.006). High sHLA-G levels during pregnancy might be associated with immune tolerance related to placental malaria. Further studies are needed but this study provides a first insight concerning the potential role of sHLA-G as a biomarker of weakness for newborns and infants.
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Affiliation(s)
- Tania C. d’Almeida
- Université Pierre et Marie Curie, Paris, France
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- * E-mail:
| | - Ibrahim Sadissou
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Faculté des Sciences de la Santé, Cotonou, Bénin
- Université d’Abomey-Calavi, Cotonou, Bénin
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Jacqueline Milet
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Gilles Cottrell
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Amandine Mondière
- UMR 216-MERIT, Institut de Recherche pour le Développement, Campus de la Faculté des Sciences de la Santé (FSS) et de l’Institut des Sciences Biomédicales Appliquées (ISBA), Cotonou, Bénin
| | | | - Laure Gineau
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Audrey Sabbagh
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Achille Massougbodji
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Faculté des Sciences de la Santé, Cotonou, Bénin
- Université d’Abomey-Calavi, Cotonou, Bénin
| | | | - Eduardo A. Donadi
- Division of Clinical Immunology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
| | - Benoit Favier
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Edgardo Carosella
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Philippe Moreau
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - Nathalie Rouas-Freiss
- CEA, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), Service de Recherches en Hémato-Immunologie (SRHI), Hôpital Saint-Louis, IUH, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, IUH, Hôpital Saint-Louis, UMR_E5, IUH, Paris, France
| | - David Courtin
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - André Garcia
- Université Pierre et Marie Curie, Paris, France
- UMR 216-MERIT, Institut de Recherche pour le Développement, Faculté de Pharmacie - Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Centre d’Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfance, Faculté des Sciences de la Santé, Cotonou, Bénin
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Almond D, Madanitsa M, Mwapasa V, Kalilani-Phiri L, Webster J, Ter Kuile F, Paintain L. Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi. Malar J 2016; 15:574. [PMID: 27894353 PMCID: PMC5126811 DOI: 10.1186/s12936-016-1627-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Malaria in pregnancy is a major cause of adverse maternal and fetal outcomes. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) is one of the control strategies promoted by WHO. In response to mounting resistance to SP, intermittent screening and treatment (ISTp) has been proposed as an alternative. The objective of this study was to explore the acceptability of ISTp for health workers and pregnant women. Methods Semi-structured interviews of ten health workers and five focus group discussions of 38 women enrolled in an ongoing trial comparing IPTp-SP and ISTp with dihydroartemisinin–piperaquine (DP) were conducted at two antenatal clinics in rural Malawi. All transcripts were coded and themes were identified using a content analysis approach. Results Amongst health workers, there were contrasting opinions on the preference of blood sampling methods, and the influence of method on reliability of diagnosis. The perceived greater effectiveness of DP compared to SP was appreciated, however concerns of user compliance with the full dose of DP in non-trial settings were raised. Despite the discomfort of repeated finger pricks, pregnant women were generally accepting of ISTp, particularly the chance for regular blood tests to check for infections and the perceived greater effectiveness with fewer side effects of DP compared to SP. Conclusion In the trial context, pregnant women tended to prefer ISTp-DP over IPTp-SP. Health workers were also accepting of ISTp-DP as an alternative to IPTp-SP in light of increasing SP resistance. However, reliability of stock, adherence to malaria test results and user adherence to the full course of DP may present barriers to successful routine implementation. Effective communication with health workers and between health workers, pregnant women and their communities will be essential for the acceptability of focused antenatal care, including the best malaria control measures available.
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Affiliation(s)
- Deborah Almond
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mwayi Madanitsa
- College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Feiko Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucy Paintain
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK.
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Kakuru A, Natureeba P, Muhindo MK, Clark TD, Havlir DV, Cohan D, Dorsey G, Kamya MR, Ruel T. Malaria burden in a birth cohort of HIV-exposed uninfected Ugandan infants living in a high malaria transmission setting. Malar J 2016; 15:500. [PMID: 27756308 PMCID: PMC5070200 DOI: 10.1186/s12936-016-1568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background HIV-exposed, uninfected (HEU) infants suffer high morbidity and mortality in the first year of life compared to HIV-unexposed, uninfected (HUU) infants, but accurate data on the contribution of malaria are limited. Methods The incidence of febrile illnesses and malaria were evaluated in a birth cohort of HEU infants. Infants were prescribed daily trimethoprim–sulfamethoxazole (TS) prophylaxis from 6 weeks of age until exclusion of HIV-infection after cessation of breastfeeding. Infants were followed for all illnesses using passive surveillance and routine blood smears were done monthly. Malaria was diagnosed as a positive blood smear plus fever. Placental malaria was determined by histopathology, placental blood smear and PCR. Risk factors for time to first episode of malaria were assessed using a Cox proportional hazards model. Malaria incidence among HEU infants aged 6–12 months was compared to that in other cohorts of HEU and HUU infants from the same region. Results Among 361 HEU infants enrolled, 248 completed 12 months of follow-up resulting in 1562 episodes of febrile illness and 253 episodes of malaria after 305 person-years of follow-up. The incidence of febrile illness was 5.12 episodes per person-year (PPY), ranging from 4.13 episodes PPY in the first 4 months of life to 5.71 episodes PPY between 5 and 12 months of age. The overall malaria incidence was 0.83 episodes per person-year (PPY), increasing from 0.03 episodes PPY in the first 2 months of life to 2.00 episodes PPY between 11 and 12 months of age. There were no episodes of complicated malaria. The prevalence of asymptomatic parasitaemia was 1.2 % (19 of 1568 routine smears positive). Infants born to mothers with parasites detected from placental blood smears were at higher risk of malaria (hazard ratio = 4.51, P < 0.001). HEU infants in this study had a 2.4- to 3.5-fold lower incidence of malaria compared to HUU infants in other cohort studies from the same area. Conclusion The burden of malaria in this birth cohort of HEU infants living in a high-transmission setting and taking daily TS prophylaxis was relatively low. Alternative etiologies of fever should be considered in HEU-infants taking daily TS prophylaxis who present with fever. Trial Registration NCT00993031, registered 8 October, 2009
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Affiliation(s)
- Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | - Paul Natureeba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mary K Muhindo
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Tamara D Clark
- Department of Medicine, University of California, San Francisco, USA
| | - Diane V Havlir
- Department of Medicine, University of California, San Francisco, USA
| | - Deborah Cohan
- Department of Obstetrics and Gynecology, University of California, San Francisco, USA
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, USA
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Timing of in utero malaria exposure influences fetal CD4 T cell regulatory versus effector differentiation. Malar J 2016; 15:497. [PMID: 27717402 PMCID: PMC5055709 DOI: 10.1186/s12936-016-1545-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/04/2016] [Indexed: 11/26/2022] Open
Abstract
Background In malaria-endemic areas, the first exposure to malaria antigens often occurs in utero when the fetal immune system is poised towards the development of tolerance. Children exposed to placental malaria have an increased risk of clinical malaria in the first few years of life compared to unexposed children. Recent work has suggested the potential of pregnancy-associated malaria to induce immune tolerance in children living in malaria-endemic areas. A study was completed to evaluate the effect of malaria exposure during pregnancy on fetal immune tolerance and effector responses. Methods Using cord blood samples from a cohort of mother-infant pairs followed from early in pregnancy until delivery, flow cytometry analysis was completed to assess the relationship between pregnancy-associated malaria and fetal cord blood CD4 and dendritic cell phenotypes. Results Cord blood FoxP3+ Treg counts were higher in infants born to mothers with Plasmodium parasitaemia early in pregnancy (12–20 weeks of gestation; p = 0.048), but there was no association between Treg counts and the presence of parasites in the placenta at the time of delivery (by loop-mediated isothermal amplification (LAMP); p = 0.810). In contrast, higher frequencies of activated CD4 T cells (CD25+FoxP3−CD127+) were observed in the cord blood of neonates with active placental Plasmodium infection at the time of delivery (p = 0.035). This population exhibited evidence of effector memory differentiation, suggesting priming of effector T cells in utero. Lastly, myeloid dendritic cells were higher in the cord blood of infants with histopathologic evidence of placental malaria (p < 0.0001). Conclusion Together, these data indicate that in utero exposure to malaria drives expansion of both regulatory and effector T cells in the fetus, and that the timing of this exposure has a pivotal role in determining the polarization of the fetal immune response.
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Odorizzi PM, Feeney ME. Impact of In Utero Exposure to Malaria on Fetal T Cell Immunity. Trends Mol Med 2016; 22:877-888. [PMID: 27614925 DOI: 10.1016/j.molmed.2016.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 01/10/2023]
Abstract
Pregnancy-associated malaria, including placental malaria, causes significant morbidity and mortality worldwide. Recently, it has been suggested that in utero exposure of the fetus to malaria antigens may negatively impact the developing immune system and result in tolerance to malaria. Here, we review our current knowledge of fetal immunity to malaria, focusing on the dynamic interactions between maternal malaria infection, placental development, and the fetal immune system. A better understanding of the long-term impact of in utero malaria exposure on the development of natural immunity to malaria, immune responses to other childhood pathogens, and vaccine immunogenicity is urgently needed. This may guide the implementation of novel chemoprevention strategies during pregnancy and facilitate the push toward malaria vaccines.
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Affiliation(s)
- Pamela M Odorizzi
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret E Feeney
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
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Madanitsa M, Kalilani L, Mwapasa V, van Eijk AM, Khairallah C, Ali D, Pace C, Smedley J, Thwai KL, Levitt B, Wang D, Kang’ombe A, Faragher B, Taylor SM, Meshnick S, ter Kuile FO. Scheduled Intermittent Screening with Rapid Diagnostic Tests and Treatment with Dihydroartemisinin-Piperaquine versus Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy in Malawi: An Open-Label Randomized Controlled Trial. PLoS Med 2016; 13:e1002124. [PMID: 27622558 PMCID: PMC5021271 DOI: 10.1371/journal.pmed.1002124] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Africa, most plasmodium infections during pregnancy remain asymptomatic, yet are associated with maternal anemia and low birthweight. WHO recommends intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). However, sulfadoxine-pyrimethamine (SP) efficacy is threatened by high-level parasite resistance. We conducted a trial to evaluate the efficacy and safety of scheduled intermittent screening with malaria rapid diagnostic tests (RDTs) and treatment of RDT-positive women with dihydroartemisinin-piperaquine (DP) as an alternative strategy to IPTp-SP. METHODS AND FINDINGS This was an open-label, two-arm individually randomized superiority trial among HIV-seronegative women at three sites in Malawi with high SP resistance. The intervention consisted of three or four scheduled visits in the second and third trimester, 4 to 6 wk apart. Women in the IPTp-SP arm received SP at each visit. Women in the intermittent screening and treatment in pregnancy with DP (ISTp-DP) arm were screened for malaria at every visit and treated with DP if RDT-positive. The primary outcomes were adverse live birth outcome (composite of small for gestational age, low birthweight [<2,500 g], or preterm birth [<37 wk]) in paucigravidae (first or second pregnancy) and maternal or placental plasmodium infection at delivery in multigravidae (third pregnancy or higher). Analysis was by intention to treat. Between 21 July 2011 and 18 March 2013, 1,873 women were recruited (1,155 paucigravidae and 718 multigravidae). The prevalence of adverse live birth outcome was similar in the ISTp-DP (29.9%) and IPTp-SP (28.8%) arms (risk difference = 1.08% [95% CI -3.25% to 5.41%]; all women: relative risk [RR] = 1.04 [95% CI 0.90-1.20], p = 0.625; paucigravidae: RR = 1.10 [95% CI 0.92-1.31], p = 0.282; multigravidae: RR = 0.92 [95% CI 0.71-1.20], p = 0.543). The prevalence of malaria at delivery was higher in the ISTp-DP arm (48.7% versus 40.8%; risk difference = 7.85%, [95% CI 3.07%-12.63%]; all women: RR = 1.19 [95% CI 1.07-1.33], p = 0.007; paucigravidae: RR = 1.16 [95% CI 1.04-1.31], p = 0.011; multigravidae: RR = 1.29 [95% CI 1.02-1.63], p = 0.037). Fetal loss was more common with ISTp-DP (2.6% versus 1.3%; RR = 2.06 [95% CI 1.01-4.21], p = 0.046) and highest among non-DP-recipients (3.1%) in the ISTp-DP arm. Limitations included the open-label design. CONCLUSIONS Scheduled screening for malaria parasites with the current generation of RDTs three to four times during pregnancy as part of focused antenatal care was not superior to IPTp-SP in this area with high malaria transmission and high SP resistance and was associated with higher fetal loss and more malaria at delivery. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201103000280319; ISRCTN Registry ISRCTN69800930.
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Affiliation(s)
- Mwayiwawo Madanitsa
- College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Linda Kalilani
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anna M. van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carole Khairallah
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Doreen Ali
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Cheryl Pace
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - James Smedley
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kyaw-Lay Thwai
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brandt Levitt
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Arthur Kang’ombe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brian Faragher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Steve M. Taylor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Steve Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Sylvester B, Gasarasi DB, Aboud S, Tarimo D, Massawe S, Mpembeni R, Swedberg G. Prenatal exposure to Plasmodium falciparum increases frequency and shortens time from birth to first clinical malaria episodes during the first two years of life: prospective birth cohort study. Malar J 2016; 15:379. [PMID: 27448394 PMCID: PMC4957302 DOI: 10.1186/s12936-016-1417-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background Prenatal exposure to Plasmodium falciparum affects development of protective immunity and susceptibility to subsequent natural challenges with similar parasite antigens. However, the nature of these effects has not been fully elucidated. The aim of this study was to determine the effect of prenatal exposure to P. falciparum on susceptibility to natural malaria infection, with a focus on median time from birth to first clinical malaria episode and frequency of clinical malaria episodes in the first 2 years of life. Methods A prospective birth cohort study was conducted in Rufiji district in Tanzania, between January 2013 and December 2015. Infants born to mothers with P. falciparum in the placenta at time of delivery were defined as exposed, and infants born to mothers without P. falciparum parasites in placenta were defined as unexposed. Placental infection was established by histological techniques. Out of 206 infants recruited, 41 were in utero exposed to P. falciparum and 165 infants were unexposed. All infants were monitored for onset of clinical malaria episodes in the first 2 years of life. The outcome measure was time from birth to first clinical malaria episode, defined by fever (≥37 °C) and microscopically determined parasitaemia. Median time to first clinical malaria episode between exposed and unexposed infants was assessed using Kaplan–Meier survival analysis and comparison was done by log rank. Association of clinical malaria episodes with prenatal exposure to P. falciparum was assessed by multivariate binary logistic regression. Comparative analysis of mean number of clinical malaria episodes between exposed and unexposed infants was done using independent sample t test. Results The effect of prenatal exposure to P. falciparum infection on clinical malaria episodes was statistically significant (Odds Ratio of 4.79, 95 % CI 2.21–10.38, p < 0.01) when compared to other confounding factors. Median time from birth to first clinical malaria episode for exposed and unexposed infants was 32 weeks (95 % CI 30.88–33.12) and 37 weeks (95 % CI 35.25–38.75), respectively, and the difference was statistically significant (p = 0.003). The mean number of clinical malaria episodes in exposed and unexposed infants was 0.51 and 0.30 episodes/infant, respectively, and the difference was statistically significant (p = 0.038). Conclusions Prenatal exposure to P. falciparum shortens time from birth to first clinical malaria episode and increases frequency of clinical malaria episodes in the first 2 years of life.
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Affiliation(s)
- Boniphace Sylvester
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania.
| | - Dinah B Gasarasi
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Siriel Massawe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Rose Mpembeni
- Department of Community Medicine, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry, Biomedical Centre, Uppsala University, Uppsala, Sweden
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Non-malaria fevers in a high malaria endemic area of Ghana. BMC Infect Dis 2016; 16:327. [PMID: 27400781 PMCID: PMC4940727 DOI: 10.1186/s12879-016-1654-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/07/2016] [Indexed: 12/04/2022] Open
Abstract
Background The importance of fevers not due to malaria [non–malaria fevers, NMFs] in children in sub-Saharan Africa is increasingly being recognised. We have investigated the influence of exposure-related factors and placental malaria on the risk of non-malaria fevers among children in Kintampo, an area of Ghana with high malaria transmission. Methods Between 2008 and 2011, a cohort of 1855 newborns was enrolled and followed for at least 12 months. Episodes of illness were detected by passive case detection. The primary analysis covered the period from birth up to 12 months of age, with an exploratory analysis of a sub-group of children followed for up to 24 months. Results The incidence of all episodes of NMF in the first year of life (first and subsequent) was 1.60 per child-year (95 % CI 1.54, 1.66). The incidence of NMF was higher among infants with low birth weight [adjusted hazard ratio (aHR) 1.22 (95 % CI 1.04–1.42) p = 0.012], infants from households of poor socio-economic status [aHR 1.22 (95 % CI 1.02–1.46) p = 0.027] and infants living furthest from a health facility [aHR 1.20 (95 % CI 1.01–1.43) p = 0.037]. The incidence of all episodes of NMF was similar among infants born to mothers with or without placental malaria [aHR 0.97 (0.87, 1.08; p = 0.584)]. Conclusion The incidence of NMF in infancy is high in the study area. The incidence of NMF is associated with low birth weight and poor socioeconomic status but not with placental malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1654-4) contains supplementary material, which is available to authorized users.
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Chen T, Liu HX, Yan HY, Wu DM, Ping J. Developmental origins of inflammatory and immune diseases. Mol Hum Reprod 2016; 22:858-65. [PMID: 27226490 DOI: 10.1093/molehr/gaw036] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/18/2016] [Indexed: 12/23/2022] Open
Abstract
Epidemiological and experimental animal studies show that suboptimal environments in fetal and neonatal life exert a profound influence on physiological function and risk of diseases in adult life. The concepts of the 'developmental programming' and Developmental Origins of Health and Diseases (DOHaD) have become well accepted and have been applied across almost all fields of medicine. Adverse intrauterine environments may have programming effects on the crucial functions of the immune system during critical periods of fetal development, which can permanently alter the immune function of offspring. Immune dysfunction may in turn lead offspring to be susceptible to inflammatory and immune diseases in adulthood. These facts suggest that inflammatory and immune disorders might have developmental origins. In recent years, inflammatory and immune disorders have become a growing health problem worldwide. However, there is no systematic report in the literature on the developmental origins of inflammatory and immune diseases and the potential mechanisms involved. Here, we review the impacts of adverse intrauterine environments on the immune function in offspring. This review shows the results from human and different animal species and highlights the underlying mechanisms, including damaged development of cells in the thymus, helper T cell 1/helper T cell 2 balance disturbance, abnormal epigenetic modification, effects of maternal glucocorticoid overexposure on fetal lymphocytes and effects of the fetal hypothalamic-pituitary-adrenal axis on the immune system. Although the phenomena have already been clearly implicated in epidemiologic and experimental studies, new studies investigating the mechanisms of these effects may provide new avenues for exploiting these pathways for disease prevention.
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Affiliation(s)
- Ting Chen
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Han-Xiao Liu
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Hui-Yi Yan
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Dong-Mei Wu
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
| | - Jie Ping
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan 430071, China
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De Beaudrap P, Turyakira E, Nabasumba C, Tumwebaze B, Piola P, Boum Ii Y, McGready R. Timing of malaria in pregnancy and impact on infant growth and morbidity: a cohort study in Uganda. Malar J 2016; 15:92. [PMID: 26879849 PMCID: PMC4754923 DOI: 10.1186/s12936-016-1135-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/29/2016] [Indexed: 11/06/2022] Open
Abstract
Background Malaria in pregnancy (MiP) is a major cause of fetal growth restriction and low birth weight in endemic areas of sub-Saharan Africa. Understanding of the impact of MiP on infant growth and infant risk of malaria or morbidity is poorly characterized. The objective of this study was to describe the impact of MIP on subsequent infant growth, malaria and morbidity. Methods Between 2006 and 2009, 82 % (832/1018) of pregnant women with live-born singletons and ultrasound determined gestational age were enrolled in a prospective cohort with active weekly screening and treatment for malaria. Infants were followed monthly for growth and morbidity and received active monthly screening and treatment for malaria during their first year of life. Multivariate analyses were performed to analyse the association between malaria exposure during pregnancy and infants’ growth, malaria infections, diarrhoea episodes and acute respiratory infections. Results Median time of infant follow-up was 12 months and infants born to a mother who had MiP were at increased risk of impaired height and weight gain (−2.71 cm, 95 % CI −4.17 to −1.25 and −0.42 kg, 95 % CI −0.76 to −0.08 at 12 months for >1 MiP compared to no MiP) and of malaria infection (relative risk 10.42, 95 % CI 2.64–41.10 for infants born to mothers with placental malaria). The risks of infant growth restriction and infant malaria infection were maximal when maternal malaria occurred in the 12 weeks prior to delivery. Recurrent MiP was also associated with acute respiratory infection (RR 1.96, 95 % CI 1.25–3.06) and diarrhoea during infancy (RR 1.93, 95 % CI 1.02–3.66). Conclusion This study shows that despite frequent active screening and prompt treatment of MiP, impaired growth and an increased risk of malaria and non-malaria infections can be observed in the infants. Effective preventive measures in pregnancy remain a research priority. This study was registered with ClinicalTrials.gov, number NCT00495508.
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Affiliation(s)
- Pierre De Beaudrap
- Epicentre, Paris, France. .,Ceped, Institut de Recherche pour le Développement, Paris, France.
| | - Eleanor Turyakira
- Epicentre, Mbarara, Uganda. .,Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | | | | | - Patrice Piola
- Institut Pasteur de Madagascar, Tananarive, Madagascar.
| | | | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. .,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Rupérez M, González R, Mombo-Ngoma G, Kabanywanyi AM, Sevene E, Ouédraogo S, Kakolwa MA, Vala A, Accrombessi M, Briand V, Aponte JJ, Manego Zoleko R, Adegnika AA, Cot M, Kremsner PG, Massougbodji A, Abdulla S, Ramharter M, Macete E, Menéndez C. Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study. PLoS Med 2016; 13:e1001964. [PMID: 26905278 PMCID: PMC4764647 DOI: 10.1371/journal.pmed.1001964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/15/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes. METHODS AND FINDINGS In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27%) from the MQ group and 377 (26%) from the SP group. Reasons for not completing the study were death (4% of total study population), study withdrawal (6%), migration (8%), and loss to follow-up (9%). CONCLUSIONS No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve further studies. TRIAL REGISTRATION ClinicalTrials.gov NCT00811421.
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Affiliation(s)
- María Rupérez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Raquel González
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden Medical University Center, Leiden, The Netherlands
- Ngounié Medical Research Centre, Fougamou, Gabon
| | | | | | - Smaïla Ouédraogo
- Faculté des Sciences de la Santé (FSS), Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement (IRD), Paris, France
| | | | - Anifa Vala
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
| | - Manfred Accrombessi
- Faculté des Sciences de la Santé (FSS), Université d’Abomey-Calavi, Cotonou, Benin
- Institut de Recherche pour le Développement (IRD), Paris, France
| | - Valérie Briand
- Institut de Recherche pour le Développement (IRD), Paris, France
- Université René Descartes, Paris, France
| | - John J. Aponte
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
| | - Rella Manego Zoleko
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Ngounié Medical Research Centre, Fougamou, Gabon
| | - Ayôla A. Adegnika
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden Medical University Center, Leiden, The Netherlands
| | - Michel Cot
- Institut de Recherche pour le Développement (IRD), Paris, France
- Université René Descartes, Paris, France
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Achille Massougbodji
- Faculté des Sciences de la Santé (FSS), Université d’Abomey-Calavi, Cotonou, Benin
| | | | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Division of Infectious Diseases and Tropical Medicine I, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eusébio Macete
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
| | - Clara Menéndez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Centre (CISM), Manhiça, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- * E-mail:
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Awine T, Belko MM, Oduro AR, Oyakhirome S, Tagbor H, Chandramohan D, Milligan P, Cairns M, Greenwood B, Williams JE. The risk of malaria in Ghanaian infants born to women managed in pregnancy with intermittent screening and treatment for malaria or intermittent preventive treatment with sulfadoxine/pyrimethamine. Malar J 2016; 15:46. [PMID: 26821532 PMCID: PMC4730594 DOI: 10.1186/s12936-016-1094-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/10/2016] [Indexed: 01/02/2023] Open
Abstract
Background Several studies have reported an association between malaria infection of the placenta and the risk of malaria in young children in the first year of life, but it is not known if this is causal, or influenced by malaria control measures during pregnancy. This paper compares the incidence of malaria in infants born to mothers who received either intermittent preventive treatment with sulfadoxine/pyrimethamine (IPTp-SP) or screening with a rapid diagnostic test and treatment with artemether–lumefantrine (ISTp-AL) during their pregnancy. Methods From July 2011 to April 2013, 988 infants of women enrolled in a trial of IPTp-SP versus ISTp-AL in the Kassena-Nankana districts of northern Ghana were followed to determine the risk of clinical malaria during early life, and their risk of parasitaemia and anaemia at 6 and 12 months of age. In addition, the incidence of clinical malaria in infants whose mothers had malaria infection of the placenta was compared with that in infants born to women free of placental malaria. Results The incidence of clinical malaria was 0.237 and 0.211 episodes per child year in infants whose mothers had received ISTp-AL or IPTp-SP, respectively. The adjusted incidence rate ratio and the adjusted rate difference were 0.94 (95 % CI 0.68, 1.33) and 0.029 (95 % CI −0.053, 0.110) cases per child year at risk respectively. The incidence of clinical malaria was similar in infants born to women with placental malaria (0.195 episodes per child year) and in infants of women without placental malaria (0.224 episodes per child year) (rate ratio = 0.86 [95 % CI 0.54, 1.37]). Conclusion Infants born to women managed with ISTp-AL during pregnancy were not at greatly increased risk of malaria compared with infants born to women who had received IPTp-SP. The incidence of malaria in infants was similar whether or not their mother had had placental malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1094-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy Awine
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana.
| | - Mark M Belko
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana.
| | - Abraham R Oduro
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana.
| | - Sunny Oyakhirome
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana. .,Novartis Pharma Services, Lagos, Nigeria.
| | - Harry Tagbor
- Department of Community Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Paul Milligan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Matthew Cairns
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - John E Williams
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana.
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Ndam NT, Denoeud-Ndam L, Doritchamou J, Viwami F, Salanti A, Nielsen MA, Fievet N, Massougbodji A, Luty AJF, Deloron P. Protective Antibodies against Placental Malaria and Poor Outcomes during Pregnancy, Benin. Emerg Infect Dis 2016; 21:813-23. [PMID: 25898123 PMCID: PMC4412227 DOI: 10.3201/eid2105.141626] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Immunity requires a vaccine that inhibits binding of infected erythrocytes to chondroitin sulfate. Placental malaria is caused by Plasmodium falciparum–infected erythrocytes that bind to placental tissue. Binding is mediated by VAR2CSA, a parasite antigen coded by the var gene, which interacts with chondroitin sulfate A (CSA). Consequences include maternal anemia and fetal growth retardation. Antibody-mediated immunity to placental malaria is acquired during successive pregnancies, but the target of VAR2CSA-specific protective antibodies is unclear. We assessed VAR2CSA-specific antibodies in pregnant women and analyzed their relationships with protection against placental infection, preterm birth, and low birthweight. Antibody responses to the N-terminal region of VAR2CSA during early pregnancy were associated with reduced risks for infections and low birthweight. Among women infected during pregnancy, an increase in CSA binding inhibition was associated with reduced risks for placental infection, preterm birth, and low birthweight. These data suggest that antibodies against VAR2CSA N-terminal region mediate immunity to placental malaria and associated outcomes. Our results validate current vaccine development efforts with VAR2CSA N-terminal constructs.
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MESH Headings
- Adult
- Antibodies, Protozoan/blood
- Antibodies, Protozoan/immunology
- Antibody Specificity/immunology
- Antigens, Protozoan/immunology
- Benin/epidemiology
- Erythrocytes/immunology
- Erythrocytes/parasitology
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Infant
- Infant, Newborn
- Malaria/epidemiology
- Malaria/immunology
- Malaria/parasitology
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Patient Outcome Assessment
- Placenta/parasitology
- Plasmodium falciparum/immunology
- Pregnancy
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/immunology
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Outcome
- Protein Binding
- Risk Factors
- Young Adult
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Abstract
Malaria is one of the most serious infectious diseases with most of the severe disease
caused by Plasmodium falciparum (Pf). Naturally acquired immunity
develops over time after repeated infections and the development of antimalarial
antibodies is thought to play a crucial role. Neonates and young infants are relatively
protected from symptomatic malaria through mechanisms that are poorly understood. The
prevailing paradigm is that maternal antimalarial antibodies transferred to the fetus in
the last trimester of pregnancy protect the infant from early infections. These
antimalarial antibodies wane by approximately 6 months of age leaving the infant
vulnerable to malaria, however direct evidence supporting this epidemiologically based
paradigm is lacking. As infants are the target population for future malaria vaccines,
understanding how they begin to develop immunity to malaria and the gaps in their
responses is key. This review summarizes the antimalarial antibody responses detected in
infants and how they change over time. We focus primarily on Pf antibody responses and
will briefly mention Plasmodium vivax responses in infants.
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Dechavanne C, Cottrell G, Garcia A, Migot-Nabias F. Placental Malaria: Decreased Transfer of Maternal Antibodies Directed to Plasmodium falciparum and Impact on the Incidence of Febrile Infections in Infants. PLoS One 2015; 10:e0145464. [PMID: 26698578 PMCID: PMC4689360 DOI: 10.1371/journal.pone.0145464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 12/15/2022] Open
Abstract
The efficacy of mother-to-child placental transfer of antibodies specific to malaria blood stage antigens was investigated in the context of placental malaria infection, taking into account IgG specificity and maternal hypergammaglobulinemia. The impact of the resulting maternal antibody transfer on infections in infants up to the age of 6 months was also explored. This study showed that i) placental malaria was associated with a reduced placental transfer of total and specific IgG, ii) antibody placental transfer varied according to IgG specificity and iii) cord blood malaria IgG levels were similar in infants born to mothers with or without placental malaria. The number of malaria infections was negatively associated with maternal age, whereas it was not associated with the transfer of any malaria-specific IgG from the mother to the fetus. These results suggest that i) malaria-specific IgG may serve as a marker of maternal exposure but not as a useful marker of infant protection from malaria and ii) increasing maternal age contributes to diminishing febrile infections diagnosed in infants, perhaps by means of the transmission of an effective antibody response.
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Affiliation(s)
- Celia Dechavanne
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
- * E-mail:
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - André Garcia
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Florence Migot-Nabias
- Institut de Recherche pour le Développement (IRD), UMR 216 Mère et enfant face aux infections tropicales, Université Paris Descartes, Paris, France
- COMUE Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
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Abstract
INTRODUCTION Placental malaria (PM) is a major public health problem that constitutes a significant health concern for the mother, and especially for the developing fetus and offspring. Current means of prevention have limitations, including a restricted window of intervention that excludes the first trimester of pregnancy, and the fact that very few drugs can be used for this purpose. The identification of the VAR2CSA antigen, specific to PM parasites, offers an excellent opportunity to develop a vaccine against this disease. Proof of concept of a first-generation vaccine is nearing completion, and two clinical trials are underway. AREAS COVERED This review focuses on PM, which is mainly caused by Plasmodium falciparum. The review highlights recent advances and the key milestones that led to the identification of the optimal vaccine target within the large VAR2CSA protein. The paper also points out how future improvements can strengthen this process to achieve an effective vaccine in the field. EXPERT OPINION The approach taken to develop a P. falciparum erythrocyte membrane protein 1-based vaccine to protect pregnant women is very promising in view of the current difficulties of achieving a sterilizing vaccine against malaria parasite. This approach could help us to control the deleterious effect of malaria infections that characterize severe clinical forms.
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Moya-Alvarez V, Cottrell G, Ouédraogo S, Accrombessi M, Massougbodgi A, Cot M. Does Iron Increase the Risk of Malaria in Pregnancy? Open Forum Infect Dis 2015; 2:ofv038. [PMID: 26380338 PMCID: PMC4567087 DOI: 10.1093/ofid/ofv038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/15/2015] [Indexed: 12/03/2022] Open
Abstract
Background. Pregnancy-associated malaria (PAM) remains a significant health concern in sub-Saharan Africa. Cross-sectional studies report that iron might be associated with increased malaria morbidity, raising fears that current iron supplementation policies will cause harm in the present context of increasing resistance against intermittent preventive treatment in pregnancy (IPTp). Therefore, it is necessary to assess the relation of iron levels with malaria risk during the entire pregnancy. Methods. To investigate the association of maternal iron levels on malaria risk in the context of an IPTp clinical trial, 1005 human immunodeficiency virus-negative, pregnant Beninese women were monitored throughout their pregnancy between January 2010 and May 2011. Multilevel models with random intercept at the individual levels and random slope for gestational age were used to analyze the factors associated with increased risk of a positive blood smear and increased Plasmodium falciparum density. Results. During the follow-up, 29% of the women had at least 1 episode of malaria. On average, women had 0.52 positive smears (95% confidence interval [CI], 0.44-0.60). High iron levels (measured by the log10 of ferritin corrected on inflammation) were significantly associated with increased risk of a positive blood smear (adjusted odds ratio = 1.75; 95% CI, 1.46-2.11; P < .001) and high P falciparum density (beta estimate = 0.22; 95% CI, 0.18-0.27; P < .001) during the follow-up period adjusted on pregnancy parameters, comorbidities, environmental and socioeconomic indicators, and IPTp regime. Furthermore, iron-deficient women were significantly less likely to have a positive blood smear and high P falciparum density (P < .001 in both cases). Conclusions. Iron levels were positively associated with increased PAM during pregnancy in the context of IPTp. Supplementary interventional studies are needed to determine the benefits and risks of differently dosed iron and folate supplements in malaria-endemic regions.
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Affiliation(s)
- Violeta Moya-Alvarez
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France
- Université Pierre et Marie Curie, Paris, France
- Réseau Doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Gilles Cottrell
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | - Smaila Ouédraogo
- Université Paris Descartes, Sorbonne Paris Cité, France
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Cotonou, Benin
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Burkina Faso
- Public Health Department, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Manfred Accrombessi
- Université Pierre et Marie Curie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
| | | | - Michel Cot
- MERIT- Mère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Développement, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, France
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González R, Boerma RS, Sinclair D, Aponte JJ, ter Kuile FO, Menéndez C. Mefloquine for preventing malaria in pregnant women. Hippokratia 2015. [DOI: 10.1002/14651858.cd011444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Raquel González
- Barcelona Institute for Global Health, ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona; Barcelona Spain
| | - Ragna S Boerma
- Barcelona Institute for Global Health, ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona; Barcelona Spain
| | - David Sinclair
- Liverpool School of Tropical Medicine; Department of Clinical Sciences; Pembroke Place Liverpool UK L3 5QA
| | - John J Aponte
- Barcelona Institute for Global Health, ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona; Barcelona Spain
| | - Feiko O ter Kuile
- Liverpool School of Tropical Medicine; Child & Reproductive Health Group; Pembroke Place Liverpool Merseyside UK L3 5QA
| | - Clara Menéndez
- Barcelona Institute for Global Health, ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona; Barcelona Spain
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Apinjoh TO, Anchang-Kimbi JK, Mugri RN, Njua-Yafi C, Tata RB, Chi HF, Tangoh DA, Loh BT, Achidi EA. Determinants of infant susceptibility to malaria during the first year of life in South Western cameroon. Open Forum Infect Dis 2015; 2:ofv012. [PMID: 26034763 PMCID: PMC4438893 DOI: 10.1093/ofid/ofv012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/22/2015] [Indexed: 12/02/2022] Open
Abstract
Background. Falciparum malaria is an important pediatric infectious disease that frequently affects pregnant women and alters infant morbidity. However, the impact of some prenatal and perinatal risk factors such as season and intermittent preventive treatment during pregnancy (IPTp) on neonatal susceptibility has not been fully elucidated. Methods. A cohort of 415 infants born to women who were positive and negative for malaria was monitored in a longitudinal study in Southwestern Cameroon. The clinical and malaria statuses were assessed throughout, whereas paired maternal-cord and 1-year-old antimalarial antibodies were assayed by enzyme-linked immunosorbent assay. Infant susceptibility to malaria was ascertained after accounting for IPTp and season in the statistical analysis. Results. Malaria prevalence was higher in women (P = .039) who delivered during the rainy season and their infants (P = .030) compared with their dry season counterparts. Infants born to women who were positive for malaria (6.40 ± 2.83 months) were older (P = .028) than their counterparts who were negative for malaria (5.52 ± 2.85 months) when they experienced their first malaria episode. Infants born in September-November (adjusted odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.13-0.72) and to mothers on 1 or no IPTp-sulfadoxine/pyrimethamine (SP) dose (adjusted OR = 0.51, 95% CI = 0.28-0.91) were protected, whereas those born in the rainy season (adjusted OR = 2.82, 95% CI = 1.21-6.55) were susceptible to malaria. Conclusions. Intermittent preventive treatment during pregnancy and month of birth have important implications for infant susceptibility to malaria, with 2 or more IPTp-SP dosage possibly reducing immunoglobulin M production.
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Affiliation(s)
| | | | - Regina N. Mugri
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Clarisse Njua-Yafi
- Department of Animal Biology and Physiology, University of Yaounde I, Cameroon
| | - Rolland B. Tata
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Hanesh F. Chi
- Medical Laboratory Science
- Microbiology and Parasitology, University of Buea
| | - Delphine A. Tangoh
- Departments of Biochemistry and Molecular Biology
- Medical Laboratory Science
| | | | - Eric A. Achidi
- Departments of Biochemistry and Molecular Biology
- Medical Laboratory Science
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Ateba-Ngoa U, Mombo-Ngoma G, Zettlmeissl E, van der Vlugt LEPM, de Jong S, Matsiegui PB, Ramharter M, Kremsner PG, Yazdanbakhsh M, Adegnika AA. CD4+CD25hiFOXP3+ cells in cord blood of neonates born from filaria infected mother are negatively associated with CD4+Tbet+ and CD4+RORγt+ T cells. PLoS One 2014; 9:e114630. [PMID: 25531674 PMCID: PMC4273973 DOI: 10.1371/journal.pone.0114630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background Children who have been exposed in utero to maternal filarial infection are immunologically less responsive to filarial antigens, have less pathology, and are more susceptible to acquire infection than offspring of uninfected mothers. Moreover children from filaria infected mothers have been shown to be less responsive to vaccination as a consequence of an impairment of their immune response. However, it is not well known how in utero exposure to parasite antigens affects cellular immune responses. Methodology Here, 30 pregnant women were examined for the presence of microfilaria of Loa loa and Mansonella perstans in peripheral blood. At delivery, cord blood mononuclear cells (CBMC) were obtained and the CD4+T cells were phenotyped by expression of the transcription factors Tbet, RORγt, and FOXP3. Results No significant difference was observed between newborns from infected versus uninfected mothers in the frequencies of total CD4+T cells and CD4+T cells subsets including CD4+Tbet+, CD4+RORγt+ T and CD4+CD25hiFOXP3+ T cells. However, there was a negative association between CD4+CD25hiFOXP3+T cells and CD4+Tbet+ as well as CD4+RORγt+ T cells in the infected group only (B = −0.242, P = 0.002; B = −0.178, P = 0.013 respectively). Conclusion Our results suggest that filarial infection during pregnancy leads to an expansion of functionally active regulatory T cells that keep TH1 and TH17 in check.
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Affiliation(s)
- Ulysse Ateba-Ngoa
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
| | - Eva Zettlmeissl
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
| | | | - Sanne de Jong
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
| | - Pierre-Blaise Matsiegui
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Centre de Recherches Médicales de la Ngounié, Fougamou, Gabon
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
| | - Maria Yazdanbakhsh
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, BP 118, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Wilhelmstraβe 27 D-72074 Tübingen, Germany
- * E-mail:
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Mother-to-Children Plasmodium falciparum Asymptomatic Malaria Transmission at Saint Camille Medical Centre in Ouagadougou, Burkina Faso. Malar Res Treat 2014; 2014:390513. [PMID: 25506464 PMCID: PMC4259075 DOI: 10.1155/2014/390513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/01/2014] [Indexed: 12/04/2022] Open
Abstract
Background. Malaria's prevalence during pregnancy varies widely in parts of sub-Saharan Africa, including Burkina Faso. The objective of this study was to evaluate the incidence of mother-to-child malaria transmission during childbirth at St. Camille Medical Centre in the city of Ouagadougou. Methods. Two hundred and thirty-eight (238) women and their newborns were included in the study. Women consenting to participate in this study responded to a questionnaire that identified their demographic characteristics. Asymptomatic malaria infection was assessed by rapid detection test Acon (Acon Malaria Pf, San Diego, USA) and by microscopic examination of Giemsa-stained thick and thin smears from peripheral, placental, and umbilical cord blood. Birth weights were recorded and the biological analyses of mothers and newborns' blood were also performed. Results. The utilization of long-lasting insecticidal nets (LLINs) and intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) were 86.6% and 84.4%, respectively. The parasitic infection rates of 9.5%, 8.9%, and 2.8% were recorded, respectively, for the peripheral, placental, and umbilical cord blood. Placental infection was strongly associated with the presence of parasites in the maternal peripheral blood and a parasite density of >1000 parasites/µL. Conclusion. The prevalence of congenital malaria was reduced but was associated with a high rate of mother-to-child malaria transmission.
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