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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31822d1451
Original Studies

Antibodies to Plasmodium falciparum Erythrocyte-binding Antigen-175 are Associated With Protection From Clinical Malaria

McCarra, Matthew B. BS*; Ayodo, George PhD; Sumba, Peter O. PhD; Kazura, James W. MD; Moormann, Ann M. MPH, PhD§; Narum, David L. PhD; John, Chandy C. MD, MS*

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Abstract

Background: Antibodies to blood-stage Plasmodium falciparum antigens have been associated with protection against clinical malaria in some studies but not others. Many of these studies have not assessed whether high-titer antibodies are associated with protection and have not adjusted for differences in malaria exposure.

Methods: The presence of high-titer antibodies to apical membrane antigen-1, erythrocyte-binding antigen-175 (EBA-175), and merozoite surface protein-119 (MSP-119) was assessed in 87 children living in a malaria holoendemic area of Kenya. The children were prospectively assessed during 1 year for clinical malaria.

Results: In unadjusted analyses, high-titer antibodies to MSP-119, but not EBA-175 or apical membrane antigen-1, were associated with protection from clinical malaria. However, after adjustment for exposure, only high-titer antibodies to EBA-175 were associated with protection from clinical malaria (hazard ratio, 0.48; 95% confidence interval [CI], 0.24, 0.95; P = 0.03), and with reduced episodes of clinical malaria (incidence rate ratio, 0.50; 95% CI, 0.31, 0.81; P = 0.005). A trend toward increased protection from clinical malaria in children was seen with antibodies to both EBA-175 and MSP-119 (hazard ratio, 0.26; 95% CI, 0.03, 1.94; P = 0.18).

Conclusions: High-titer antibodies to EBA-175 are associated with protection from clinical malaria in children in a malaria holoendemic area of Kenya. Accurate estimates of antibody-associated protection from clinical malaria require adjustment for malaria exposure.

© 2011 Lippincott Williams & Wilkins, Inc.

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