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Tiono AB, Plieskatt JL, Ouedraogo A, Soulama BI, Miura K, Bougouma EC, Naghizadeh M, Barry A, Yaro JBB, Ezinmegnon S, Henry N, Ofori EA, Adu B, Singh SK, Konkobo A, Lövgren Bengtsson K, Diarra A, Carnrot C, Reimer JM, Ouedraogo A, Tienta M, Long CA, Ouedraogo IN, Sagara I, Sirima SB, Theisen M. A randomized first-in-human phase I trial of differentially adjuvanted Pfs48/45 malaria vaccines in Burkinabé adults. J Clin Invest 2024; 134:e175707. [PMID: 38290009 PMCID: PMC10977980 DOI: 10.1172/jci175707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/26/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUNDMalaria transmission-blocking vaccines aim to interrupt the transmission of malaria from one person to another.METHODSThe candidates R0.6C and ProC6C share the 6C domain of the Plasmodium falciparum sexual-stage antigen Pfs48/45. R0.6C utilizes the glutamate-rich protein (GLURP) as a carrier, and ProC6C includes a second domain (Pfs230-Pro) and a short 36-amino acid circumsporozoite protein (CSP) sequence. Healthy adults (n = 125) from a malaria-endemic area of Burkina Faso were immunized with 3 intramuscular injections, 4 weeks apart, of 30 μg or 100 μg R0.6C or ProC6C each adsorbed to Alhydrogel (AlOH) adjuvant alone or in combination with Matrix-M (15 μg or 50 μg, respectively). The allocation was random and double-blind for this phase I trial.RESULTSThe vaccines were safe and well tolerated with no vaccine-related serious adverse events. A total of 7 adverse events, mild to moderate in intensity and considered possibly related to the study vaccines, were recorded. Vaccine-specific antibodies were highest in volunteers immunized with 100 μg ProC6C-AlOH with Matrix-M, and 13 of 20 (65%) individuals in the group showed greater than 80% transmission-reducing activity (TRA) when evaluated in the standard membrane feeding assay at 15 mg/mL IgG. In contrast, R0.6C induced sporadic TRA.CONCLUSIONAll formulations were safe and well tolerated in a malaria-endemic area of Africa in healthy adults. The ProC6C-AlOH/Matrix-M vaccine elicited the highest levels of functional antibodies, meriting further investigation.TRIAL REGISTRATIONPan-African Clinical Trials Registry (https://pactr.samrc.ac.za) PACTR202201848463189.FUNDINGThe study was funded by the European and Developing Countries Clinical Trials Partnership (grant RIA2018SV-2311).
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Affiliation(s)
- Alfred B. Tiono
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Jordan L. Plieskatt
- Department for Congenital Disorders, Statens Serum Institut (SSI), Copenhagen, Denmark
| | | | | | - Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Edith C. Bougouma
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Mohammad Naghizadeh
- Department for Congenital Disorders, Statens Serum Institut (SSI), Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Aissata Barry
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | | | - Sem Ezinmegnon
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Noelie Henry
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Ebenezer Addo Ofori
- Department for Congenital Disorders, Statens Serum Institut (SSI), Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Susheel K. Singh
- Department for Congenital Disorders, Statens Serum Institut (SSI), Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Augustin Konkobo
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | | | - Amidou Diarra
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | | | | | - Amidou Ouedraogo
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Moussa Tienta
- Malaria Research and Training Center, Mali–National Institute of Allergy and Infectious Diseases International Center for Excellence in Research, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Carole A. Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Issa N. Ouedraogo
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | - Issaka Sagara
- Malaria Research and Training Center, Mali–National Institute of Allergy and Infectious Diseases International Center for Excellence in Research, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Michael Theisen
- Department for Congenital Disorders, Statens Serum Institut (SSI), Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Sirima SB, Ouédraogo A, Tiono AB, Kaboré JM, Bougouma EC, Ouattara MS, Kargougou D, Diarra A, Henry N, Ouédraogo IN, Billingsley PF, Manoj A, Abebe Y, Kc N, Ruben A, Richie TL, James ER, Joshi S, Shrestha B, Strauss K, Lyke KE, Plowe CV, Potter GE, Cox C, Jones W, Sim BKL, Hoffman SL, Laurens MB. A randomized controlled trial showing safety and efficacy of a whole sporozoite vaccine against endemic malaria. Sci Transl Med 2022; 14:eabj3776. [PMID: 36475905 PMCID: PMC10041996 DOI: 10.1126/scitranslmed.abj3776] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A highly effective malaria vaccine remains elusive despite decades of research. Plasmodium falciparum sporozoite vaccine (PfSPZ Vaccine), a metabolically active, nonreplicating, whole parasite vaccine demonstrated safety and vaccine efficacy (VE) against endemic P. falciparum for 6 months in Malian adults receiving a five-dose regimen. Safety, immunogenicity, and VE of a three-dose regimen were assessed in adults in Balonghin, Burkina Faso in a two-component study: an open-label dose escalation trial with 32 participants followed by a double-blind, randomized, placebo-controlled trial (RCT) with 80 participants randomized to receive three doses of 2.7 × 106 PfSPZ (N = 39) or normal saline (N = 41) just before malaria season. To clear parasitemia, artesunate monotherapy was administered before first and last vaccinations. Thick blood smear microscopy was performed on samples collected during illness and every 4 weeks for 72 weeks after last vaccinations, including two 6-month malaria transmission seasons. Safety outcomes were assessed in all 80 participants who received at least one dose and VE for 79 participants who received three vaccinations. Myalgia was the only symptom that differed between groups. VE (1 - risk ratio; primary VE endpoint) was 38% at 6 months (P = 0.017) and 15% at 18 months (0.078). VE (1 - hazard ratio) was 48% and 46% at 6 and 18 months (P = 0.061 and 0.018). Two weeks after the last dose, antibodies to P. falciparum circumsporozoite protein and PfSPZ were higher in protected versus unprotected vaccinees. A three-dose regimen of PfSPZ Vaccine demonstrated safety and efficacy against malaria infection in malaria-experienced adults.
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Affiliation(s)
- Sodiomon B Sirima
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouédraogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alfred B Tiono
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Jean M Kaboré
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Maurice S Ouattara
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Désiré Kargougou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Noelie Henry
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa N Ouédraogo
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | | | | | | | | | | | | | - Sudhaunshu Joshi
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Biraj Shrestha
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathy Strauss
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kirsten E Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher V Plowe
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Walter Jones
- Parasitic and International Programs Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Sepúlveda N, Grignard L, Curry J, Mahey L, Bastiaens GJH, Tiono AB, Okebe J, Coulibaly SA, Gonçalves BP, Affara M, Ouédraogo A, Bougouma EC, Sanou GS, Nébié I, Lanke K, Sirima SB, Dicko A, d’Alessandro U, Clark TG, Campino S, Chen I, Eziefula AC, Gosling R, Bousema T, Drakeley C. G6PD Polymorphisms and Hemolysis After Antimalarial Treatment With Low Single-Dose Primaquine: A Pooled Analysis of Six African Clinical Trials. Front Genet 2021; 12:645688. [PMID: 33897764 PMCID: PMC8062977 DOI: 10.3389/fgene.2021.645688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Primaquine (PQ) is an antimalarial drug with the potential to reduce malaria transmission due to its capacity to clear mature Plasmodium falciparum gametocytes in the human host. However, the large-scale roll-out of PQ has to be counterbalanced by the additional risk of drug-induced hemolysis in individuals suffering from Glucose-6-phospate dehydrogenase (G6PD) deficiency, a genetic condition determined by polymorphisms on the X-linked G6PD gene. Most studies on G6PD deficiency and PQ-associated hemolysis focused on the G6PD A- variant, a combination of the two single nucleotide changes G202A (rs1050828) and A376G (rs1050829), although other polymorphisms may play a role. In this study, we tested the association of 20 G6PD single nucleotide polymorphisms (SNPs) with hemolysis measured seven days after low single dose of PQ given at the dose of 0.1 mg/kg to 0.75 mg/kg in 957 individuals from 6 previously published clinical trials investigating the safety and efficacy of this drug spanning five African countries. After adjusting for inter-study effects, age, gender, baseline hemoglobin level, PQ dose, and parasitemia at screening, our analysis showed putative association signals from the common G6PD mutation, A376G [-log10(p-value) = 2.44] and two less-known SNPs, rs2230037 [-log10(p-value] = 2.60), and rs28470352 [-log10(p-value) = 2.15]; A376G and rs2230037 were in very strong linkage disequilibrium with each other (R 2 = 0.978). However, when the effects of these SNPs were included in the same regression model, the subsequent associations were in the borderline of statistical significance. In conclusion, whilst a role for the A- variant is well established, we did not observe an important additional role for other G6PD polymorphisms in determining post-treatment hemolysis in individuals treated with low single-dose PQ.
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Affiliation(s)
- Nuno Sepúlveda
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- CEAUL – Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| | - Lynn Grignard
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Guido J. H. Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alfred B. Tiono
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sam A. Coulibaly
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Bronner P. Gonçalves
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Muna Affara
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Alphonse Ouédraogo
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Edith C. Bougouma
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Guillaume S. Sanou
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sodiomon B. Sirima
- Department of Public Health, Centre National de Recherche et de Formation sur le Paludisme & Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
| | - Umberto d’Alessandro
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Taane G. Clark
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susana Campino
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ingrid Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Alice C. Eziefula
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Roly Gosling
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Teun Bousema
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Tiono AB, Nebie I, Anagnostou N, Coulibaly SA, Lawrie A, Bougouma EC, Ouedraogo A, Yaro JB, Barry A, Roberts R, Ouedraogo A, Ewer KJ, Viebig NK, Diarra A, Leroy O, Bejon P, Hill A, Sirima SB. OC 8552 EFFICACY OF THE CHAD63-MVC ME-TRAP VECTORED MALARIA VACCINE CANDIDATE IN 5–17 MONTHS OLD INFANTS AND CHILDREN IN BURKINA FASO. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundHeterologous prime-boost immunisation with chimpanzee adenovirus 63 (ChAd63) and Modified Vaccinia Virus Ankara (MVA)-vectored vaccines is a strategy previously shown to provide substantial protective efficacy against P. falciparum infection in a UK adult phase IIa sporozoite challenge study, and in a trial in Kenyan adults.MethodsWe conducted the first phase IIb clinical trial assessing the safety, immunogenicity and efficacy of ChAd63-MVA ME-TRAP in 700 healthy malaria exposed children aged 5–17 months in a highly malaria-endemic area of Burkina Faso.Participants were randomly assigned to received either ChAd63 ME-TRAP followed eight weeks later by MVA ME-TRAP or 2 doses of rabies vaccine. Monitoring of solicited adverse events was performed for seven days after each vaccination. Unsolicited adverse events were recorded until one month post each vaccination. Serious adverse events and malaria episodes were monitored throughout the study duration. Blood samples were collected at predefined timepoints to assess vaccine immunogenicity.ResultsChAd63-MVA ME-TRAP was shown to be safe and immunogenic, inducing high-level T cell responses [median 326 SFU/106 PBMC (95% CI 290–387)]. However, non-significant low efficacy was observed against clinical malaria during the follow-up period, with efficacy against primary endpoint estimated by proportional analysis being 10.7% (95% CI: −44.2 to 44.7%) at sixth months post MVA ME-TRAP and 3.1% (95% CI −15.0 to 18.3; p=0.72) by cox regression.ConclusionThis study has confirmed ChAd63-MVA ME-TRAP is a safe and highly immunogenic vaccine regimen in children and infants with prior exposure to malaria. No significant protective efficacy was observed in this highly endemic context.
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Sirima S, Tiono AB, Houard S, Bougouma EC, Coulibaly SA, Leroy O, Palacpac N, Horii T, Ouedraogo IN. OC 8546 SAFETY AND IMMUNOGENICITY OF THE MALARIA VACCINE CANDIDATE BK-SE36 IN YOUNG CHILDREN LIVING IN BURKINA FASO. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundThe malaria blood stage vaccine candidate SE-36 is based on the serine repeat antigen of Plasmodium falciparum. Epidemiological studies have shown that antibodies against SE36 correlate with lower parasitaemia in Solomon Island residents. In a phase I b trial conducted in Uganda, the BK-SE36 vaccine, SE36 formulated with aluminium hydroxide gel, was found safe and immunogenic. Interestingly, highest levels of IgG anti-SE36 protein associated with protection against severe malaria were found in the youngest Ugandan trial participants.ObjectivesTo assess the safety and immunogenicity of the BK-SE36 vaccine in a randomised controlled double-blind age de-escalating phase Ib clinical trial in younger (≤5 years) malaria-exposed children living in Burkina Faso.MethodsHealthy participants (108) were included in two age cohorts, one consisting of 54 children aged 25–60 months and the other of 54 children aged 12–24 months. Trial participants received 3 intramuscular or subcutaneous injections of the BK-SE36 vaccine at Day 0, Week 4 and 26. Participants allocated to the control group received the control Synflorix vaccine via intramuscular route at Day 0 and Week 26 and saline at Week 4. The participants were followed for one year. Immune responses were evaluated by ELISA, ELISpot and parasite carriage by microscopy and PCR.ResultsPreliminary data from an interim analysis (data collected one month after the last immunisation) indicated that the vaccine was safe, well-tolerated and induced an IgG anti-SE36 response in these younger populations. The trial’s latest safety, immunogenicity and preliminary efficacy results will be presented.
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Grignard L, Mair C, Curry J, Mahey L, Bastiaens GJH, Tiono AB, Okebe J, Coulibaly SA, Gonçalves BP, Affara M, Ouédraogo A, Bougouma EC, Sanou GS, Nébié I, Lanke KHW, Sirima SB, d'Alessandro U, Clark TG, Campino S, Bousema T, Drakeley C. Bead-based assays to simultaneously detect multiple human inherited blood disorders associated with malaria. Malar J 2019; 18:14. [PMID: 30665411 PMCID: PMC6341711 DOI: 10.1186/s12936-019-2648-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase deficiency (G6PDd), haemoglobin C (HbC) and S (HbS) are inherited blood disorders (IBD) common in populations in malaria endemic areas. All are associated to some degree with protection against clinical malaria whilst additionally G6PDd is associated with haemolysis following treatment with 8-aminoquinolines. Measuring the prevalence of these inherited blood disorders in affected populations can improve understanding of disease epidemiology. Current methodologies in epidemiological studies commonly rely on individual target amplification and visualization; here a method is presented to simultaneously detect the polymorphisms and that can be expanded to include other single nucleotide polymorphisms (SNPs) of interest. METHODS Human DNA from whole blood samples was amplified in a novel, multiplex PCR reaction and extended with SNP-specific probes in an allele specific primer extension (ASPE) to simultaneously detect four epidemiologically important human markers including G6PD SNPs (G202A and A376G) and common haemoglobin mutations (HbS and HbC). The products were hybridized to magnetic beads and the median fluorescence intensity (MFI) was read on MAGPIX® (Luminex corp.). Genotyping data was compared to phenotypical data generated by flow cytometry and to established genotyping methods. RESULTS Seventy-five samples from Burkina Faso (n = 75/78, 96.2%) and 58 samples from The Gambia (n = 58/61, 95.1%) had a G6PD and a HBB genotype successfully assigned by the bead-based assay. Flow cytometry data available for n = 61 samples further supported the concordance between % G6PD normal/deficient cells and genotype. CONCLUSIONS The bead based assay compares well to alternative measures of genotyping and phenotyping for G6PD. The screening is high throughput, adaptable to inclusion of multiple targets of interest and easily standardized.
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Affiliation(s)
- Lynn Grignard
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | - Catherine Mair
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Guide J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Joseph Okebe
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sam A Coulibaly
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Muna Affara
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alphonse Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Guillaume S Sanou
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Kjerstin H W Lanke
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sodiomon B Sirima
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Umberto d'Alessandro
- Disease Control & Elimination Theme, Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Taane G Clark
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Susana Campino
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
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7
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Tiono AB, Nébié I, Anagnostou N, Coulibaly AS, Bowyer G, Lam E, Bougouma EC, Ouedraogo A, Yaro JBB, Barry A, Roberts R, Rampling T, Bliss C, Hodgson S, Lawrie A, Ouedraogo A, Imoukhuede EB, Ewer KJ, Viebig NK, Diarra A, Leroy O, Bejon P, Hill AVS, Sirima SB. First field efficacy trial of the ChAd63 MVA ME-TRAP vectored malaria vaccine candidate in 5-17 months old infants and children. PLoS One 2018; 13:e0208328. [PMID: 30540808 PMCID: PMC6291132 DOI: 10.1371/journal.pone.0208328] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/13/2018] [Indexed: 01/21/2023] Open
Abstract
Background Heterologous prime boost immunization with chimpanzee adenovirus 63 (ChAd63) and Modified Vaccinia Virus Ankara (MVA) vectored vaccines is a strategy previously shown to provide substantial protective efficacy against P. falciparum infection in United Kingdom adult Phase IIa sporozoite challenge studies (approximately 20–25% sterile protection with similar numbers showing clear delay in time to patency), and greater point efficacy in a trial in Kenyan adults. Methodology We conducted the first Phase IIb clinical trial assessing the safety, immunogenicity and efficacy of ChAd63 MVA ME-TRAP in 700 healthy malaria exposed children aged 5–17 months in a highly endemic malaria transmission area of Burkina Faso. Results ChAd63 MVA ME-TRAP was shown to be safe and immunogenic but induced only moderate T cell responses (median 326 SFU/106 PBMC (95% CI 290–387)) many fold lower than in previous trials. No significant efficacy was observed against clinical malaria during the follow up period, with efficacy against the primary endpoint estimate by proportional analysis being 13.8% (95%CI -42.4 to 47.9) at sixth month post MVA ME-TRAP and 3.1% (95%CI -15.0 to 18.3; p = 0.72) by Cox regression. Conclusions This study has confirmed ChAd63 MVA ME-TRAP is a safe and immunogenic vaccine regimen in children and infants with prior exposure to malaria. But no significant protective efficacy was observed in this very highly malaria-endemic setting. Trial registration ClinicalTrials.gov NCT01635647. Pactr.org PACTR201208000404131.
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Affiliation(s)
- Alfred B. Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Nicholas Anagnostou
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Aboubacar S. Coulibaly
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Georgina Bowyer
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Erika Lam
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Edith C. Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Jean Baptist B. Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Aïssata Barry
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Rachel Roberts
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Tommy Rampling
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Carly Bliss
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Susanne Hodgson
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Alison Lawrie
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Amidou Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Katie J. Ewer
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicola K. Viebig
- European Vaccine Initiative, Universitäts Klinikum Heidelberg, Heidelberg, Germany
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Odile Leroy
- European Vaccine Initiative, Universitäts Klinikum Heidelberg, Heidelberg, Germany
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Adrian V. S. Hill
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
- * E-mail:
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8
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Tiono AB, Ouédraogo A, Ouattara D, Bougouma EC, Coulibaly S, Diarra A, Faragher B, Guelbeogo MW, Grisales N, Ouédraogo IN, Ouédraogo ZA, Pinder M, Sanon S, Smith T, Vanobberghen F, Sagnon N, Ranson H, Lindsay SW. Efficacy of Olyset Duo, a bednet containing pyriproxyfen and permethrin, versus a permethrin-only net against clinical malaria in an area with highly pyrethroid-resistant vectors in rural Burkina Faso: a cluster-randomised controlled trial. Lancet 2018; 392:569-580. [PMID: 30104047 DOI: 10.1016/s0140-6736(18)31711-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Substantial reductions in malaria incidence in sub-Saharan Africa have been achieved with massive deployment of long-lasting insecticidal nets (LLINs), but pyrethroid resistance threatens control. Burkina Faso is an area with intense malaria transmission and highly pyrethroid-resistant vectors. We assessed the effectiveness of bednets containing permethrin, a pyrethroid, and pyriproxyfen, an insect growth regulator, versus permethrin-only (standard) LLINs against clinical malaria in children younger than 5 years in Banfora, Burkina Faso. METHODS In this two-group, step-wedge, cluster-randomised, controlled, superiority trial, standard LLINs were incrementally replaced with LLINs treated with permethrin plus pyriproxyfen (PPF) in 40 rural clusters in Burkina Faso. In each cluster, 50 children (aged 6 months to 5 years) were followed up by passive case detection for clinical malaria. Cross-sectional surveys were done at the start and the end of the transmission seasons in 2014 and 2015. We did monthly collections from indoor light traps to estimate vector densities. Primary endpoints were the incidence of clinical malaria, measured by passive case detection, and the entomological inoculation rate. Analyses were adjusted for clustering and for month and health centre. This trial is registered as ISRCTN21853394. FINDINGS 1980 children were enrolled in the cohort in 2014 and 2157 in 2015. At the end of the study, more than 99% of children slept under a bednet. The incidence of clinical malaria was 2·0 episodes per child-year in the standard LLIN group and 1·5 episodes per child-year in the PPF-treated LLIN group (incidence rate ratio 0·88 [95% CI 0·77-0·99; p=0·04]). The entomological inoculation rate was 85 (95% CI 63-108) infective bites per transmission season in the standard LLIN group versus 42 (32-52) infective bites per transmission season in the PPF-treated LLIN group (rate ratio 0·49, 95% CI 0·32-0·66; p<0·0001). INTERPRETATION PPF-treated LLINs provide greater protection against clinical malaria than do standard LLINs and could be used as an alternative to standard LLINs in areas with intense transmission of Plasmodium falciparum malaria and highly pyrethroid-resistant vectors. FUNDING EU Seventh Framework Programme.
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Affiliation(s)
- Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Daouda Ouattara
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Sam Coulibaly
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Moussa W Guelbeogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Issa N Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | | | - Souleymane Sanon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Tom Smith
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Fiona Vanobberghen
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - N'Fale Sagnon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Hilary Ranson
- Liverpool School of Tropical Medicine, Liverpool, UK
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9
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Bastiaens GJH, Tiono AB, Okebe J, Pett HE, Coulibaly SA, Gonçalves BP, Affara M, Ouédraogo A, Bougouma EC, Sanou GS, Nébié I, Bradley J, Lanke KHW, Niemi M, Sirima SB, d’Alessandro U, Bousema T, Drakeley C. Safety of single low-dose primaquine in glucose-6-phosphate dehydrogenase deficient falciparum-infected African males: Two open-label, randomized, safety trials. PLoS One 2018; 13:e0190272. [PMID: 29324864 PMCID: PMC5764271 DOI: 10.1371/journal.pone.0190272] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022] Open
Abstract
Background Primaquine (PQ) actively clears mature Plasmodium falciparum gametocytes but in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals can cause hemolysis. We assessed the safety of low-dose PQ in combination with artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) in G6PDd African males with asymptomatic P. falciparum malaria. Methods and findings In Burkina Faso, G6PDd adult males were randomized to treatment with AL alone (n = 10) or with PQ at 0.25 (n = 20) or 0.40 mg/kg (n = 20) dosage; G6PD-normal males received AL plus 0.25 (n = 10) or 0.40 mg/kg (n = 10) PQ. In The Gambia, G6PDd adult males and boys received DP alone (n = 10) or with 0.25 mg/kg PQ (n = 20); G6PD-normal males received DP plus 0.25 (n = 10) or 0.40 mg/kg (n = 10) PQ. The primary study endpoint was change in hemoglobin concentration during the 28-day follow-up. Cytochrome P-450 isoenzyme 2D6 (CYP2D6) metabolizer status, gametocyte carriage, haptoglobin, lactate dehydrogenase levels and reticulocyte counts were also determined. In Burkina Faso, the mean maximum absolute change in hemoglobin was -2.13 g/dL (95% confidence interval [CI], -2.78, -1.49) in G6PDd individuals randomized to 0.25 PQ mg/kg and -2.29 g/dL (95% CI, -2.79, -1.79) in those receiving 0.40 PQ mg/kg. In The Gambia, the mean maximum absolute change in hemoglobin concentration was -1.83 g/dL (95% CI, -2.19, -1.47) in G6PDd individuals receiving 0.25 PQ mg/kg. After adjustment for baseline concentrations, hemoglobin reductions in G6PDd individuals in Burkina Faso were more pronounced compared to those in G6PD-normal individuals receiving the same PQ doses (P = 0.062 and P = 0.022, respectively). Hemoglobin levels normalized during follow-up. Abnormal haptoglobin and lactate dehydrogenase levels provided additional evidence of mild transient hemolysis post-PQ. Conclusions Single low-dose PQ in combination with AL and DP was associated with mild and transient reductions in hemoglobin. None of the study participants developed moderate or severe anemia; there were no severe adverse events. This indicates that single low-dose PQ is safe in G6PDd African males when used with artemisinin-based combination therapy. Trial registration Clinicaltrials.gov NCT02174900 Clinicaltrials.gov NCT02654730
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Affiliation(s)
- Guido J. H. Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Alfred B. Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Joseph Okebe
- Disease Control & Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Helmi E. Pett
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sam A. Coulibaly
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Bronner P. Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Muna Affara
- Disease Control & Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Alphonse Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C. Bougouma
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Guillaume S. Sanou
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kjerstin H. W. Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sodiomon B. Sirima
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Umberto d’Alessandro
- Disease Control & Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
- Department of Disease Control, Faculty of infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
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10
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Leffler EM, Band G, Busby GBJ, Kivinen K, Le QS, Clarke GM, Bojang KA, Conway DJ, Jallow M, Sisay-Joof F, Bougouma EC, Mangano VD, Modiano D, Sirima SB, Achidi E, Apinjoh TO, Marsh K, Ndila CM, Peshu N, Williams TN, Drakeley C, Manjurano A, Reyburn H, Riley E, Kachala D, Molyneux M, Nyirongo V, Taylor T, Thornton N, Tilley L, Grimsley S, Drury E, Stalker J, Cornelius V, Hubbart C, Jeffreys AE, Rowlands K, Rockett KA, Spencer CCA, Kwiatkowski DP. Resistance to malaria through structural variation of red blood cell invasion receptors. Science 2017; 356:science.aam6393. [PMID: 28522690 DOI: 10.1126/science.aam6393] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/08/2017] [Indexed: 12/29/2022]
Abstract
The malaria parasite Plasmodium falciparum invades human red blood cells by a series of interactions between host and parasite surface proteins. By analyzing genome sequence data from human populations, including 1269 individuals from sub-Saharan Africa, we identify a diverse array of large copy-number variants affecting the host invasion receptor genes GYPA and GYPB We find that a nearby association with severe malaria is explained by a complex structural rearrangement involving the loss of GYPB and gain of two GYPB-A hybrid genes, which encode a serologically distinct blood group antigen known as Dantu. This variant reduces the risk of severe malaria by 40% and has recently increased in frequency in parts of Kenya, yet it appears to be absent from west Africa. These findings link structural variation of red blood cell invasion receptors with natural resistance to severe malaria.
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Affiliation(s)
- Ellen M Leffler
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.,Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Gavin Band
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.,Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - George B J Busby
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Katja Kivinen
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Quang Si Le
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Geraldine M Clarke
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Kalifa A Bojang
- Medical Research Council Unit, Atlantic Boulevard, Fajara, Post Office Box 273, The Gambia
| | - David J Conway
- Medical Research Council Unit, Atlantic Boulevard, Fajara, Post Office Box 273, The Gambia.,Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Muminatou Jallow
- Medical Research Council Unit, Atlantic Boulevard, Fajara, Post Office Box 273, The Gambia.,Royal Victoria Teaching Hospital, Independence Drive, Post Office Box 1515, Banjul, The Gambia
| | - Fatoumatta Sisay-Joof
- Medical Research Council Unit, Atlantic Boulevard, Fajara, Post Office Box 273, The Gambia
| | - Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208 Ouagadougou 01, Burkina Faso
| | | | - David Modiano
- University of Rome La Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Sodiomon B Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Eric Achidi
- Department of Medical Laboratory Sciences, University of Buea, Post Office Box 63, Buea, South West Region, Cameroon
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Post Office Box 63, Buea, South West Region, Cameroon
| | - Kevin Marsh
- Kenyan Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Post Office Box 230-80108, Kilifi, Kenya.,Nuffield Department of Medicine, NDM Research Building, Roosevelt Drive, Headington, Oxford OX3 7FZ, UK
| | - Carolyne M Ndila
- Kenyan Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Post Office Box 230-80108, Kilifi, Kenya
| | - Norbert Peshu
- Kenyan Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Post Office Box 230-80108, Kilifi, Kenya
| | - Thomas N Williams
- Kenyan Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Post Office Box 230-80108, Kilifi, Kenya.,Faculty of Medicine, Department of Medicine, Imperial College, Exhibition Road, London SW7 2AZ, UK
| | - Chris Drakeley
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Post Office Box 2228, Moshi, Tanzania.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Alphaxard Manjurano
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Post Office Box 2228, Moshi, Tanzania.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,National Institute for Medical Research, Mwanza Research Centre, Mwanza City, Tanzania
| | - Hugh Reyburn
- Joint Malaria Programme, Kilimanjaro Christian Medical Centre, Post Office Box 2228, Moshi, Tanzania.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Eleanor Riley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Kachala
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Post Office Box 30096, Chichiri, Blantyre 3, Malawi
| | - Malcolm Molyneux
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Post Office Box 30096, Chichiri, Blantyre 3, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Vysaul Nyirongo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Post Office Box 30096, Chichiri, Blantyre 3, Malawi
| | - Terrie Taylor
- Blantyre Malaria Project, Queen Elizabeth Central Hospital, College of Medicine, Post Office Box 30096, Chichiri, Blantyre 3, Malawi.,College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Nicole Thornton
- International Blood Group Reference Laboratory, National Health Service (NHS) Blood and Transplant, 500 North Bristol Park, Filton, Bristol BS34 7QH, UK
| | - Louise Tilley
- International Blood Group Reference Laboratory, National Health Service (NHS) Blood and Transplant, 500 North Bristol Park, Filton, Bristol BS34 7QH, UK
| | - Shane Grimsley
- International Blood Group Reference Laboratory, National Health Service (NHS) Blood and Transplant, 500 North Bristol Park, Filton, Bristol BS34 7QH, UK
| | - Eleanor Drury
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Jim Stalker
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Victoria Cornelius
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Christina Hubbart
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Anna E Jeffreys
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Kate Rowlands
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
| | - Kirk A Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.,Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Chris C A Spencer
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK.
| | - Dominic P Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK. .,Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
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11
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Clarke GM, Rockett K, Kivinen K, Hubbart C, Jeffreys AE, Rowlands K, Jallow M, Conway DJ, Bojang KA, Pinder M, Usen S, Sisay-Joof F, Sirugo G, Toure O, Thera MA, Konate S, Sissoko S, Niangaly A, Poudiougou B, Mangano VD, Bougouma EC, Sirima SB, Modiano D, Amenga-Etego LN, Ghansah A, Koram KA, Wilson MD, Enimil A, Evans J, Amodu OK, Olaniyan S, Apinjoh T, Mugri R, Ndi A, Ndila CM, Uyoga S, Macharia A, Peshu N, Williams TN, Manjurano A, Sepúlveda N, Clark TG, Riley E, Drakeley C, Reyburn H, Nyirongo V, Kachala D, Molyneux M, Dunstan SJ, Phu NH, Quyen NN, Thai CQ, Hien TT, Manning L, Laman M, Siba P, Karunajeewa H, Allen S, Allen A, Davis TME, Michon P, Mueller I, Molloy SF, Campino S, Kerasidou A, Cornelius VJ, Hart L, Shah SS, Band G, Spencer CCA, Agbenyega T, Achidi E, Doumbo OK, Farrar J, Marsh K, Taylor T, Kwiatkowski DP. Characterisation of the opposing effects of G6PD deficiency on cerebral malaria and severe malarial anaemia. eLife 2017; 6:e15085. [PMID: 28067620 PMCID: PMC5222559 DOI: 10.7554/elife.15085] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 11/03/2016] [Indexed: 01/27/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is believed to confer protection against Plasmodium falciparum malaria, but the precise nature of the protective effecthas proved difficult to define as G6PD deficiency has multiple allelic variants with different effects in males and females, and it has heterogeneous effects on the clinical outcome of P. falciparum infection. Here we report an analysis of multiple allelic forms of G6PD deficiency in a large multi-centre case-control study of severe malaria, using the WHO classification of G6PD mutations to estimate each individual's level of enzyme activity from their genotype. Aggregated across all genotypes, we find that increasing levels of G6PD deficiency are associated with decreasing risk of cerebral malaria, but with increased risk of severe malarial anaemia. Models of balancing selection based on these findings indicate that an evolutionary trade-off between different clinical outcomes of P. falciparum infection could have been a major cause of the high levels of G6PD polymorphism seen in human populations.
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Affiliation(s)
- Geraldine M Clarke
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,MRC Centre for Genomics and Global Health, University of Oxford, Oxford, United Kingdom, (GMC)
| | - Kirk Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,MRC Centre for Genomics and Global Health, University of Oxford, Oxford, United Kingdom,The Wellcome Trust Sanger Institute, Cambridge, United Kingdom, (KRoc)
| | - Katja Kivinen
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Christina Hubbart
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Anna E Jeffreys
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Kate Rowlands
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Muminatou Jallow
- Medical Research Council Unit The Gambia, Fajara, Gambia,Edward Francis Small Teaching Hospital, Independence Drive, Banjul, Gambia
| | - David J Conway
- Medical Research Council Unit The Gambia, Fajara, Gambia,Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Stanley Usen
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Giorgio Sirugo
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Ousmane Toure
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Mahamadou A Thera
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Salimata Konate
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Sibiry Sissoko
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Amadou Niangaly
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Belco Poudiougou
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | | | - Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Sodiomon B Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | | | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Michael D Wilson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Jennifer Evans
- Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany,Kumasi Centre for Collaborative Research, Kumasi, Ghana
| | | | | | - Tobias Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
| | - Regina Mugri
- Department of Medical Laboratory Sciences, University of Buea, Buea, Cameroon
| | - Andre Ndi
- Department of Medical Laboratory Sciences, University of Buea, Buea, Cameroon
| | | | - Sophie Uyoga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Norbert Peshu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Thomas N Williams
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya,Department of Medicine, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Alphaxard Manjurano
- Joint Malaria Programme, Kilimanjaro Christian Medical College, Moshi, Tanzania,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nuno Sepúlveda
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Taane G Clark
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eleanor Riley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Joint Malaria Programme, Kilimanjaro Christian Medical College, Moshi, Tanzania,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hugh Reyburn
- Joint Malaria Programme, Kilimanjaro Christian Medical College, Moshi, Tanzania,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vysaul Nyirongo
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, Malawi
| | - David Kachala
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
| | - Malcolm Molyneux
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, Malawi,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Sarah J Dunstan
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Nguyen Hoan Phu
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Nguyen Ngoc Quyen
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
| | - Cao Quang Thai
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam,Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Laurens Manning
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Peter Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | | | - Angela Allen
- Weatherall Institute of Molecular Medicine, Oxford University, Oxford, United Kingdom
| | | | - Pascal Michon
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea,Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia,Barcelona Centre for International Health Research, Barcelona, Spain
| | - Síle F Molloy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Susana Campino
- The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Angeliki Kerasidou
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,Nuffield Department of Population Health, The Ethox Centre, University of Oxford, Oxford, United Kingdom
| | - Victoria J Cornelius
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,MRC Centre for Genomics and Global Health, University of Oxford, Oxford, United Kingdom
| | - Lee Hart
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Shivang S Shah
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Gavin Band
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,MRC Centre for Genomics and Global Health, University of Oxford, Oxford, United Kingdom
| | - Chris CA Spencer
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Tsiri Agbenyega
- Komfo Anoyke Teaching Hospital, Kumasi, Ghana,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Achidi
- Department of Medical Laboratory Sciences, University of Buea, Buea, Cameroon
| | - Ogobara K Doumbo
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Jeremy Farrar
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam,Nuffield Department of Clinical Medicine, Center for Tropical Medicine, Oxford University, Oxford, United Kingdom
| | - Kevin Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Terrie Taylor
- Blantyre Malaria Project at the College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dominic P Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,MRC Centre for Genomics and Global Health, University of Oxford, Oxford, United Kingdom,The Wellcome Trust Sanger Institute, Cambridge, United Kingdom, (DPK)
| | - MalariaGEN Consortium
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
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12
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Gonçalves BP, Tiono AB, Ouédraogo A, Guelbéogo WM, Bradley J, Nebie I, Siaka D, Lanke K, Eziefula AC, Diarra A, Pett H, Bougouma EC, Sirima SB, Drakeley C, Bousema T. Single low dose primaquine to reduce gametocyte carriage and Plasmodium falciparum transmission after artemether-lumefantrine in children with asymptomatic infection: a randomised, double-blind, placebo-controlled trial. BMC Med 2016; 14:40. [PMID: 26952094 PMCID: PMC4782330 DOI: 10.1186/s12916-016-0581-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/12/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A single low dose (0.25 mg/kg) of primaquine is recommended as a gametocytocide in combination with artemisinin-based combination therapies for Plasmodium falciparum but its effect on post-treatment gametocyte circulation and infectiousness to mosquitoes has not been quantified. METHODS In this randomised, double-blind, placebo-controlled trial, 360 asymptomatic parasitaemic children aged 2-15 years were enrolled and assigned to receive: artemether-lumefantrine (AL) and a dose of placebo; AL and a 0.25 mg/kg primaquine dose; or AL and a 0.40 mg/kg primaquine dose. On days 0, 2, 3, 7, 10 and 14, gametocytes were detected and quantified by microscopy, Pfs25 mRNA quantitative nucleic acid sequence based amplification (QT-NASBA), and quantitative reverse-transcriptase PCR (qRT-PCR). For a subset of participants, pre- and post-treatment infectiousness was assessed by mosquito feeding assays on days -1, 3, 7, 10 and 14. RESULTS Both primaquine arms had lower gametocyte prevalences after day 3 compared to the placebo arm, regardless of gametocyte detection method. The mean (95% confidence interval) number of days to gametocyte clearance in children with patent gametocytes on day 0 (N = 150) was 19.7 (14.6 - 24.8), 7.7 (6.3 - 9.1) and 8.2 (6.7 - 9.6) for the AL-placebo, the 0.25 mg/kg primaquine dose and the 0.40 mg/kg primaquine dose arms, respectively. While 38.0% (30/79) of selected gametocytaemic individuals were infectious before treatment, only 1/251 participant, from the AL-placebo group, infected mosquitoes after treatment. CONCLUSIONS We observed similar gametocyte clearance rates after 0.25 and 0.40 mg/kg primaquine doses. Infectivity to mosquitoes after AL was very low and absent in primaquine arms. CLINICALTRIALS. GOV REGISTRATION NCT01935882.
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Affiliation(s)
- Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Alphonse Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Wamdaogo M Guelbéogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - John Bradley
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Issa Nebie
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Débé Siaka
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Alice C Eziefula
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | - Amidou Diarra
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Helmi Pett
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Edith C Bougouma
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Sodiomon B Sirima
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK.
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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13
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Mangano VD, Kabore Y, Bougouma EC, Verra F, Sepulveda N, Bisseye C, Santolamazza F, Avellino P, Tiono AB, Diarra A, Nebie I, Rockett KA, Sirima SB, Modiano D. Novel Insights Into the Protective Role of Hemoglobin S and C Against Plasmodium falciparum Parasitemia. J Infect Dis 2015; 212:626-34. [PMID: 25712976 PMCID: PMC4512610 DOI: 10.1093/infdis/jiv098] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/13/2015] [Indexed: 02/04/2023] Open
Abstract
Although hemoglobin S (HbS) and hemoglobin C (HbC) are well known to protect against severe Plasmodium falciparum malaria, conclusive evidence on their role against infection has not yet been obtained. Here we show, in 2 populations from Burkina Faso (2007-2008), that HbS is associated with a 70% reduction of harboring P. falciparum parasitemia at the heterozygous state (odds ratio [OR] for AS vs AA, 0.27; 95% confidence interval [CI], .11-.66; P = .004). There is no evidence of protection for HbC in the heterozygous state (OR for AC vs AA, 1.49; 95% CI, .69-3.21; P = .31), whereas protection even higher than that observed with AS is observed in the homozygous and double heterozygous states (OR for CC + SC vs AA, 0.04; 95% CI, .01-.29; P = .002). The abnormal display of parasite-adhesive molecules on the surface of HbS and HbC infected erythrocytes, disrupting the pathogenic process of sequestration, might displace the parasite from the deep to the peripheral circulation, promoting its elimination at the spleen level.
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Affiliation(s)
- Valentina D Mangano
- Department of Public Health and Infectious Diseases Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Italy
| | - Youssouf Kabore
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | - Nuno Sepulveda
- London School of Hygiene and Tropical Medicine Center of Statistics and Applications of University of Lisbon, Portugal
| | - Cyrille Bisseye
- Department of Public Health and Infectious Diseases Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | | | | | - Alfred B Tiono
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nebie
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Kirk A Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Sodiomon B Sirima
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - David Modiano
- Department of Public Health and Infectious Diseases Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Italy
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14
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Cherif MK, Sanou GS, Bougouma EC, Diarra A, Ouédraogo A, Dolo A, Troye-Blomberg M, Cavanagh DR, Theisen M, Modiano D, Sirima SB, Nebié I. Is Fc gamma receptor IIA (FcγRIIA) polymorphism associated with clinical malaria and Plasmodium falciparum specific antibody levels in children from Burkina Faso? Acta Trop 2015; 142:41-6. [PMID: 25447268 DOI: 10.1016/j.actatropica.2014.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022]
Abstract
In the present study, the influences of FcγRIIA polymorphism on susceptibility to malaria and antibody responses to Plasmodium falciparum antigens were analyzed in children. We recruited 96 healthy children between 3 and 10 years at the beginning of the high transmission season and we followed up for 5 months through the high transmission season to assess the parasitological, immunological and genetic endpoints in relation to clinical malaria status. There was a similar distribution of homozygous and heterozygous individuals carrying the FcγRIIA-131R/R and FcγRIIA-131R/H allele, whereas the number of FcγRIIA-131H/H homozygous individuals was lower. P. falciparum infection frequency was not associated with the FcγRIIa-131R/H polymorphism. Only IgG antibody responses to GLURP R0 showed a significant association between antibody levels and FcγRIIA polymorphism (p=0.02). IgG levels to MSP2a were significantly higher in children who did not experience any clinical malaria episode compared to those who experienced at least one malaria episode (p=0.019). Cytophilic and non-cytophylic IgG subclass levels were higher in children without malaria than those who experienced at least one malaria episode. This difference was statistically significant for IgG1 to MSP3 (p=0.003) and to MSP2a (p=0.006); IgG3 to MSP2a (p=0.007) and to GLURP R0 (p=0.044); IgG2 to MSP2b (p=0.007) and IgG4 to MSP3 (p=0.051) and to MSP2a (p=0.049). In this study, homozygous carriers of the FcγRIIA-131R/R allele had higher malaria-specific antibody levels compare to the heterozygous carriers FcγRIIA-131R/H alleles and to homozygous carriers of FcγRIIA-131H/H alleles. The pre-existing antibodies responses were related to a reduced subsequent risk of clinical malaria.
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Affiliation(s)
- Mariama K Cherif
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso; Université de Ouagadougou, Burkina Faso
| | - Guillaume S Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso; Polytechnic University of Bobo Dioulasso, Burkina Faso
| | - Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amagana Dolo
- Malaria Research and Training Centre, University of Mali, Bamako, Mali
| | | | - David R Cavanagh
- Institute of Immunology and Infection Research, University of Edinburgh, EH9 3JT, Scotland, United Kingdom
| | - Michael Theisen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, Denmark; Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - David Modiano
- Department of Public Health Sciences, University La Sapienza, Rome, Italy
| | - Sodiomon B Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nebié
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
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15
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Ouédraogo AL, Bastiaens GJH, Tiono AB, Guelbéogo WM, Kobylinski KC, Ouédraogo A, Barry A, Bougouma EC, Nebie I, Ouattara MS, Lanke KHW, Fleckenstein L, Sauerwein RW, Slater HC, Churcher TS, Sirima SB, Drakeley C, Bousema T. Efficacy and safety of the mosquitocidal drug ivermectin to prevent malaria transmission after treatment: a double-blind, randomized, clinical trial. Clin Infect Dis 2014; 60:357-65. [PMID: 25414262 DOI: 10.1093/cid/ciu797] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Artemisinin combination therapy effectively clears asexual malaria parasites and immature gametocytes but does not prevent posttreatment malaria transmission. Ivermectin (IVM) may reduce malaria transmission by killing mosquitoes that take blood meals from IVM-treated humans. METHODS In this double-blind, placebo-controlled trial, 120 asymptomatic Plasmodium falciparum parasite carriers were randomized to receive artemether-lumefantrine (AL) plus placebo or AL plus a single or repeated dose (200 µg/kg) of ivermectin (AL-IVM1 and AL-IVM2, respectively). Mosquito membrane feeding was performed 1, 3, and 7 days after initiation of treatment to determine Anopheles gambiae and Anopheles funestus survival and infection rates. RESULTS The AL-IVM combination was well tolerated. IVM resulted in a 4- to 7-fold increased mortality in mosquitoes feeding 1 day after IVM (P < .001). Day 7 IVM plasma levels were positively associated with body mass index (r = 0.57, P < .001) and were higher in female participants (P = .003), for whom An. gambiae mosquito mortality was increased until 7 days after a single dose of IVM (hazard rate ratio, 1.34 [95% confidence interval, 1.07-1.69]; P = .012). Although we found no evidence that IVM reduced Plasmodium infection rates among surviving mosquitoes, the mosquitocidal effect of AL-IVM1 and AL-IVM2 resulted in 27% and 35% reductions, respectively, in estimated malaria transmission potential during the first week after initiation of treatment. CONCLUSIONS We conclude that IVM can be safely given in combination with AL and can reduce the likelihood of malaria transmission by reducing the life span of feeding mosquitoes. CLINICAL TRIALS REGISTRATION NCT0160325.
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Affiliation(s)
- André Lin Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Guido J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Wamdaogo M Guelbéogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Kevin C Kobylinski
- Entomology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland Entomology Department, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Alphonse Ouédraogo
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Aïssata Barry
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C Bougouma
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nebie
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Maurice San Ouattara
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Kjerstin H W Lanke
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hannah C Slater
- MRC Centre for Outbreak Analysis and Modelling, Infectious Disease Epidemiology, Imperial College London
| | - Thomas S Churcher
- MRC Centre for Outbreak Analysis and Modelling, Infectious Disease Epidemiology, Imperial College London
| | - Sodiomon B Sirima
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
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16
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Ouédraogo A, Tiono AB, Kargougou D, Yaro JB, Ouédraogo E, Kaboré Y, Kangoye D, Bougouma EC, Gansane A, Henri N, Diarra A, Sanon S, Soulama I, Konate AT, Watson NL, Brown V, Hendriks J, Pau MG, Versteege I, Wiesken E, Sadoff J, Nebie I, Sirima SB. A phase 1b randomized, controlled, double-blinded dosage-escalation trial to evaluate the safety, reactogenicity and immunogenicity of an adenovirus type 35 based circumsporozoite malaria vaccine in Burkinabe healthy adults 18 to 45 years of age. PLoS One 2013; 8:e78679. [PMID: 24244339 PMCID: PMC3823848 DOI: 10.1371/journal.pone.0078679] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022] Open
Abstract
Background Ad35.CS.01 is a pre-erythrocytic malaria candidate vaccine. It is a codon optimized nucleotide sequence representing the P. falciparum circumsporozoite (CS) surface antigen inserted in a replication deficient Adenovirus 35 backbone. A Phase 1a trial has been conducted in the USA in naïve adults and showed that the vaccine was safe. The aim of this study is to assess the safety and immunogenicity of ascending dosages in sub Saharan Africa. Methods A double blind, randomized, controlled, dose escalation, phase Ib trial was conducted in a rural area of Balonghin, the Saponé health district (Burkina Faso). Forty-eight healthy adults aged 18-45 years were randomized into 4 cohorts of 12 to receive three vaccine doses (day 0, 28 and 84) of 109, 1010, 5X1010, 1011 vp of Ad35.CS.01 or normal saline by intra muscular injection. Subjects were monitored carefully during the 14 days following each vaccination for non serious adverse events. Severe and serious adverse events were collected throughout the participant study duration (12 months from the first vaccination). Humoral and cellular immune responses were measured on study days 0, 28, 56, 84, 112 and 140. Results Of the forty-eight subjects enrolled, forty-four (91.7%) received all three scheduled vaccine doses. Local reactions, all of mild severity, occurred in thirteen (27.1%) subjects. Severe (grade 3) laboratory abnormalities occurred in five (10.4%) subjects. One serious adverse event was reported and attributed to infection judged unrelated to vaccine. The vaccine induced both antibody titers and CD8 T cells producing IFNγ and TNFα with specificity to CS while eliciting modest neutralizing antibody responses against Ad35. Conclusion Study vaccine Ad35.CS.01 at four different dose levels was well-tolerated and modestly immunogenic in this population. These results suggest that Ad35.CS.01 should be further investigated for preliminary efficacy in human challenge models and as part of heterologous prime-boost vaccination strategies. Trial Registration ClinicalTrials.gov NCT01018459 http://clinicaltrials.gov/ct2/show/NCT01018459
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Affiliation(s)
- Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alfred B. Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Désiré Kargougou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Jean Baptiste Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Esperance Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Youssouf Kaboré
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - David Kangoye
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C. Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Adama Gansane
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Noelie Henri
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Souleymane Sanon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amadou T. Konate
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Nora L. Watson
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Valerie Brown
- The EMMES Corporation, Rockville, Maryland, United States of America
| | | | | | | | | | | | - Issa Nebie
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Groupe d’action et de Recherche en Santé, Ouagadougou, Burkina Faso
- * E-mail:
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Ouédraogo A, Tiono AB, Diarra A, Sanon S, Yaro JB, Ouedraogo E, Bougouma EC, Soulama I, Gansané A, Ouedraogo A, Konate AT, Nebie I, Watson NL, Sanza M, Dube TJT, Sirima SB. Malaria morbidity in high and seasonal malaria transmission area of Burkina Faso. PLoS One 2013; 8:e50036. [PMID: 23320064 PMCID: PMC3540059 DOI: 10.1371/journal.pone.0050036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malariometric parameters are often primary endpoints of efficacy trials of malaria vaccine candidates. This study aims to describe the epidemiology of malaria prior to the conduct of a series of drug and vaccine trials in a rural area of Burkina Faso. METHODS Malaria incidence was prospectively evaluated over one year follow-up among two cohorts of children aged 0-5 years living in the Saponé health district. The parents of 1089 children comprising a passive case detection cohort were encouraged to seek care from the local health clinic at any time their child felt sick. Among this cohort, 555 children were randomly selected for inclusion in an active surveillance sub-cohort evaluated for clinical malaria during twice weekly home visits. Malaria prevalence was evaluated by cross-sectional survey during the low and high transmission seasons. RESULTS Number of episodes per child ranged from 0 to 6 per year. Cumulative incidence was 67.4% in the passive and 86.2% in the active cohort and was highest among children 0-1 years. Clinical malaria prevalence was 9.8% in the low and 13.0% in the high season (p>0.05). Median days to first malaria episode ranged from 187 (95% CI 180-193) among children 0-1 years to 228 (95% CI 212, 242) among children 4-5 years. The alternative parasite thresholds for the malaria case definition that achieved optimal sensitivity and specificity (70-80%) were 3150 parasites/µl in the high and 1350 parasites/µl in the low season. CONCLUSION Clinical malaria burden was highest among the youngest age group children, who may represent the most appropriate target population for malaria vaccine candidate development. The pyrogenic threshold of parasitaemia varied markedly by season, suggesting a value for alternative parasitaemia levels in the malaria case defintion. Regional epidemiology of malaria described, Sapone area field centers are positioned for future conduct of malaria vaccine trials.
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Affiliation(s)
- Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alfred B. Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Souleymane Sanon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Jean Baptiste Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Esperance Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Edith C. Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Adama Gansané
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amathe Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amadou T. Konate
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issa Nebie
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Nora L. Watson
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Megan Sanza
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Tina J. T. Dube
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Sodiomon Bienvenu Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Groupe d'action et de Recherche en Santé, Ouagadougou, Burkina Faso
- * E-mail:
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18
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Cherif MK, Sanou GS, Maiga B, Israelsson E, Ouédraogo AL, Bougouma EC, Diarra A, Ouédraogo A, Ouattara AS, Troye-Blomberg M, Dolo A, Cavanagh DR, Theisen M, Modiano D, Sirima SB, Nebié I. FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso. Scand J Immunol 2012; 75:606-13. [PMID: 22268665 DOI: 10.1111/j.1365-3083.2012.02690.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.
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Affiliation(s)
- M K Cherif
- Centre National de Recherche et de Formation sur le Paludisme, Burkina Faso Université de Ouagadougou, Burkina Faso
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19
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Bougouma EC, Tiono AB, Ouédraogo A, Soulama I, Diarra A, Yaro JB, Ouédraogo E, Sanon S, Konaté AT, Nébié I, Watson NL, Sanza M, Dube TJT, Sirima SB. Haemoglobin variants and Plasmodium falciparum malaria in children under five years of age living in a high and seasonal malaria transmission area of Burkina Faso. Malar J 2012; 11:154. [PMID: 22559271 PMCID: PMC3544150 DOI: 10.1186/1475-2875-11-154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/19/2012] [Indexed: 11/25/2022] Open
Abstract
Background Genetic factors play a key role in determining resistance/susceptibility to infectious disease. Susceptibility of the human host to malaria infection has been reported to be influenced by genetic factors, which could be confounders if not taken into account in the assessment of the efficacy of interventions against malaria. This study aimed to assess the relationship between haemoglobin genotypes and malaria in children under five years in a site being characterized for future malaria vaccine trials. Methods The study population consisted of 452 children living in four rural villages. Hb genotype was determined at enrolment. Clinical malaria incidence was evaluated over a one-year period using combined active and passive surveillance. Prevalence of infection was evaluated via bi-annual cross-sectional surveys. At each follow-up visit, children received a brief clinical examination and thick and thin blood films were prepared for malaria diagnosis. A clinical malaria was defined as Plasmodium falciparum parasitaemia >2,500 parasites/μl and axillary temperature ≥37.5°C or reported fever over the previous 24 hours. Results Frequencies of Hb genotypes were 73.2% AA; 15.0% AC; 8.2% AS; 2.2% CC; 1.1% CS and 0.2% SS. Prevalence of infection at enrolment ranged from 61.9%-54.1% among AA, AC and AS children. After one year follow-up, clinical malaria incidence (95% CI) (episodes per person-year) was 1.9 (1.7-2.0) in AA, 1.6 (1.4-2.1) in AC, and 1.7 (1.4-2.0) in AS children. AC genotype was associated with lower incidence of clinical malaria relative to AA genotype among children aged 1–2 years [rate ratio (95% CI) 0.66 (0.42-1.05)] and 2–3 years [rate ratio (95% CI) 0.37 (0.18-0.75)]; an association of opposite direction was however apparent among children aged 3–4 years. AS genotype was associated with lower incidence of clinical malaria relative to AA genotype among children aged 2–3 years [rate ratio (95% CI) 0.63 (0.40-1.01)]. Conclusions In this cohort of children, AC or AS genotype was associated with lower risk of clinical malaria relative to AA genotype only among children aged one to three years. It would be advisable for clinical studies of malaria in endemic regions to consider haemoglobin gene differences as a potentially important confounder, particularly among younger children.
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Affiliation(s)
- Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
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20
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Soulama I, Bigoga JD, Ndiaye M, Bougouma EC, Quagraine J, Casimiro PN, Stedman TT, Sirima SB. Genetic diversity of polymorphic vaccine candidate antigens (apical membrane antigen-1, merozoite surface protein-3, and erythrocyte binding antigen-175) in Plasmodium falciparum isolates from western and central Africa. Am J Trop Med Hyg 2011; 84:276-84. [PMID: 21292899 PMCID: PMC3029182 DOI: 10.4269/ajtmh.2011.10-0365] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The malaria vaccine candidate antigens erythrocyte binding antigen 175 (EBA-175), merozoite surface protein 3 (MSP-3), and apical membrane antigen (AMA-1) from Plasmodium falciparum isolates from countries in central and west Africa were assessed for allelic diversity. Samples were collected on filter paper from 600 P. falciparum-infected symptomatic patients in Cameroon, Republic of Congo, Burkina Faso, Ghana, and Senegal and screened for class-specific amplification fragments. Genetic diversity, assessed by mean heterozygosity, was comparable among countries. We detected a clinical increase in eba 175 F-allele frequency from west to east across the study region. No statistical difference in msp-3 allele distribution between countries was observed. The ama-1 3D7 alleles were present at a lower frequency in central Africa than in West Africa. We also detected little to no genetic differentiation among sampling locations. This finding indicates that, at least at the level of resolution offered by restriction fragment length polymorphism analysis, these antigens showed remarkable genetic homogeneity throughout the region sampled, perhaps caused by balancing selection to maintain a diverse array of antigen haplotyes.
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Affiliation(s)
- Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
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21
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Soulama I, Bougouma EC, Diarra A, Nebie I, Sirima SB. Low-high season variation in Plasmodium falciparum erythrocyte binding antigen 175 (eba-175) allelic forms in malaria endemic area of Burkina Faso. Trop Med Int Health 2009; 15:51-9. [PMID: 19891760 DOI: 10.1111/j.1365-3156.2009.02415.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of seasonal variation on the distribution of the eba-175 allelic forms in the area where malaria transmission is markedly seasonal. METHODS Blood samples were collected from 291 and 239 children under 5 years of age during the low and the high malaria transmission season, respectively, in four villages named Dawelgué, Kounda, Tanghin and Watenga of Saponé Health District, then screened for eba 175 F- and C- alleles by nested PCR analysis. RESULTS F- alleles were more prevalent than C-alleles in the low [0.66 vs. 0.34 (P < 0.0001)] and high transmission season [0.67 vs. 0.33 (P < 0.0001)]. No significant seasonal variation was observed in the distribution of the two alleles. However, according to Sewall Wright rules, the population pairwise F(ST) values, between Dawelgué and Tanghin during the low transmission season (F(ST_) value = 0.10415, P-value = 0.0090 and during the high season (F(ST_)value = 0.08244, P-value < 0.00001), between Tanghin and Watenga during the low season (F(ST) value = 0.07414, P-value = 0.009) indicated a moderate but statistically significant genetic differentiation. CONCLUSION Although there was a moderate but significant genetic differentiation between some study villages at different times of the year, this study result in the seasonal stability of eba-175 allele's distribution in the study area.
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Affiliation(s)
- Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
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22
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Tiono AB, Ouedraogo A, Bougouma EC, Diarra A, Konaté AT, Nébié I, Sirima SB. Placental malaria and low birth weight in pregnant women living in a rural area of Burkina Faso following the use of three preventive treatment regimens. Malar J 2009; 8:224. [PMID: 19811649 PMCID: PMC2768741 DOI: 10.1186/1475-2875-8-224] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 10/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. There was a need to test the benefits of new strategies over the classical chemoprophylaxis. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process. It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus. METHODS Pregnant women attending the first antenatal care visit were randomly assigned to one of the three treatment regimens. They were subsequently followed up till delivery. Maternal, placental and cord blood samples were obtained upon delivery to check for P. falciparum infection. RESULTS A total of 648 pregnant women were enrolled in the study. Delivery outcome were available for 423 of them. Peripheral maternal P. falciparum infection at delivery was found in 25.8% of the women. The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P << 0.000). The prevalence of placental malaria was 18.8% in the CWC/CQ group; 15.9% in the IPTp/CQ group and 10.6% in the IPTp/SP group. The incidence of LBW (weight < 2,500 g) was significantly higher among infants of mothers in the CWC/CQ group (23.9%) as compared with those of mothers in the IPTp/CQ (15.6%) and IPTp/SP (11.6%) groups (p = 0.02) CONCLUSION Intermittent preventive treatment with SP has shown clear superiority in reducing adverse outcomes at delivery, as compared with intermittent preventive treatment with CQ and classical chemoprophylaxis with CQ.
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Affiliation(s)
- Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso.
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23
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Soulama I, Nébié I, Ouédraogo A, Gansane A, Diarra A, Tiono AB, Bougouma EC, Konaté AT, Kabré GB, Taylor WRJ, Sirima SB. Plasmodium falciparum genotypes diversity in symptomatic malaria of children living in an urban and a rural setting in Burkina Faso. Malar J 2009; 8:135. [PMID: 19545390 PMCID: PMC2705376 DOI: 10.1186/1475-2875-8-135] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 06/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical presentation of malaria, considered as the result of a complex interaction between parasite and human genetics, is described to be different between rural and urban areas. The analysis of the Plasmodium falciparum genetic diversity in children with uncomplicated malaria, living in these two different areas, may help to understand the effect of urbanization on the distribution of P. falciparum genotypes. METHODS Isolates collected from 75 and 89 children with uncomplicated malaria infection living in a rural and an urban area of Burkina Faso, respectively, were analysed by a nested PCR amplification of msp1 and msp2 genes to compare P. falciparum diversity. RESULTS The K1 allelic family was widespread in children living in the two sites, compared to other msp1 allelic families (frequency >90%). The MAD 20 allelic family of msp1 was more prevalent (p = 0.0001) in the urban (85.3%) than the rural area (63.2%). In the urban area, the 3D7 alleles of msp2 were more prevalent compared to FC27 alleles, with a high frequency for the 3D7 300bp allele (>30%). The multiplicity of infection was in the range of one to six in the urban area and of one to seven in the rural area. There was no difference in the frequency of multiple infections (p = 0.6): 96.0% (95% C.I: 91.6-100) in urban versus 93.1% (95%C.I: 87.6-98.6) in rural areas. The complexity of infection increased with age [p = 0.04 (rural area), p = 0.06 (urban area)]. CONCLUSION Urban-rural area differences were observed in some allelic families (MAD20, FC27, 3D7), suggesting a probable impact of urbanization on genetic variability of P. falciparum. This should be taken into account in the implementation of malaria control measures.
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Affiliation(s)
- Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Issa Nébié
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Adama Gansane
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Edith C Bougouma
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Amadou T Konaté
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
| | - Gustave B Kabré
- Université de Ouagadougou, Unité de Formation et de Recherche Science de la Vie et de la Terre, Ouagadougou, Burkina Faso
| | - Walter RJ Taylor
- Travel and Migration Medicine Unit, Geneva University Hospital, Geneva, Switzerland
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Sodiomon B Sirima
- Centre National de Recherche et de Formation sur le Paludisme. 01 BP 2208 Ouagadougou 01, Burkina Faso
- Groupe de Recherche et d'Action en Santé, Ouagadougou, Burkina Faso
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Ouédraogo A, Bougouma EC, Diarra A, Konaté AT, Nébié I, Tiono AB, Sirima SB. [Comparative impact of three malaria preventive regimens during pregnancy on maternal anemia due to malaria in Burkina Faso]. Med Mal Infect 2008; 38:180-6. [PMID: 18262380 DOI: 10.1016/j.medmal.2007.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 10/09/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The main objective of this study was to compare the efficacy of three regimens of malaria prevention during pregnancy for the reduction of anemia between the first and third antenatal consultations. The first treatment arm was the classical weekly chemoprophylaxis with chloroquine; the other two were the intermittent preventive treatment using either three doses of chloroquine or sulfadoxine-pyrimethamine. DESIGN We conducted an open, randomized, three-arm study in a rural district of Burkina Faso. A cohort was constituted by 648 pregnant women of any parity. RESULTS The hemoglobin gain was more significant with the intermittent preventive treatment using sulfadoxine-pyrimethamine compared to the other treatment arms. The hemoglobin increased from 10.3g/dl (at the first antenatal consultation) to 11.4 g/dl (at the third antenatal consultation). In the three arms of treatment, the chemoprophylaxis reduced the prevalence of moderate anemia and severe anemia. The reduction of moderate anemia was more substantial in the sulfadoxine-pyrimethamine arm (65.6 to 36.7%) at second antenatal consultation (p=0.069) and third antenatal consultation (p=0.014). Conversely, in the two chloroquine arms, there was no significant reduction either at second antenatal consultation (p=0.72) or third antenatal consultation (p=0.55). The prevalence of peripheral parasitemia decreased in all treatment groups. However, it was significantly higher in the sulfadoxine-pyrimethamine group (44.3%). CONCLUSIONS Intermittent preventive treatment with three doses of sulfadoxine-pyrimethamine is a more effective strategy to prevent maternal anemia during pregnancy in Burkina Faso.
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Affiliation(s)
- A Ouédraogo
- Centre national de recherche et de formation sur le paludisme, ministère de la Santé-01, B.P. 2208, Ouagadougou 01, Burkina Faso
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Sirima SB, Cotte AH, Konaté A, Moran AC, Asamoa K, Bougouma EC, Diarra A, Ouédraogo A, Parise ME, Newman RD. Malaria prevention during pregnancy: assessing the disease burden one year after implementing a program of intermittent preventive treatment in Koupela District, Burkina Faso. Am J Trop Med Hyg 2006; 75:205-11. [PMID: 16896120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
The World Health Organization recommends that pregnant women in malaria-endemic areas receive >or= 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp/SP) in the second and third trimesters of pregnancy to prevent maternal anemia, placental parasitemia, and low birth weight (LBW). In 2001, a program evaluation in Koupéla District, Burkina Faso demonstrated that despite widespread use of chloroquine chemoprophylaxis, the burden of malaria during pregnancy remained high. In 2003, the Burkina Faso Ministry of Health piloted a program of IPTp/SP (three doses) and accelerated distribution of insecticide-treated nets (ITN) to pregnant women in Koupéla District. In 2004, a follow-up program evaluation was conducted. Coverage with >or= 1 doses of IPTp/SP was high among women attending antenatal clinics (ANCs) (96.2%) and delivery units (DUs) (93.5%); ITN ownership was moderately high (ANC = 53.9%, DU = 61.6%). In multivariate analysis, >or= 1 dose of IPTp/SP was associated with a significant reduction in the prevalence of peripheral parasitemia at ANCs (risk ratio [RR] = 0.49, P = 0.008), >or= 2 doses of IPTp/SP were associated with a reduction in the prevalence of placental parasitemia (RR = 0.56, P = 0.02), and three doses of IPTp/SP were associated with a reduced risk of LBW (RR = 0.51, P = 0.04). The proportions of women at ANCs with peripheral parasitemia and anemia were significantly lower in 2004 than in 2001 (RR = 0.53, P = 0.001 and RR = 0.78, P = 0.003, respectively). The proportions of women at DUs with peripheral and placental parasitemia were also significantly lower in 2004 than in 2001 (RR = 0.66, P < 0.0001 and RR = 0.71, P = 0.0002, respectively). These data suggest that a package of IPTp/SP and ITNs is effective in reducing the burden of malaria during pregnancy in Burkina Faso.
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Affiliation(s)
- Sodiomon B Sirima
- Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, Ouagadougou, Burkina Faso
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