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Updated: Jan 31, 2026

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Published on: October 6, 2015
Two-Faced Immunity? The Evidence for Antibody Enhancement of Malaria Transmission
Will Stone1, Teun Bousema2, Robert Sauerwein2
1Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Abstract:
Plasmodium gametocytes can induce an immune response in humans that interferes with the development of sexual-stage parasites in the mosquito gut. Many early studies of the sexual-stage immune response noted that mosquito infection could be enhanced as well as reduced by immune sera. For Plasmodium falciparum, these reports are scarce, and the phenomenon is generally regarded as a methodological artefact. Plasmodium transmission enhancement (TE) remains contentious, but the clinical development of transmission-blocking vaccines based on sexual-stage antigens requires that it is further studied. In this essay, we review the early literature on the sexual-stage immune response and transmission-modulating immunity. We discuss hypotheses for the mechanism of TE, suggest experiments to prove or disprove its existence, and discuss its possible implications.
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