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Multiplicity of Asymptomatic Plasmodium falciparum Infections and Risk of Clinical Malaria : A Systematic Review and Pooled Analysis of Individual Participant Data

Eldh, Martina LU orcid ; Hammar, Ulf ; Arnot, David ; Beck, Hans-Peter ; Garcia, André ; Liljander, Anne ; Mercereau-Puijalon, Odile ; Migot-Nabias, Florence ; Mueller, Ivo and Ntoumi, Francine , et al. (2020) In The Journal of infectious diseases 221(5). p.775-785
Abstract

BACKGROUND: The malaria parasite Plasmodium falciparum holds an extensive genetic polymorphism. In this pooled analysis, we investigate how the multiplicity in asymptomatic P. falciparum infections-that is, the number of coinfecting clones-affects the subsequent risk of clinical malaria in populations living under different levels of transmission.

METHODS: A systematic search of the literature was performed to identify studies in which P. falciparum infections were genotyped in asymptomatic individuals who were followed up prospectively regarding the incidence of clinical malaria. Individual participant data were pooled from 15 studies (n = 3736 individuals).

RESULTS: Multiclonal asymptomatic infections were associated with... (More)

BACKGROUND: The malaria parasite Plasmodium falciparum holds an extensive genetic polymorphism. In this pooled analysis, we investigate how the multiplicity in asymptomatic P. falciparum infections-that is, the number of coinfecting clones-affects the subsequent risk of clinical malaria in populations living under different levels of transmission.

METHODS: A systematic search of the literature was performed to identify studies in which P. falciparum infections were genotyped in asymptomatic individuals who were followed up prospectively regarding the incidence of clinical malaria. Individual participant data were pooled from 15 studies (n = 3736 individuals).

RESULTS: Multiclonal asymptomatic infections were associated with a somewhat increased subsequent risk of clinical malaria in the youngest children, followed by an initial declining risk with age irrespective of transmission intensity. At approximately 5 years of age, the risk continued the gradual decline with age in high-transmission settings. However, in older children in moderate-, low-, and seasonal-transmission settings, multiclonal infections were either not significantly associated with the risk of subsequent febrile malaria or were associated with an increased risk.

CONCLUSIONS: The number of clones in asymptomatic P. falciparum infections is associated with different risks of subsequent clinical malaria depending on age and transmission intensity.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Adult, Aged, Aged, 80 and over, Antigens, Protozoan/genetics, Asymptomatic Infections/epidemiology, Child, Child, Preschool, Female, Follow-Up Studies, Genotype, Humans, Incidence, Infant, Malaria, Falciparum/epidemiology, Male, Merozoite Surface Protein 1/genetics, Middle Aged, Plasmodium falciparum/genetics, Prospective Studies, Protozoan Proteins/genetics, Risk, Young Adult
in
The Journal of infectious diseases
volume
221
issue
5
pages
775 - 785
publisher
Oxford University Press
external identifiers
  • pmid:31585009
  • scopus:85081654757
ISSN
1537-6613
DOI
10.1093/infdis/jiz510
language
English
LU publication?
no
additional info
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
id
b8434f2b-8192-4c48-b30b-d151088cb62a
date added to LUP
2025-11-25 09:38:22
date last changed
2025-11-26 04:01:15
@article{b8434f2b-8192-4c48-b30b-d151088cb62a,
  abstract     = {{<p>BACKGROUND: The malaria parasite Plasmodium falciparum holds an extensive genetic polymorphism. In this pooled analysis, we investigate how the multiplicity in asymptomatic P. falciparum infections-that is, the number of coinfecting clones-affects the subsequent risk of clinical malaria in populations living under different levels of transmission.</p><p>METHODS: A systematic search of the literature was performed to identify studies in which P. falciparum infections were genotyped in asymptomatic individuals who were followed up prospectively regarding the incidence of clinical malaria. Individual participant data were pooled from 15 studies (n = 3736 individuals).</p><p>RESULTS: Multiclonal asymptomatic infections were associated with a somewhat increased subsequent risk of clinical malaria in the youngest children, followed by an initial declining risk with age irrespective of transmission intensity. At approximately 5 years of age, the risk continued the gradual decline with age in high-transmission settings. However, in older children in moderate-, low-, and seasonal-transmission settings, multiclonal infections were either not significantly associated with the risk of subsequent febrile malaria or were associated with an increased risk.</p><p>CONCLUSIONS: The number of clones in asymptomatic P. falciparum infections is associated with different risks of subsequent clinical malaria depending on age and transmission intensity.</p>}},
  author       = {{Eldh, Martina and Hammar, Ulf and Arnot, David and Beck, Hans-Peter and Garcia, André and Liljander, Anne and Mercereau-Puijalon, Odile and Migot-Nabias, Florence and Mueller, Ivo and Ntoumi, Francine and Ross, Amanda and Smith, Thomas and Sondén, Klara and Vafa Homann, Manijeh and Yman, Victor and Felger, Ingrid and Färnert, Anna}},
  issn         = {{1537-6613}},
  keywords     = {{Adolescent; Adult; Aged; Aged, 80 and over; Antigens, Protozoan/genetics; Asymptomatic Infections/epidemiology; Child; Child, Preschool; Female; Follow-Up Studies; Genotype; Humans; Incidence; Infant; Malaria, Falciparum/epidemiology; Male; Merozoite Surface Protein 1/genetics; Middle Aged; Plasmodium falciparum/genetics; Prospective Studies; Protozoan Proteins/genetics; Risk; Young Adult}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{5}},
  pages        = {{775--785}},
  publisher    = {{Oxford University Press}},
  series       = {{The Journal of infectious diseases}},
  title        = {{Multiplicity of Asymptomatic Plasmodium falciparum Infections and Risk of Clinical Malaria : A Systematic Review and Pooled Analysis of Individual Participant Data}},
  url          = {{http://dx.doi.org/10.1093/infdis/jiz510}},
  doi          = {{10.1093/infdis/jiz510}},
  volume       = {{221}},
  year         = {{2020}},
}