1. Epidemiology and Global Health
  2. Immunology and Inflammation
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The complex relationship of exposure to new Plasmodium infections and incidence of clinical malaria in Papua New Guinea

  1. Natalie E Hofmann
  2. Stephan Karl
  3. Rahel Wampfler
  4. Benson Kiniboro
  5. Albina Teliki
  6. Jonah Iga
  7. Andreea Waltmann
  8. Inoni Betuela
  9. Ingrid Felger
  10. Leanne J Robinson  Is a corresponding author
  11. Ivo Mueller  Is a corresponding author
  1. Swiss Tropical and Public Health Institute, Switzerland
  2. Walter and Eliza Hall Institute of Medical Research, Australia
  3. Papua New Guinea Institute of Medical Research, Papua New Guinea
Research Article
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Cite this article as: eLife 2017;6:e23708 doi: 10.7554/eLife.23708

Abstract

The molecular force of blood-stage infection (molFOB) is a quantitative surrogate metric for malaria transmission at population level and for exposure at individual level. Relationships between molFOB, parasite prevalence and clinical incidence were assessed in a treatment-to-reinfection cohort, where P.vivax (Pv) hypnozoites were eliminated in half the children by primaquine (PQ). Discounting relapses, children acquired equal numbers of new P. falciparum (Pf) and Pv blood-stage infections/year (Pf-molFOB=0-18, Pv-molFOB=0-23) resulting in comparable spatial and temporal patterns in incidence and prevalence of infections. Including relapses, Pv-molFOB increased >3-fold (relative to PQ-treated children) showing greater heterogeneity at individual (Pv-molFOB=0-36) and village levels. Pf- and Pv-molFOB were strongly associated with clinical episode risk. Yearly Pf clinical incidence rate (IR=0.28) was higher than for Pv (IR=0.12) despite lower Pf-molFOB. These relationships between molFOB, clinical incidence and parasite prevalence reveal a comparable decline in Pf and Pv transmission that is normally hidden by the high burden of Pv relapses.

Article and author information

Author details

  1. Natalie E Hofmann

    Swiss Tropical and Public Health Institute, Basel, Switzerland
    Competing interests
    The authors declare that no competing interests exist.
  2. Stephan Karl

    Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
    Competing interests
    The authors declare that no competing interests exist.
  3. Rahel Wampfler

    Swiss Tropical and Public Health Institute, Basel, Switzerland
    Competing interests
    The authors declare that no competing interests exist.
  4. Benson Kiniboro

    Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
    Competing interests
    The authors declare that no competing interests exist.
  5. Albina Teliki

    Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
    Competing interests
    The authors declare that no competing interests exist.
  6. Jonah Iga

    Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
    Competing interests
    The authors declare that no competing interests exist.
  7. Andreea Waltmann

    Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
    Competing interests
    The authors declare that no competing interests exist.
  8. Inoni Betuela

    Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
    Competing interests
    The authors declare that no competing interests exist.
  9. Ingrid Felger

    Swiss Tropical and Public Health Institute, Basel, Switzerland
    Competing interests
    The authors declare that no competing interests exist.
  10. Leanne J Robinson

    Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
    For correspondence
    robinson@wehi.edu.au
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-9903-1023
  11. Ivo Mueller

    Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
    For correspondence
    ivomueller@fastmail.fm
    Competing interests
    The authors declare that no competing interests exist.

Funding

Swiss National Science Foundation (310030-134889 310030-159580)

  • Ingrid Felger
  • Ivo Mueller

National Institute of Allergy and Infectious Diseases (South West Pacific International Centers of Excellence in malaria research U19 AI089686)

  • Inoni Betuela
  • Ingrid Felger
  • Leanne J Robinson
  • Ivo Mueller

Bill and Melinda Gates Foundation

  • Inoni Betuela
  • Ingrid Felger
  • Leanne J Robinson
  • Ivo Mueller

National Health and Medical Research Council (Project Grant #1021544)

  • Inoni Betuela
  • Ingrid Felger
  • Leanne J Robinson
  • Ivo Mueller

Cellex Foundation

  • Inoni Betuela
  • Ivo Mueller

National Health and Medical Research Council (Early Career Fellowship #1016443)

  • Leanne J Robinson

National Health and Medical Research Council (Early Career Fellowship #1052760)

  • Stephan Karl

National Health and Medical Research Council (Senior Research Fellowship #1043345)

  • Ivo Mueller

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: The study received ethical clearance from the PNG IMR Institutional Review Board (0908), the PNG Medical Advisory Committee (09.11), the Ethics Committee of Basel 237/11 and was conducted in full concordance with the Declaration of Helsinki. Written informed consent was obtained from the parents/guardians of all children enrolled in the study.

Reviewing Editor

  1. Ben Cooper, Mahidol Oxford Tropical Medicine Research Unit, Thailand

Publication history

  1. Received: December 7, 2016
  2. Accepted: August 18, 2017
  3. Accepted Manuscript published: September 1, 2017 (version 1)
  4. Version of Record published: September 20, 2017 (version 2)

Copyright

© 2017, Hofmann et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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