1
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Gonçalves BP, Pérez-Caballero R, Barry A, Gaoussou S, Lewin A, Issiaka D, Keita S, Diarra BS, Mahamar A, Attaher O, Narum DL, Kurtis JD, Dicko A, Duffy PE, Fried M. Natural History of Malaria Infections During Early Childhood in Twins. J Infect Dis 2023; 227:171-178. [PMID: 35849702 DOI: 10.1093/infdis/jiac294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 07/15/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The frequency and clinical presentation of malaria infections show marked heterogeneity in epidemiological studies. However, deeper understanding of this variability is hampered by the difficulty in quantifying all relevant factors. Here, we report the history of malaria infections in twins, who are exposed to the same in utero milieu, share genetic factors, and are similarly exposed to vectors. METHODS Data were obtained from a Malian longitudinal birth cohort. Samples from 25 twin pairs were examined for malaria infection and antibody responses. Bayesian models were developed for the number of infections during follow-up. RESULTS In 16 of 25 pairs, both children were infected and often developed symptoms. In 8 of 25 pairs, only 1 twin was infected, but usually only once or twice. Statistical models suggest that this pattern is not inconsistent with twin siblings having the same underlying infection rate. In a pair with discordant hemoglobin genotype, parasite densities were consistently lower in the child with hemoglobin AS, but antibody levels were similar. CONCLUSIONS By using a novel design, we describe residual variation in malaria phenotypes in naturally matched children and confirm the important role of environmental factors, as suggested by the between-twin pair heterogeneity in malaria history.
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Affiliation(s)
- Bronner P Gonçalves
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Raúl Pérez-Caballero
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Amadou Barry
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Santara Gaoussou
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Djibrilla Issiaka
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bacary S Diarra
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Almahamoudou Mahamar
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Oumar Attaher
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - David L Narum
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan D Kurtis
- Center for International Health Research, Rhode Island Hospital, and Department of Pathology and Laboratory Medicine, Brown University Medical School, Providence, Rhode Island, USA
| | - Alassane Dicko
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michal Fried
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Idris IO, Ayeni GO, Iyamu IO, Sina-Odunsi AB, Adebisi YA, Obwoya JG. Factors influencing severity of recurrent malaria in a conflict-affected state of South Sudan: an unmatched case-control study. Confl Health 2022; 16:34. [PMID: 35690836 PMCID: PMC9188688 DOI: 10.1186/s13031-022-00463-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background The burden of malaria remains the highest in sub-Saharan Africa and South Sudan is not an exception. The country has borne the brunt of years of chronic warfare and remains endemic of malaria, with increasing mortality and morbidity. Limited data still exists on factors influencing the recurrence of severe malaria, especially in emergency contexts such as South Sudan, affected by various conflicts and humanitarian situations. This study therefore aimed to investigate factors influencing severity of occurrence malaria in selected primary healthcare centres in South Sudan. This would assist and guide in malaria prevention, treatment, and eradication efforts. Methods We conducted an unmatched case-control study using routinely collected clinic data for individuals aged 1 year and above who received a diagnosis of severe malaria at 3 primary healthcare centres (PHCC); Malual Bab PHCC, Matangai PHCC and Malek PHCC between September 15, 2019 to December 15, 2019 in South Sudan. Patient characteristics were analyzed using simple descriptive statistics. Inferential statistics were also conducted to identify the associated factors influencing recurrence of severe malaria. All analyses were conducted using R Version 3.6.2. Results A total of 289 recurrent malaria cases were included in this study. More than half of the participants were female. Overall, the prevalence of severe recurrent malaria was 66.1% (191) while 74.4% (215) did not complete malaria treatment. Among those who did not complete malaria treatment, 76.7% (165) had severe recurrent malaria, while among those who completed malaria treatment 35.1% (26) had severe recurrent malaria (p < 0.001). There is a significant association between marital status (OR 0.33, 95% CI 0.19–0.56, p < 0.001), employment status (OR 0.35, 95% CI 0.14–0.87, p = 0.024), the use of preventive measures (OR 3.82, 95% CI 1.81–8.43, p < 0.001) and nutrition status (OR 0.22, 95% CI 0.13–0.37, p < 0.001). When adjusted for employment, marital status, nutritional and prevention measures in turns using Mantel–Haenszel test of association, this effect remained statistically significant. Conclusions Our study showed that there is a high prevalence of severe recurrent malaria in South Sudan and that a significant relationship exists between severe recurrent malaria and antimalarial treatment dosage completion influenced by certain personal and social factors such as marital status, employment status, the use of preventive measures and nutrition status. Findings from our study would be useful for effective response to control and prevent malaria in endemic areas of South Sudan.
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Affiliation(s)
- Israel Oluwaseyidayo Idris
- Department of Field Operation and Project Coordination, Health Pooled Fund, Juba, South Sudan. .,Department of Social and Preventive Medicine, V.N Karazin Kharkiv National University, Kharkiv, Ukraine. .,Department of Population Health, Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, UK.
| | - Gabriel Omoniyi Ayeni
- Department of Field Operation and Project Coordination, Health Pooled Fund, Juba, South Sudan
| | - Ihoghosa Osamuyi Iyamu
- School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada
| | - Ayomide Busayo Sina-Odunsi
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Regional Office for the East and Horn of Africa, International Organization for Migration, United Nations Migration Agency, Nairobi, Kenya
| | | | - Justin Geno Obwoya
- Department of Field Operation and Project Coordination, Health Pooled Fund, Juba, South Sudan
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3
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Valletta JJ, Addy JW, Reid AJ, Ndungu FM, Bediako Y, Mwacharo J, Mohammed KS, Musyoki J, Ngoi JM, Wambua J, Otieno E, Berriman M, Bejon P, Marsh K, Langhorne J, Newbold CI, Recker M. Individual-level variations in malaria susceptibility and acquisition of clinical protection. Wellcome Open Res 2022; 6:22. [PMID: 35310901 PMCID: PMC8914138 DOI: 10.12688/wellcomeopenres.16524.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
After decades of research, our understanding of when and why individuals infected with
Plasmodium falciparum develop clinical malaria is still limited. Correlates of immune protection are often sought through prospective cohort studies, where measured host factors are correlated against the incidence of clinical disease over a set period of time. However, robustly inferring individual-level protection from these population-level findings has proved difficult due to small effect sizes and high levels of variance underlying such data. In order to better understand the nature of these inter-individual variations, we analysed the long-term malaria epidemiology of children ≤12 years old growing up under seasonal exposure to the parasite in the sub-location of Junju, Kenya. Despite the cohort’s limited geographic expanse (ca. 3km x 10km), our data reveal a high degree of spatial and temporal variability in malaria prevalence and incidence rates, causing individuals to experience varying levels of exposure to the parasite at different times during their life. Analysing individual-level infection histories further reveal an unexpectedly high variability in the rate at which children experience clinical malaria episodes. Besides exposure to the parasite, measured as disease prevalence in the surrounding area, we find that the birth time of year has an independent effect on the individual’s risk of experiencing a clinical episode. Furthermore, our analyses reveal that those children with a history of an above average number of episodes are more likely to experience further episodes during the upcoming transmission season. These findings are indicative of phenotypic differences in the rates by which children acquire clinical protection to malaria and offer important insights into the natural variability underlying malaria epidemiology.
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Affiliation(s)
- John Joseph Valletta
- School of Mathematics and Statistics, University of St. Andrews, St. Andrews, UK
| | - John W.G. Addy
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
| | - Adam J. Reid
- Parasite Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
| | | | - Yaw Bediako
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | | | | | | | - Joyce Mwongeli Ngoi
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Joshua Wambua
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edward Otieno
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Matt Berriman
- Parasite Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Philip Bejon
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Jean Langhorne
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
| | - Chris I. Newbold
- Parasite Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Mario Recker
- Centre for Ecology and Conservation, University of Exeter, Penryn, UK
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Omedo I, Bartilol B, Kimani D, Gonçalves S, Drury E, Rono MK, Abdi AI, Almagro-Garcia J, Amato R, Pearson RD, Ochola-Oyier LI, Kwiatkowski D, Bejon P. Spatio-temporal distribution of antimalarial drug resistant gene mutations in a Plasmodium falciparum parasite population from Kilifi, Kenya: A 25-year retrospective study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17656.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Antimalarial drug resistance is a major obstacle to sustainable malaria control. Here we use amplicon sequencing to describe molecular markers of drug resistance in Plasmodium falciparum parasites from Kilifi county in the coastal region of Kenya over a 25-year period. Methods: We performed P. falciparum amplicon sequencing on 1162 malaria-infected blood samples collected between 1994 and 2018 to identify markers of antimalarial drug resistance in the Pfcrt, Pfdhfr, Pfdhps, Pfmdr1, Pfexo, Pfkelch13, plasmepsin 2/3, Pfarps10, Pffd, and Pfmdr2 genes. We further interrogated parasite population structure using a genetic barcode of 101 drug resistance-unrelated single nucleotide polymorphisms (SNPs) distributed across the genomes of 1245 P. falciparum parasites. Results: Two major changes occurred in the parasite population over the 25 years studied. In 1994, approximately 75% of parasites carried the marker of chloroquine resistance, CVIET. This increased to 100% in 1999 and then declined steadily, reaching 6.7% in 2018. Conversely, the quintuple mutation form of sulfadoxine-pyrimethamine resistance increased from 16.7% in 1994 to 83.6% in 2018. Several non-synonymous mutations were identified in the Kelch13 gene, although none of them are currently associated with artemisinin resistance. We observed a temporal increase in the Pfmdr1 NFD haplotype associated with lumefantrine resistance, but observed no evidence of piperaquine resistance. SNPs in other parts of the genome showed no significant temporal changes despite the marked changes in drug resistance loci over this period. Conclusions: We identified substantial changes in molecular markers of P. falciparum drug resistance over 25 years in coastal Kenya, but no associated changes in the parasite population structure.
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Kapulu MC, Kimani D, Njuguna P, Hamaluba M, Otieno E, Kimathi R, Tuju J, Sim BKL, Abdi AI, Abebe Y, Bejon P, Billingsley PF, Bull PC, de Laurent Z, Hoffman SL, James ER, Kariuki S, Kinyanjui S, Kivisi C, Makale J, Marsh K, Mohammed KS, Mosobo M, Musembi J, Musyoki J, Muthui M, Mwacharo J, Mwai K, Ngoi JM, Ngoto O, Nkumama I, Ndungu F, Odera D, Ogutu B, Olewe F, Omuoyo D, Ong’echa J, Osier F, Richie TL, Shangala J, Wambua J, Williams TN. Controlled human malaria infection (CHMI) outcomes in Kenyan adults is associated with prior history of malaria exposure and anti-schizont antibody response. BMC Infect Dis 2022; 22:86. [PMID: 35073864 PMCID: PMC8785382 DOI: 10.1186/s12879-022-07044-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Individuals living in endemic areas acquire immunity to malaria following repeated parasite exposure. We sought to assess the controlled human malaria infection (CHMI) model as a means of studying naturally acquired immunity in Kenyan adults with varying malaria exposure.
Methods
We analysed data from 142 Kenyan adults from three locations representing distinct areas of malaria endemicity (Ahero, Kilifi North and Kilifi South) enrolled in a CHMI study with Plasmodium falciparum sporozoites NF54 strain (Sanaria® PfSPZ Challenge). To identify the in vivo outcomes that most closely reflected naturally acquired immunity, parameters based on qPCR measurements were compared with anti-schizont antibody levels and residence as proxy markers of naturally acquired immunity.
Results
Time to endpoint correlated more closely with anti-schizont antibodies and location of residence than other parasite parameters such as growth rate or mean parasite density. Compared to observational field-based studies in children where 0.8% of the variability in malaria outcome was observed to be explained by anti-schizont antibodies, in the CHMI model the dichotomized anti-schizont antibodies explained 17% of the variability.
Conclusions
The CHMI model is highly effective in studying markers of naturally acquired immunity to malaria.
Trial registration Clinicaltrials.gov number NCT02739763. Registered 15 April 2016
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6
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Muthui MK, Takashima E, Omondi BR, Kinya C, Muasya WI, Nagaoka H, Mwai KW, Orindi B, Wambua J, Bousema T, Drakeley C, Blagborough AM, Marsh K, Bejon P, Kapulu MC. Characterization of Naturally Acquired Immunity to a Panel of Antigens Expressed in Mature P. falciparum Gametocytes. Front Cell Infect Microbiol 2021; 11:774537. [PMID: 34869075 PMCID: PMC8633105 DOI: 10.3389/fcimb.2021.774537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Naturally acquired immune responses against antigens expressed on the surface of mature gametocytes develop in individuals living in malaria-endemic areas. Evidence suggests that such anti-gametocyte immunity can block the development of the parasite in the mosquito, thus playing a role in interrupting transmission. A better comprehension of naturally acquired immunity to these gametocyte antigens can aid the development of transmission-blocking vaccines and improve our understanding of the human infectious reservoir. Methods Antigens expressed on the surface of mature gametocytes that had not previously been widely studied for evidence of naturally acquired immunity were identified for protein expression alongside Pfs230-C using either the mammalian HEK293E or the wheat germ cell-free expression systems. Where there was sequence variation in the candidate antigens (3D7 vs a clinical isolate PfKE04), both variants were expressed. ELISA was used to assess antibody responses against these antigens, as well as against crude stage V gametocyte extract (GE) and AMA1 using archived plasma samples from individuals recruited to participate in malaria cohort studies. We analyzed antibody levels (estimated from optical density units using a standardized ELISA) and seroprevalence (defined as antibody levels greater than three standard deviations above the mean levels of a pool of malaria naïve sera). We described the dynamics of antibody responses to these antigens by identifying factors predictive of antibody levels using linear regression models. Results Of the 25 antigens selected, seven antigens were produced successfully as recombinant proteins, with one variant antigen, giving a total of eight proteins for evaluation. Antibodies to the candidate antigens were detectable in the study population (N = 216), with seroprevalence ranging from 37.0% (95% CI: 30.6%, 43.9%) for PSOP1 to 77.8% (95% CI: 71.6%, 83.1%) for G377 (3D7 variant). Responses to AMA1 and GE were more prevalent than those to the gametocyte proteins at 87.9% (95% CI: 82.8%, 91.9%) and 88.3% (95% CI: 83.1%, 92.4%), respectively. Additionally, both antibody levels and breadth of antibody responses were associated with age and concurrent parasitaemia. Conclusion Age and concurrent parasitaemia remain important determinants of naturally acquired immunity to gametocyte antigens. Furthermore, we identify novel candidates for transmission-blocking activity evaluation.
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Affiliation(s)
- Michelle K Muthui
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - Eizo Takashima
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Brian R Omondi
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - Christine Kinya
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - William I Muasya
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - Hikaru Nagaoka
- Division of Malaria Research, Proteo-Science Center, Ehime University, Matsuyama, Japan
| | - Kennedy W Mwai
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benedict Orindi
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - Juliana Wambua
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew M Blagborough
- Division of Microbiology and Parasitology, Department of Pathology, Cambridge University, Tennis Court Road, Cambridge, United Kingdom
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Philip Bejon
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Melissa C Kapulu
- Department of Biosciences, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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7
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Valletta JJ, Addy JW, Reid AJ, Ndungu FM, Bediako Y, Mwacharo J, Said K, Musyoki J, Ngoi JM, Wambua J, Otieno E, Berriman M, Bejon P, Marsh K, Langhorne J, Newbold CI, Recker M. Individual-level variations in malaria susceptibility and acquisition of clinical protection. Wellcome Open Res 2021; 6:22. [DOI: 10.12688/wellcomeopenres.16524.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
After decades of research, our understanding of when and why individuals infected with Plasmodium falciparum develop clinical malaria is still limited. Correlates of immune protection are often sought through prospective cohort studies, where measured host factors are correlated against the incidence of clinical disease over a set period of time. However, robustly inferring individual-level protection from these population-level findings has proved difficult due to small effect sizes and high levels of variance underlying such data. In order to better understand the nature of these inter-individual variations, we analysed the long-term malaria epidemiology of children ≤12 years old growing up under seasonal exposure to the parasite in the sub-location of Junju, Kenya. Despite the cohort’s limited geographic expanse (ca. 3km x 10km), our data reveal a high degree of spatial and temporal variability in malaria prevalence and incidence rates, causing individuals to experience varying levels of exposure to the parasite at different times during their life. Analysing individual-level infection histories further reveal an unexpectedly high variability in the rate at which children experience clinical malaria episodes. Besides exposure to the parasite, measured as disease prevalence in the surrounding area, we find that the birth time of year has an independent effect on the individual’s risk of experiencing a clinical episode. Furthermore, our analyses reveal that those children with a history of an above average number of episodes are more likely to experience further episodes during the upcoming transmission season. These findings are indicative of phenotypic differences in the rates by which children acquire clinical protection to malaria and offer important insights into the natural variability underlying malaria epidemiology.
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8
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Nyamwaya DK, Otiende M, Omuoyo DO, Githinji G, Karanja HK, Gitonga JN, R de Laurent Z, Otieno JR, Sang R, Kamau E, Cheruiyot S, Otieno E, Agoti CN, Bejon P, Thumbi SM, Warimwe GM. Endemic chikungunya fever in Kenyan children: a prospective cohort study. BMC Infect Dis 2021; 21:186. [PMID: 33602147 PMCID: PMC7889702 DOI: 10.1186/s12879-021-05875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background Chikungunya fever (CHIKF) was first described in Tanzania in 1952. Several epidemics including East Africa have occurred, but there are no descriptions of longitudinal surveillance of endemic disease. Here, we estimate the incidence of CHIKF in coastal Kenya and describe the associated viral phylogeny. Methods We monitored acute febrile illnesses among 3500 children visiting two primary healthcare facilities in coastal Kenya over a 5-year period (2014–2018). Episodes were linked to a demographic surveillance system and blood samples obtained. Cross-sectional sampling in a community survey of a different group of 435 asymptomatic children in the same study location was done in 2016. Reverse-transcriptase PCR was used for chikungunya virus (CHIKV) screening, and viral genomes sequenced for phylogenetic analyses. Results We found CHIKF to be endemic in this setting, associated with 12.7% (95% CI 11.60, 13.80) of all febrile presentations to primary healthcare. The prevalence of CHIKV infections among asymptomatic children in the community survey was 0.7% (95% CI 0.22, 2.12). CHIKF incidence among children < 1 year of age was 1190 cases/100,000-person years and 63 cases/100,000-person years among children aged ≥10 years. Recurrent CHIKF episodes, associated with fever and viraemia, were observed among 19 of 170 children with multiple febrile episodes during the study period. All sequenced viral genomes mapped to the ECSA genotype albeit distinct from CHIKV strains associated with the 2004 East African epidemic. Conclusions CHIKF may be a substantial public health burden in primary healthcare on the East African coast outside epidemic years, and recurrent infections are common. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05875-5.
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Affiliation(s)
- Doris K Nyamwaya
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Mark Otiende
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - George Githinji
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Henry K Karanja
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - John N Gitonga
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - James R Otieno
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | | | - Everlyn Kamau
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Stanley Cheruiyot
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Edward Otieno
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Charles N Agoti
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK
| | - Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, 99164-7090, USA.,Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578-4100, Kisumu, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, P.O Box 19676, Nairobi, 00202, Kenya
| | - George M Warimwe
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya. .,Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, NDM Research Building, Oxford, OX3 7FZ, UK.
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9
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Valletta JJ, Addy JW, Reid AJ, Ndungu FM, Bediako Y, Mwacharo J, Said K, Musyoki J, Ngoi JM, Wambua J, Otieno E, Berriman M, Bejon P, Marsh K, Langhorne J, Newbold CI, Recker M. Individual-level variations in malaria susceptibility and acquisition of clinical protection. Wellcome Open Res 2021; 6:22. [DOI: 10.12688/wellcomeopenres.16524.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/20/2022] Open
Abstract
After decades of research, our understanding of when and why individuals infected with Plasmodium falciparum develop clinical malaria is still limited. Correlates of immune protection are often sought through prospective cohort studies, where measured host factors are correlated against the incidence of clinical disease over a set period of time. However, robustly inferring individual-level protection from these population-level findings has proved difficult due to small effect sizes and high levels of variance underlying such data. In order to better understand the nature of these inter-individual variations, we analysed the long-term malaria epidemiology of children ≤12 years old growing up under seasonal exposure to the parasite in the sub-location of Junju, Kenya. Despite the cohort’s limited geographic expanse (ca. 3km x 10km), our data reveal a high degree of spatial and temporal variability in malaria prevalence and incidence rates, causing individuals to experience varying levels of exposure to the parasite at different times during their life. Analysing individual-level infection histories further reveal an unexpectedly high variability in the rate at which children experience clinical malaria episodes. Besides exposure to the parasite, measured as disease prevalence in the surrounding area, we find that the birth time of year has an independent effect on the individual’s risk of experiencing a clinical episode. Furthermore, our analyses reveal that those children with a history of an above average number of episodes are more likely to experience further episodes during the upcoming transmission season. These findings are indicative of phenotypic differences in the rates by which children acquire clinical protection to malaria and offer important insights into the natural variability underlying malaria epidemiology.
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10
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O'Meara WP, Simmons R, Bullins P, Freedman B, Abel L, Mangeni J, Taylor SM, Obala AA. Mosquito Exposure and Malaria Morbidity: A Microlevel Analysis of Household Mosquito Populations and Malaria in a Population-Based Longitudinal Cohort in Western Kenya. J Infect Dis 2021; 221:1176-1184. [PMID: 31665350 DOI: 10.1093/infdis/jiz561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malaria morbidity is highly overdispersed in the population. Fine-scale differences in mosquito exposure may partially explain this heterogeneity in individual malaria outcomes. METHODS In 38 households we explored the effect of household-level mosquito exposure and individual insecticide-treated net (ITN) use on relative risk (RR) of confirmed malaria. We conducted monthly active surveillance (n = 254; 2624 person-months) and weekly mosquito collection (2092 household-days of collection), and used molecular techniques to confirm human blood feeding and exposure to infectious mosquitoes. RESULTS Of 1494 female Anopheles (89.8% Anopheles gambiae sensu lato), 88.3% were fed, 51.9% had a human blood meal, and 9.2% were sporozoite infected. In total, 168 laboratory-confirmed malaria episodes were reported (incidence rate 0.064 episodes per person-month at risk; 95% confidence interval [CI], .055-.074). Malaria risk was directly associated with exposure to sporozoite-infected mosquitoes (RR, 1.24; 95% CI, 1.11-1.38). No direct effect was measured between ITN use and malaria morbidity; however, ITN use did moderate the effect of mosquito exposure on morbidity. CONCLUSIONS Malaria risk increases linearly with vector density and feeding success for persons with low ITN use. In contrast, malaria risk among high ITN users is consistently low and insensitive to variation in mosquito exposure.
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Affiliation(s)
- Wendy Prudhomme O'Meara
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University, Durham, North Carolina, USA.,School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Ryan Simmons
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Paige Bullins
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Betsy Freedman
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Lucy Abel
- Academic Model Providing Access to Healthcare, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Judith Mangeni
- School of Nursing, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Steve M Taylor
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Andrew A Obala
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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11
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Nyundo C, Doyle AM, Walumbe D, Otiende M, Kinuthia M, Amadi D, Jibendi B, Mochamah G, Kihuha N, Williams TN, Ross DA, Bauni E. Linking health facility data from young adults aged 18-24 years to longitudinal demographic data: Experience from The Kilifi Health and Demographic Surveillance System. Wellcome Open Res 2020; 2:51. [PMID: 32175477 PMCID: PMC7059845 DOI: 10.12688/wellcomeopenres.11302.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background: In 2014, a pilot study was conducted to test the feasibility of linking clinic attendance data for young adults at two health facilities to the population register of the Kilifi Health and Demographic Surveillance System (KHDSS). This was part of a cross-sectional survey of health problems of young people, and we tested the feasibility of using the KHDSS platform for the monitoring of future interventions. Methods: Two facilities were used for this study. Clinical data from consenting participants aged 18-24 years were matched to KHDSS records. Data matching was achieved using national identity card numbers or otherwise using a matching algorithm based on names, sex, date of birth, location of residence and the names of other homestead members. A study form was administered to all matched patients to capture reasons for their visits and time taken to access the services. Distance to health facility from a participants’ homestead was also computed. Results: 628 participated in the study: 386 (61%) at Matsangoni Health Centre, and 242 (39%) at Pingilikani Dispensary. 610 (97%) records were matched to the KHDSS register. Most records (605; 96%) were matched within these health facilities, while 5 (1%) were matched during homestead follow-up visits. 463 (75.9%) of those matched were women. Antenatal care (25%), family planning (13%), respiratory infections (9%) and malaria (9%) were the main reasons for seeking care. Antenatal clinic visits (n=175) and malaria (n=27) were the commonest reasons among women and men, respectively. Participants took 1-1.5 hours to access the services; 490 (81.0%) participants lived within 5 kilometres of a facility. Conclusions: With a full-time research clerk at each health facility, linking health-facility attendance data to a longitudinal HDSS platform was feasible and could be used to monitor and evaluate the impact of health interventions on health care outcomes among young people.
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Affiliation(s)
- Christopher Nyundo
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana
| | - Aoife M Doyle
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - David Walumbe
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana
| | - Mark Otiende
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana
| | | | - David Amadi
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - George Mochamah
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana
| | | | - Thomas N Williams
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana.,Imperial College, London, SW7 2AZ, UK
| | - David A Ross
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Evasius Bauni
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,INDEPTH, Accra, Ghana
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12
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Corder RM, Paula GA, Pincelli A, Ferreira MU. Statistical modeling of surveillance data to identify correlates of urban malaria risk: A population-based study in the Amazon Basin. PLoS One 2019; 14:e0220980. [PMID: 31398228 PMCID: PMC6688813 DOI: 10.1371/journal.pone.0220980] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Despite the recent malaria burden reduction in the Americas, focal transmission persists across the Amazon Basin. Timely analysis of surveillance data is crucial to characterize high-risk individuals and households for better targeting of regional elimination efforts. Here we analyzed 5,480 records of laboratory-confirmed clinical malaria episodes combined with demographic and socioeconomic information to identify risk factors for elevated malaria incidence in Mâncio Lima, the main urban transmission hotspot of Brazil. Overdispersed malaria count data clustered into households were fitted with random-effects zero-inflated negative binomial regression models. Random-effect predictors were used to characterize the spatial heterogeneity in malaria risk at the household level. Adult males were identified as the population stratum at greatest risk, likely due to increased occupational exposure away of the town. However, poor housing and residence in the less urbanized periphery of the town were also found to be key predictors of malaria risk, consistent with a substantial local transmission. Two thirds of the 8,878 urban residents remained uninfected after 23,975 person-years of follow-up. Importantly, we estimated that nearly 14% of them, mostly children and older adults living in the central urban hub, were free of malaria risk, being either unexposed, naturally unsusceptible, or immune to infection. We conclude that statistical modeling of routinely collected, but often neglected, malaria surveillance data can be explored to characterize drivers of transmission heterogeneity at the community level and provide evidence for the rational deployment of control interventions.
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Affiliation(s)
- Rodrigo M. Corder
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (RMC); (MUF)
| | - Gilberto A. Paula
- Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Anaclara Pincelli
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marcelo U. Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- * E-mail: (RMC); (MUF)
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13
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Muthui MK, Mogeni P, Mwai K, Nyundo C, Macharia A, Williams TN, Nyangweso G, Wambua J, Mwanga D, Marsh K, Bejon P, Kapulu MC. Gametocyte carriage in an era of changing malaria epidemiology: A 19-year analysis of a malaria longitudinal cohort. Wellcome Open Res 2019; 4:66. [PMID: 31223663 PMCID: PMC6557001 DOI: 10.12688/wellcomeopenres.15186.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Interventions to block malaria transmission from humans to mosquitoes are currently in development. To be successfully implemented, key populations need to be identified where the use of these transmission-blocking and/or reducing strategies will have greatest impact. Methods: We used data from a longitudinally monitored cohort of children from Kilifi county located along the Kenyan coast collected between 1998-2016 to describe the distribution and prevalence of gametocytaemia in relation to transmission intensity, time and age. Data from 2,223 children accounting for 9,134 person-years of follow-up assessed during cross-sectional surveys for asexual parasites and gametocytes were used in logistic regression models to identify factors predictive of gametocyte carriage in this cohort. Results: Our analysis showed that children 1-5 years of age were more likely to carry microscopically detectable gametocytes than their older counterparts. Carrying asexual parasites and recent episodes of clinical malaria were also strong predictors of gametocyte carriage. The prevalence of asexual parasites and of gametocyte carriage declined over time, and after 2006, when artemisinin combination therapy (ACT) was introduced, recent episodes of clinical malaria ceased to be a predictor of gametocyte carriage. Conclusions: Gametocyte carriage in children in Kilifi has fallen over time. Previous episodes of clinical malaria may contribute to the development of carriage, but this appears to be mitigated by the use of ACTs highlighting the impact that gametocidal antimalarials can have in reducing the overall prevalence of gametocytaemia when targeted on acute febrile illness.
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Affiliation(s)
- Michelle K Muthui
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Polycarp Mogeni
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,African Health Research Institute, Durban, Congella, 4013, Private bag X7, South Africa
| | - Kennedy Mwai
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, 2193, 27 St Andrews Road, South Africa
| | - Christopher Nyundo
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Alex Macharia
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Thomas N Williams
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Department of Medicine, Imperial College London, St Mary's Campus, London, W21NY, UK
| | - George Nyangweso
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Juliana Wambua
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Daniel Mwanga
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kevin Marsh
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Philip Bejon
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Melissa C Kapulu
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
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14
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Muthui MK, Mogeni P, Mwai K, Nyundo C, Macharia A, Williams TN, Nyangweso G, Wambua J, Mwanga D, Marsh K, Bejon P, Kapulu MC. Gametocyte carriage in an era of changing malaria epidemiology: A 19-year analysis of a malaria longitudinal cohort. Wellcome Open Res 2019; 4:66. [PMID: 31223663 PMCID: PMC6557001 DOI: 10.12688/wellcomeopenres.15186.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 10/25/2023] Open
Abstract
Background: Interventions to block malaria transmission from humans to mosquitoes are currently in development. To be successfully implemented, key populations need to be identified where the use of these transmission-blocking and/or reducing strategies will have greatest impact. Methods: We used data from a longitudinally monitored cohort of children from Kilifi county located along the Kenyan coast collected between 1998-2016 to describe the distribution and prevalence of gametocytaemia in relation to transmission intensity, time and age. Data from 2,223 children accounting for 9,134 person-years of follow-up assessed during cross-sectional surveys for asexual parasites and gametocytes were used in logistic regression models to identify factors predictive of gametocyte carriage in this cohort. Results: Our analysis showed that children 1-5 years of age were more likely to carry microscopically detectable gametocytes than their older counterparts. Carrying asexual parasites and recent episodes of clinical malaria were also strong predictors of gametocyte carriage. The prevalence of asexual parasites and of gametocyte carriage declined over time, and after 2006, when artemisinin combination therapy (ACT) was introduced, recent episodes of clinical malaria ceased to be a predictor of gametocyte carriage. Conclusions: Gametocyte carriage in children in Kilifi has fallen over time. Previous episodes of clinical malaria may contribute to the development of carriage, but this appears to be mitigated by the use of ACTs highlighting the impact that gametocidal antimalarials can have in reducing the overall prevalence of gametocytaemia when targeted on acute febrile illness.
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Affiliation(s)
- Michelle K. Muthui
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Polycarp Mogeni
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- African Health Research Institute, Durban, Congella, 4013, Private bag X7, South Africa
| | - Kennedy Mwai
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, 2193, 27 St Andrews Road, South Africa
| | - Christopher Nyundo
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Alex Macharia
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Thomas N. Williams
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Department of Medicine, Imperial College London, St Mary's Campus, London, W21NY, UK
| | - George Nyangweso
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Juliana Wambua
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Daniel Mwanga
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
| | - Kevin Marsh
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Philip Bejon
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
| | - Melissa C. Kapulu
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK
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15
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Bendabenda J, Patson N, Hallamaa L, Ashorn U, Dewey KG, Ashorn P, Maleta K. Does anthropometric status at 6 months predict the over-dispersion of malaria infections in children aged 6-18 months? A prospective cohort study. Malar J 2019; 18:143. [PMID: 31010435 PMCID: PMC6477714 DOI: 10.1186/s12936-019-2778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In malaria-endemic settings, a small proportion of children suffer repeated malaria infections, contributing to most of the malaria cases, yet underlying factors are not fully understood. This study was aimed to determine whether undernutrition predicts this over-dispersion of malaria infections in children aged 6-18 months in settings of high malaria and undernutrition prevalence. METHODS Prospective cohort study, conducted in Mangochi, Malawi. Six-months-old infants were enrolled and had length-for-age z-scores (LAZ), weight-for-age z-scores (WAZ), and weight-for-length z-scores (WLZ) assessed. Data were collected for 'presumed', clinical, and rapid diagnostic test (RDT)-confirmed malaria until 18 months. Malaria microscopy was done at 6 and 18 months. Negative binomial regression was used for malaria incidence and modified Poisson regression for malaria prevalence. RESULTS Of the 2723 children enrolled, 2561 (94%) had anthropometry and malaria data. The mean (standard deviation [SD]) of LAZ, WAZ, and WLZ at 6 months were - 1.4 (1.1), - 0.7 (1.2), and 0.3 (1.1), respectively. The mean (SD) incidences of 'presumed', clinical, and RDT-confirmed malaria from 6 to 18 months were: 1.1 (1.6), 0.4 (0.8), and 1.3 (2.0) episodes/year, respectively. Prevalence of malaria parasitaemia was 4.8% at 6 months and 9.6% at 18 months. Higher WLZ at 6 months was associated with lower prevalence of malaria parasitaemia at 18 months (prevalence ratio [PR] = 0.80, 95% confidence interval [CI] 0.67 to 0.94, p = 0.007), but not with incidences of 'presumed' malaria (incidence rate ratio [IRR] = 0.97, 95% CI 0.92 to 1.02, p = 0.190), clinical malaria (IRR = 1.03, 95% CI 0.94 to 1.12, p = 0.571), RDT-confirmed malaria (IRR = 1.00, 95% CI 0.94 to 1.06, p = 0.950). LAZ and WAZ at 6 months were not associated with malaria outcomes. Household assets, maternal education, and food insecurity were significantly associated with malaria. There were significant variations in hospital-diagnosed malaria by study site. CONCLUSION In children aged 6-18 months living in malaria-endemic settings, LAZ, WAZ, and WLZ do not predict malaria incidence. However, WLZ may be associated with prevalence of malaria. Socio-economic and micro-geographic factors may explain the variations in malaria, but these require further study. Trial registration NCT00945698. Registered July 24, 2009, https://clinicaltrials.gov/ct2/show/NCT00945698 , NCT01239693. Registered Nov 11, 2010, https://clinicaltrials.gov/ct2/show/NCT01239693.
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Affiliation(s)
- Jaden Bendabenda
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Noel Patson
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lotta Hallamaa
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Ulla Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Per Ashorn
- Faculty of Medicine and Life Sciences, Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Kenneth Maleta
- Department of Public Health, School of Public Health, University of Malawi College of Medicine, Mahatma Gandhi Road, Private Bag 360, Blantyre 3, Malawi.
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16
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Lawpoolsri S, Sattabongkot J, Sirichaisinthop J, Cui L, Kiattibutr K, Rachaphaew N, Suk-Uam K, Khamsiriwatchara A, Kaewkungwal J. Epidemiological profiles of recurrent malaria episodes in an endemic area along the Thailand-Myanmar border: a prospective cohort study. Malar J 2019; 18:124. [PMID: 30961583 PMCID: PMC6454765 DOI: 10.1186/s12936-019-2763-5] [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: 02/07/2019] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In low malaria transmission areas, many people acquire multiple malaria infections within a single season. This study aimed to describe the pattern and epidemiological profile of malaria recurrence in a hypoendemic area of western Thailand and identify factors associated with having multiple malaria episodes. METHODS An open cohort of 7000 residents in seven clusters along the Thai-Myanmar border was followed during a 6.5-year period (2011-mid 2017). Symptomatic and asymptomatic malaria infections were detected by passive case detection (PCD), weekly household visit, and mass blood surveys every 4-6 months. Malaria recurrence was defined as subsequent parasitaemic episodes occurred later than 7 days after receiving anti-malarial treatment. This study focused on analysis of recurrent episodes that occurred within 1 year after treatment. Numbers of malaria cases with single and multiple episodes were compared between clusters. Kaplan-Meier curve was performed to determine the intervals of recurrent episodes by Plasmodium species and age groups. The ordinal logistic model was used to determine factors associated with multiple malaria episodes, and to compare with single episodes, and those with no malaria infection. RESULTS The cumulative incidence of malaria in the study area was 5.2% over the 6.5 years. Overall, 410 malaria patients were detected. Of these patients, 20% and 16% had multiple malaria episodes during the entire period and within 1 year after initial treatment, respectively. About 80% of repeated malaria episodes were caused by the same Plasmodium species as the primary infections. The median interval and interquartile range (IQR) between the first and second episode was 88 (43-175) days for all parasites, 56 (35-133) days for two Plasmodium falciparum episodes, and 90 (59-204) days for two Plasmodium vivax episodes. The interval between the episodes was increased with age. Factors significantly associated with multiple episodes of malaria infection included male sex, young age, Karen ethnicity, forest-related occupation, and having other malaria infected persons in the same house in the same period. CONCLUSIONS People who have multiple malaria episodes may play an important role in maintaining malaria transmission in the area. Understanding epidemiological profiles of this group is important for planning strategies to achieve the elimination goal.
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Affiliation(s)
- Saranath Lawpoolsri
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jeeraphat Sirichaisinthop
- Bureau of Vector-Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Liwang Cui
- Division of Infectious Diseases and Internal Medicine, Department of Internal Medicine, University of South Florida, Tampa, USA
| | - Kirakorn Kiattibutr
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattawan Rachaphaew
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kritsana Suk-Uam
- Vector-Borne Disease Control Center 2.3, Ministry of Public Health, Tak, Thailand
| | - Amnat Khamsiriwatchara
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jaranit Kaewkungwal
- Center of Excellence in Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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17
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Abstract
A single exposure to many viral and bacterial pathogens typically induces life-long immunity, however, the development of the protective immunity to Plasmodium parasites is strikingly less efficient and achieves only partial protection, with adults residing in endemic areas often experiencing asymptomatic infections. Although naturally acquired immunity to malaria requires both cell-mediated and humoral immune responses, antibodies govern the control of malarial disease caused by the blood-stage form of the parasites. A large body of epidemiological evidence described that antibodies to Plasmodium antigens are inefficiently generated and rapidly lost without continued parasite exposure, suggesting that malaria is accompanied by defects in the development of immunological B cell memory. This topic has been of focus of recent studies of malaria infection in humans and mice. This review examines the main findings to date on the processes that modulate the acquisition of memory B cell responses to malaria, and highlights the importance of closing outstanding gaps of knowledge in the field for the rational design of next generation therapeutics against malaria.
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Affiliation(s)
- Ann Ly
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Diana S Hansen
- The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
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18
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Wamae K, Wambua J, Nyangweso G, Mwambingu G, Osier F, Ndung’u F, Bejon P, Ochola-Oyier LI. Transmission and Age Impact the Risk of Developing Febrile Malaria in Children with Asymptomatic Plasmodium falciparum Parasitemia. J Infect Dis 2019; 219:936-944. [PMID: 30307567 PMCID: PMC6386809 DOI: 10.1093/infdis/jiy591] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plasmodium falciparum infections lead to febrile illness unless the host has sufficient immunity, in which case infection may cause no immediate symptoms (ie, "asymptomatic parasitemia"). Previous studies are conflicting on the role of asymptomatic parasitemia in determining the risk of developing febrile malaria. METHODS We monitored 2513 children (living in Kilifi, Kenyan Coast) by blood smears in 17 cross-sectional surveys to identify asymptomatic parasitemia and used active surveillance over 11325 child-years of follow-up to detect febrile malaria. We evaluated the interaction between transmission intensity, age, and asymptomatic parasitemia in determining the risk of developing febrile malaria. RESULTS In the moderate and high transmission intensity settings, asymptomatic parasitemia was associated with a reduced risk of febrile malaria in older children (> 3 years), while in the lower transmission setting, asymptomatic parasitemia was associated with an increased risk of febrile malaria in children of all ages. Additionally, the risk associated with asymptomatic parasitemia was limited to the first 90 days of follow-up. CONCLUSIONS Asymptomatic parasitemia is modified by transmission intensity and age, altering the risk of developing febrile episodes and suggesting that host immunity plays a prominent role in mediating this process.
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Affiliation(s)
- Kevin Wamae
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Juliana Wambua
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - George Nyangweso
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gabriel Mwambingu
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Faith Osier
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis Ndung’u
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, United Kingdom
| | - Philip Bejon
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, United Kingdom
| | - Lynette Isabella Ochola-Oyier
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Biotechnology and Bioinformatics, University of Nairobi, Kenya
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19
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Guelbéogo WM, Gonçalves BP, Grignard L, Bradley J, Serme SS, Hellewell J, Lanke K, Zongo S, Sepúlveda N, Soulama I, Wangrawa DW, Yakob L, Sagnon N, Bousema T, Drakeley C. Variation in natural exposure to anopheles mosquitoes and its effects on malaria transmission. eLife 2018; 7:32625. [PMID: 29357976 PMCID: PMC5780040 DOI: 10.7554/elife.32625] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022] Open
Abstract
Variation in biting frequency by Anopheles mosquitoes can explain some of the heterogeneity in malaria transmission in endemic areas. In this study in Burkina Faso, we assessed natural exposure to mosquitoes by matching the genotype of blood meals from 1066 mosquitoes with blood from residents of local households. We observed that the distribution of mosquito bites exceeded the Pareto rule (20/80) in two of the three surveys performed (20/85, 76, and 96) and, at its most pronounced, is estimated to have profound epidemiological consequences, inflating the basic reproduction number of malaria by 8-fold. The distribution of bites from sporozoite-positive mosquitoes followed a similar pattern, with a small number of individuals within households receiving multiple potentially infectious bites over the period of a few days. Together, our findings indicate that heterogeneity in mosquito exposure contributes considerably to heterogeneity in infection risk and suggest significant variation in malaria transmission potential.
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Affiliation(s)
- Wamdaogo M Guelbéogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Bronner Pamplona Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lynn Grignard
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Bradley
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel S Serme
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Joel Hellewell
- MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Soumanaba Zongo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Nuno Sepúlveda
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre of Statistics and Applications, University of Lisbon, Lisbon, Portugal
| | - Issiaka Soulama
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Dimitri W Wangrawa
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - N'Falé Sagnon
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
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From hospitalization records to surveillance: The use of local patient profiles to characterize cholera in Vellore, India. PLoS One 2017; 12:e0182642. [PMID: 28820902 PMCID: PMC5562306 DOI: 10.1371/journal.pone.0182642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/22/2017] [Indexed: 11/19/2022] Open
Abstract
Despite availability of high quality medical records, health care systems often do not have the resources or tools to utilize these data efficiently. Yet, hospital-based, laboratory-confirmed records may pave the way for building reliable surveillance systems capable of monitoring temporal trends of emerging infections. In this communication, we present a new tool to compress and visualize medical records with a local population profile (LPP) approach, which transforms information into statistically comparable patterns. We provide a step-by-step tutorial on how to build, interpret, and expand the use of LPP using hospitalization records of laboratory-confirmed cholera. We abstracted case information from the databases maintained by the Department of Clinical Microbiology at Christian Medical College in Vellore, India. We used a single-year age distribution to construct LPPs for O1, O139, and non O1/O139 serotypes of Vibrio cholerae. Disease counts and hospitalization rates were converted into fitted kernel-based probability densities. We formally compared LPPs with the Kolmogorov-Smirnov test, and created multi-panel visuals to depict temporal trend, age distribution, and hospitalization rates simultaneously. Our first implementation of LPPs revealed information that is typically gathered from surveillance systems such as: i) estimates of the demographic distribution of diseases and identification of a population at risk, ii) changes in the dominant pathogen presence; and iii) trends in disease occurrence. The LPP demonstrated the benefit of increased resolution in pattern detection of disease for different Vibrio cholerae serotypes and two demographic categories by showing patterns and anomalies that would be obscured by traditional methods of analysis and visualization. LPP can be used effectively to compile basic patient information such as age, sex, diagnosis, location, and time into compact visuals. Future development of the proposed approach will allow public health researchers and practitioners to broadly utilize and efficiently compress large volumes of medical records without loss of information.
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Burgess SL, Gilchrist CA, Lynn TC, Petri WA. Parasitic Protozoa and Interactions with the Host Intestinal Microbiota. Infect Immun 2017; 85:e00101-17. [PMID: 28584161 PMCID: PMC5520446 DOI: 10.1128/iai.00101-17] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Parasitic protozoan infections represent a major health burden in the developing world and contribute significantly to morbidity and mortality. These infections are often associated with considerable variability in clinical presentation. An emerging body of work suggests that the intestinal microbiota may help to explain some of these differences in disease expression. The objective of this minireview is to synthesize recent progress in this rapidly advancing field. Studies of humans and animals and in vitro studies of the contribution of the intestinal microbiota to infectious disease are discussed. We hope to provide an understanding of the human-protozoal pathogen-microbiome interaction and to speculate on how that might be leveraged for treatment.
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Affiliation(s)
- Stacey L Burgess
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Carol A Gilchrist
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tucker C Lynn
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Nyundo C, Doyle AM, Walumbe D, Otiende M, Kinuthia M, Amadi D, Jibendi B, Mochamah G, Kihuha N, Williams TN, Ross DA, Bauni E. Linking health facility data from young adults aged 18-24 years to longitudinal demographic data: Experience from The Kilifi Health and Demographic Surveillance System. Wellcome Open Res 2017; 2:51. [DOI: 10.12688/wellcomeopenres.11302.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/20/2022] Open
Abstract
Background: In 2014, a pilot study was conducted to test the feasibility of linking clinic attendance data for young adults at two health facilities to the population register of the Kilifi Health and Demographic Surveillance System (KHDSS). This was part of a cross-sectional survey of health problems of young people, and we tested the feasibility of using the KHDSS platform for the monitoring of future interventions. Methods: Two facilities were used for this study. Clinical data from consenting participants aged 18-24 years were matched to KHDSS records. Data matching was achieved using national identity card numbers or otherwise using a matching algorithm based on names, sex, date of birth, location of residence and the names of other homestead members. A study form was administered to all matched patients to capture reasons for their visits and time taken to access the services. Distance to health facility from a participants’ homestead was also computed. Results: 628 participated in the study: 386 (61%) at Matsangoni Health Centre, and 242 (39%) at Pingilikani Dispensary. 610 (97%) records were matched to the KHDSS register. Most records (605; 96%) were matched within these health facilities, while 5 (1%) were matched during homestead follow-up visits. 463 (75.9%) of those matched were women. Antenatal care (25%), family planning (13%), respiratory infections (9%) and malaria (9%) were the main reasons for seeking care. Antenatal clinic visits (n=175) and malaria (n=27) were the commonest reasons among women and men, respectively. Participants took 1-1.5 hours to access the services; 490 (81.0%) participants lived within 5 kilometres of a facility. Conclusions: With a full-time research clerk at each health facility, linking health-facility attendance data to a longitudinal HDSS platform was feasible and could be used to monitor and evaluate the impact of health interventions on health care outcomes among young people.
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Abstract
With increasing malaria control and goals of malaria elimination, many endemic areas are transitioning from high-to-low-to-no malaria transmission. Reductions in transmission will impact on the development of naturally acquired immunity to malaria, which develops after repeated exposure to Plasmodium spp. However, it is currently unclear how declining transmission and malaria exposure will affect the development and maintenance of naturally acquired immunity. Here we review the key processes which underpin this knowledge; the amount of Plasmodium spp. exposure required to generate effective immune responses, the longevity of antibody responses and the ability to mount an effective response upon re-exposure through memory responses. Lastly we identify research priorities which will increase our understanding of how changing transmission will impact on malarial immunity.
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