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Association Between Age and Plasmodium falciparum Infection Dynamics
Andrea G Buchwald1, John D Sorkin2,3, Alick Sixpence4
1Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
American Journal of Epidemiology
|September 26, 2018
Summary
School-aged children experience frequent Plasmodium falciparum infections, similar to younger children, but infections persist longer in both groups compared to the youngest. This impacts malaria control strategies.
Area of Science:
- Malariology
- Infectious Disease Epidemiology
- Parasitology
Background:
- Limited data exist on Plasmodium falciparum infection dynamics in high-transmission areas.
- School-aged children (SAC) bear a significant burden of malaria, but reasons are unclear.
Purpose of the Study:
- To estimate the incidence and duration of unique Plasmodium falciparum infections across different age groups.
- To understand age-related differences in infection dynamics for improved malaria control.
Main Methods:
- Longitudinal cohort study (Mfera Cohort Study, Malawi, 2014-2017) with 2-year follow-up.
- Monthly and sick visit testing for P. falciparum using microscopy and PCR; genotyping of positive samples.
- Statistical modeling to adjust for age-dependent detection rates of low-parasitemia infections.
Main Results:
- SAC and children under 5 had higher incidence of unique infections (6.3-6.6 per person/year) than adults (2.5 per person/year).
- Infections were significantly longer in adults (180 days) and SAC (163 days) versus children under 5 (97 days).
- Over half of detected infections were persistent; SAC maintained infections longer, similar to adults.
Conclusions:
- School-aged children acquire new Plasmodium falciparum infections at high rates but maintain them for extended periods.
- Infection duration, not just incidence, contributes to the high burden in SAC.
- Findings necessitate revised malaria control strategies considering age-specific infection dynamics.
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