Plasmodium falciparum transmission blocking immunity under conditions of low and high endemicity in Cameroon

Transmission blocking immunity (TBI) was studied in relation to age, gametocyte density and transmission intensity. subjects with high gametocytaemias were selected in a hypo-endemic urban district and a hyper-endemic rural area in South Cameroon. TBI was determined in blood from gametocyte carriers in a bioassay (Direct Membrane Feeding Assay), with either autologous plasma (OWN) or control serum (AB). Mosquito infection rates (IR) were compared. infection rates correlated positively with gametocyte and oocyst densities. Three TBI indicators were analysed: the proportion of transmission reducers (IRAB > IROWN, P < 0.01), the mean intensity of TBI (IRAB - IROWN), and the contribution of TBI to total inhibition [(IRAB-IROWN)/(100-IROWN)]. we could not discriminate between areas with regard to either the proportion of transmission reducers (urban 15% and rural 29%) or the mean levels of TBI (urban 10% and rural 9%), or contribution of TBI to total inhibition (urban 10% and rural 13%). there was no relationship between TBI indicators and age, but a trend of increasing values was observed with rising gametocytaemia, which was considered as a confusing factor. a multivariable analysis showed that the probability of being a reducer was 4.6 fold higher in the rural area than in the urban district.

Stage-specific effects of host plasma factors on the early sporogony of autologous Plasmodium falciparum isolates within Anopheles gambiae

Summary Quantitatively assessing the impact of naturally occurring transmission-blocking (TB) immunity on malaria parasite sporogonic development may provide a useful interpretation of the underlying mechanisms. Here, we compare the effects of plasma derived from 23 naturally infected gametocyte carriers (OWN) with plasma from donors without previous malaria exposure (AB) on the early sporogonic development of Plasmodium falciparum in Anopheles gambiae. Reduced parasite development efficiency was associated with mosquitoes taking a blood meal mixed with the gametocyte carriers' own plasma, whereas replacing autologous plasma with non-immune resulted in the highest level of parasite survival. Seven days after an infective blood meal, 39.1% of the gametocyte carriers' plasma tested showed TB activity as only a few macrogametocytes ingested along with immune plasma ended up as ookinetes but subsequent development was blocked in the presence of immune plasma. In other experiments (60.9%), the effective number of parasites declined dramatically from one developmental stage to the next, and resulted in an infection rate that was two-fold lower in OWN than in AB infection group. These findings are in agreement with those in other reports and go further by quantitatively examining at which transition stages TB immunity exerts its action. The transitions from macrogametocytes to gamete/zygote and from gamete/zygote to ookinete were identified as main targets. However, the net contribution of host plasma factors to these interstage parasite reductions was low (5-20%), suggesting that irrespective of the host plasma factors, mosquito factors might also lower the survival level of parasites during the early sporogonic development.

Underreporting of malaria incidence in The Netherlands: results from a capture-recapture study

The aim of this study was to estimate the completeness of notification of malaria by physicians and laboratories in the Netherlands in 1996. We used a capture-recapture (CRC) analysis of three incomplete, partially overlapping registers of malaria cases: a laboratory survey, the Notification Office and the hospital admission registration. The response of the laboratories was 83.2%. In 1996 the laboratories microscopically identified 535 cases of malaria, 330 patients with malaria were admitted to hospital and physicians notified 311 malaria cases. 667 malaria cases were recorded in at least one register. CRC analysis estimated the total number of malaria cases at 774 (95 % CI of 740-821). This implies a completeness of notification of 40.2% for physicians and 69.1% for the laboratories. It can be concluded that laboratory-based notification can considerably increase the number of officially reported malaria cases as compared to notification by physicians. However, possibly one-third of the cases may still go unreported.

Sulphadoxine/pyrimethamine: an appropriate first-line alternative for the treatment of uncomplicated falciparum malaria in Ghanaian children under 5 years of age

OBJECTIVE

To assess whether chloroquine (CQ) still is an appropriate first-line drug for the treatment of uncomplicated falciparum malaria in Ghana and whether sulphadoxine/pyrimethamine (SP) could be a good alternative.

METHOD

The parasitological, clinical and haematological responses to CQ and SP were studied in children < 5 years of age according to a modified WHO 28-day in vivo protocol. A total of 142 children attending the outpatients department meeting the inclusion criteria were randomly assigned to the CQ (n=72) or SP (n=70) group.

RESULTS

In the CQ group, 15 children (20.8%) exhibited early clinical failure (within 3 days) compared with only 1 (1.4%) in the SP group (P < 0.01). The clinical failure rate before day 14 (early treatment failure plus late treatment failure before day 14) also showed a marked advantage in favour of the SP group (1.4 against 29.2%). The median time to clinical failure was 11.5 days in the CQ group and 26 days in the SP group (P < 0.01). Of the 72 children treated with CQ, 9 (12.5%) had RIII resistance and 19 (26.4%) had RII resistance. A total of 36 (50.0%) were sensitive to CQ. From the 70 children treated with SP, none had RIII or RII resistance. There was no difference in haematological response between the two treatment groups.

CONCLUSION

Although there is little concordance on when to change treatment policy, the high resistance to CQ in this study supports the change to another first-line drug for children under 5 years of age. SP seems to be a good alternative, although a high RII and RIII resistance against this drug has already been reported in the coastal zones of Ghana.

[Considerable underreporting of malaria in the Netherlands; a capture-recapture analysis]

OBJECTIVE

To estimate the completeness of notification of malaria by physicians and laboratories in the Netherlands.

METHOD

Capture-recapture analysis was applied to three incomplete, partially overlapping registers of malaria cases in 1995 and 1996: a laboratory survey, the Notification Office and the hospital admission registration.

RESULTS

The average response of the 107 laboratories approached was 83.6% over both years. In 1995 and 1996 581 and 535 malaria cases respectively were microscopically diagnosed. In each year physicians officially notified 311 patients. 350 and 330 patients respectively were admitted to hospital. Capture-recapture analysis estimated the total number of new malaria cases at 933 (95% confidence interval: 849-1072) in 1995 and at 774 cases (740-821) in 1996. The estimated completeness of notification in 1995 and 1996 was therefore 33.3% and 40.2% for physicians and 62.3% and 69.1% for the laboratories.

CONCLUSION

Laboratory-based notification, introduced in the Infectious Diseases Act, can considerably increase the number of officially reported malaria cases as compared with notification by physicians. However, approximately one-third of the estimated number of cases may still go unreported.

Anti-NANP antibody and treatment efficacy in patients with acute uncomplicated falciparum malaria attacks

African patients originating from the hypoendemic, urban area of Greater Dakar (Senegal, West Africa) who presented with an acute Plasmodium falciparum infection were studied using an in-vivo chloroquine sensitivity assay for 28 days. Forty-seven patients with acute malaria infections were treated with 25 mg/body weight of chloroquine. Adequate responses to treatment were observed in 24 patients (51%), whereas 23 (49%) were resistant. On the day of admission, these two groups of patients were comparable with respect to age, level of parasitemia and delay before initiation of treatment, but not with respect to gametocyte prevalence which was higher in patients resistant to therapy (48%) than in those who responded to treatment (17%). In order to evaluate whether the therapeutic response was associated with any given specific immune response, antibody activities against different stages of the parasite cycle were evaluated: anti-NANP repeats (i.e. antisporozoite stage antigen), anti-Pfs 45 kDa (i.e. antigametocyte stage antigen), and anti-MSP3 (i.e. antimerozoite stage antigen) antibodies were measured by ELISA at day 0 (i.e. on the day of admission and before initiation of treatment), day 7 and day 28. No significant differences between treatment-sensitive and treatment-resistant infections were observed for antibody prevalences and optical densities, except at day 0, when the prevalence of antibodies against NANP repeats was 2.4 times more frequent in the group of patients with a propitious response to treatment: 62.5% of the patients with an infection sensitive to chloroquine had anti-NANP antibodies, whereas only 26.1% of the patients resistant to chloroquine treatment had such a humoral response. These observations are discussed in relation to (1) the finding that gametocyte prevalence was markedly increased at a time when resistance to antimalarial treatment was observed; (2) the possibility that the efficacy of the therapeutic response could be the result of the combined effects of treatment and the individual immune status of the patients at the time of drug cure; and (3) the presence of detectable anti-NANP activity as potential indicator of the level of premunition acquired in an area of low and seasonal malaria transmission.

The disappearance of Dutch malaria and the Rockefeller Foundation

Sixty years ago Professor Nico Swellengrebel wrote his famous book 'Malaria in the Netherlands' (Swellengrebel and de Buck, 1938). At that time tertian malaria was still endemic, with its epidemic ups and downs. Malaria disappeared as recently as 1960 and the Rockefeller Foundation (RF) contributed substantially to this effect. The Rockefeller Archives proved a valuable source of anecdotal information, which puts the scientific publications of the Dutch malariologists in a more vivid perspective. Following the course of history, first the already existing links with the RF are explained along with some peculiarities of tertian malaria in the Dutch temperate climate. The emergence of a new epidemic during the war years and the implication of new tools and principles for control as advocated by the RF are described. The subsequent shriveling of the vector population and the disappearance of malaria are presented, along with some details about the reluctance of WHO to declare the Netherlands malaria-free. Finally, recent unrest about possible return of malaria is put into perspective.

The use of anti-Pfs 25 monoclonal antibody for early determination of Plasmodium falciparum oocyst infections in Anopheles gambiae: comparison with the current technique of direct microscopic diagnosis

Experimental infections of laboratory-reared anopheline mosquitoes were carried out with 57 Plasmodium falciparum gametocyte carriers from Cameroon. Prevalence of infected mosquitoes and oocyst intensity were determined by two independent methods. Young P. falciparum oocysts were detected on day 2 after feeding using an immunofluorescent assay, and the results were compared with direct microscopic examination of midgut oocysts on day 7 postinfection. The immunofluorescent assay was based on a FITC-labeled anti-25-kDa monoclonal antibody, while the direct microscopy was performed on midguts stained with 2% mercurochrome. Young oocysts were easily detected by their typical and bright green-fluorescing Pfs25 positive coat and their characteristic pattern of pigment granules under transmitted white light examination. The agreement between the results of the two methods was assessed using the Kappa coefficient on prevalences of positive infections and the interclass correlation coefficient on arithmetic mean oocyst load per infected midgut. The results indicated a low agreement between the two methods for the comparison of prevalences of infected mosquitoes. However, this agreement was near perfect for the comparison of mean oocyst intensities. Prevalences of positive infections and the overall number of parasites per positive gut were significantly correlated for both methods. Thus, the immunofluorescent test could be an appropriate tool for early determination of malaria infection in mosquitoes, particularly under laboratory conditions. The possible applications of this immuno-fluorescent technique are discussed.

Plasmodium falciparum: membrane feeding assays and competition ELISAs for the measurement of transmission reduction in sera from Cameroon

The effect of natural malaria transmission-blocking factors in the blood of Plasmodium falciparum gametocyte carriers was assessed in two types of functional bioassays. In the direct membrane feeding assay (DMFA), a comparison is made between the infectivity of gametocytes from a naturally infected gametocyte carrier in the presence of autologous plasma and the infectivity in the presence of replacement plasma from nonimmune donors. In the standard membrane feeder assay (SMFA), cultured NF54 gametocytes are used to measure the capacity of endemic sera to block transmission. In the DMFA, 18 out of 48 sera (37.5%) from Cameroonian gametocyte carriers reduced transmission significantly, while in the SMFA 22 out of 48 sera (45.8%) produced transmission reduction. There was a positive correlation between both assays (r + 0.41, P < 0.05). Antibodies against epitopes of transmission-blocking target antigens Pfs48/45 and Pfs230 were measured in competition ELISAs and compared with the results of DMFA and SMFA. Serological reactivity in competition ELISAs against three epitopes of Pfs48/45 was significantly higher in the group of transmission-reducing sera in both the DMFA and the SMFA, especially for epitope III. No significant difference was found for Pfs230 antibodies (epitope I). Sensitivity of the serological assays was approximately 60%, with a specificity of around 70%. Serological tests cannot replace the functional bioassay in field situations as yet, but can contribute in the selection of sera for SMFA evaluation.

Testing for anti-circumsporozoite and anti-blood-stage antibodies for epidemiologic assessment of Plasmodium falciparum infection in travelers

The purpose of this investigation was to assess the role of serology for establishing incidences of Plasmodium falciparum malaria and of exposure to P. falciparum in epidemiologic studies of travelers using chemoprophylaxis. The design was a prospective cohort study involving 548 short-term Dutch travelers to areas endemic for P. falciparum malaria. Sera were collected before departure and, together with the medical history, 2-6 weeks after return. All sera were tested for anti-circumsporozoite (CS) antibodies by an R32tet32-ELISA; sera of subjects reporting febrile illness during travel or after return or with anti-CS responses were tested for anti-blood-stage antibodies by an indirect fluorescence antibody test (IFAT). Five subjects (0.9%) reported P. falciparum malaria confirmed by thick blood smear examination (documented cases) and six (1.0%) reported treatment for malaria without a documented diagnosis (presumptive cases). Conversions in the IFAT were detected in six subjects, including all five documented cases and one presumptive case. Anti-CS antibodies were detected in seven subjects (1.3%), including three documented cases and four of 442 subjects with no history of fever or malaria treatment (0.9%). Incidence rates per 1,000 person-months of travel (95% confidence interval) of infection with P. falciparum, whether or not suppressed by chemoprophylaxis, were 16.9 (8-31) for all destinations and 91.6 (33-200) for West Africa. In epidemiologic studies of P. falciparum malaria in travelers, testing for antibodies to blood stages can increase the sensitivity and specificity of case detection; testing for antibodies to sporozoites may be useful for the assessment of exposure to P. falciparum in travelers using chemoprophylaxis, but the sensitivity is limited.

Malaria anticircumsporozoite antibodies in Dutch soldiers returning from sub-Saharan Africa

One hundred and twenty-five Dutch servicemen returning from central Africa after a short deployment were enrolled in a study aimed at assessing the effectiveness of malaria prevention measures. None of the persons developed an episode of clinically overt malaria during or after deployment, and no antibodies against blood stages of Plasmodium falciparum could be found. However, antibodies against the circumsporozoite protein (CS) of P. falciparum were demonstrable in 14 persons (11.2% of the study population) by an ELISA test using the recombinant CS-antigen R32tet32, while one person only was positive in an IFA test based on schizonts of P. fieldi as antigen. We concluded that the anti-CS-positive servicemen were probably bitten by mosquitoes carrying P. falciparum parasites while the IFA-positive person was possibly infected by P. vivax, P. ovale or P. malariae parasites. There was no significant association between the different antimalaria preventive measures and the development of anti-CS antibodies. Therefore mefloquine prophylaxis as the single most widely used preventive measure in this group of servicemen was possibly a major contributing factor in averting development of overt malaria.

The early sporogonic cycle of Plasmodium falciparum in laboratory-infected Anopheles gambiae: an estimation of parasite efficacy

This study investigated the successive losses in the parasite densities of Plasmodium falciparum stages during the early sporogony in laboratory-reared Anopheles gambiae infected by membrane feeding with blood from naturally infected gametocyte carriers (>50 gametocytes/mm3). The developmental stages of P. falciparum in the mosquito were studied from zygote to oocyst, by immunofluorescent method using monoclonal antibodies against the Pfs25 protein present on the surface of newly formed gametes. This method allows for assessment of the various sporogonic stages before, during and after passage of the midgut wall. Parasite densities were determined within the entire blood meal at 3 h (zygotes and macrogametes) and 24 h (ookinetes) post-infection. At 48 h after the mosquito blood meal, midguts were checked for the presence of early oocysts. For the mid-size oocysts count, classic microscopy examination was used at day 7 postinfection. The parasite efficacy was estimated by following successive losses in parasite densities between different early stages of the sporogonic cycle in A. gambiae. Thirty-seven experimental infections were realized with high gametocyte densities, ranging from 64 to 2392 gametocytes/mm3. All gametocyte carriers showed infection with round forms 100%; ookinetes were found in 91.9%. The prevalences of infections with oocysts were 48.6% at day 2 (young oocyst) and 37.8% at day 7 (mid-size oocyst). The mean densities per mosquito for each parasite stage were 12.6 round forms, 5.5 ookinetes, 1.8 young oocyst and 2 mid-size oocysts. Significant correlations were found between two consecutive parasite stages (round forms/ookinetes, ookinetes/young oocysts, young oocysts/mid-size oocysts) and between round forms and mid-size oocysts. The mean parasite density significantly decreased between round forms and ookinetes (yield Y1 = 41.6%) and between ookinetes and young oocysts (Y2 = 61.4%). By contrast, no significant decrease was observed between young oocysts and mid-size oocysts (Y3 = 91.2%). The overall yield of the early sporogonic cycle (from round form to oocyst at day 7) was equal to 25.7%, indicating that almost 3/4 of the total parasites were lost during the early step of the sporogonic cycle, from 3 h post-infection to day 7.

Identification of human liver carboxylesterase as one of the proteins involved in Plasmodium falciparum malaria sporozoite invasion in primary cultures of human hepatocytes

BACKGROUND/AIMS

In a previous study, we have demonstrated that primary human hepatocytes in culture are susceptible for Plasmodium falciparum sporozoite invasion and for development of parasites into exo-erythrocytic forms. In a separate study we demonstrated the involvement of two human liver plasma membrane proteins (55 kD and 20 kD) in the invasion of P. falciparum sporozoites in vitro. In this study, we have unravelled the nature of the 55 kD protein.

METHODS

For the identification of this protein, a 53-58 kD membrane protein fraction from human liver was isolated, radioactively labelled, incubated with sporozoites and cross-linked. After reduction of the cross-linker, the released proteins were mixed with unlabelled 53-58 kD protein fraction and separated on two-dimensional SDS-PAGE. Autoradiography showed a single spot corresponding to a protein of 55 kD and pI of 5.7-5.8.

RESULTS

Amino acid sequencing revealed the 55 kD protein as carboxylesterase. The biological activity of purified human liver carboxylesterase and of an antiserum against carboxylesterase on sporozoite invasion in vitro was evaluated. Human carboxylesterase as well as a rabbit antiserum against carboxylesterase inhibited the invasion of P. falciparum sporozoites into primary human hepatocytes in culture. A number of carboxylesterase cDNA clones were isolated from a human liver cDNA library. Sequence analysis revealed two different iso-types. Immunoaffinity purified recombinant human carboxylesterase was shown also to inhibit the invasion of sporozoites into primary human hepatocytes. Immunocytochemical analysis of the localisation of carboxylesterase in primary cultures of human hepatocytes using specific antibodies, showed its presence inside the hepatocytes and on the membrane.

CONCLUSIONS

Carboxylesterase plays a role in the invasion process of P. falciparum sporozoites into human hepatocytes in vitro. The implications of these findings are further discussed.

Effect of gametocyte sex ratio on infectivity of Plasmodium falciparum to Anopheles gambiae

Insectary-reared Anopheles gambiae were experimentally fed with the blood of 90 naturally infected human volunteers carrying gametocytes of Plasmodium falciparum. At least one mosquito was successfully infected in 74% of experiments. The probability that a gametocyte carrier was infective, the probability that a mosquito became infected, and the number of oocysts harboured were related to gametocyte density. The mean proportion of male gametocytes was 0.217 (i.e., 3.6 females for every male). Sex ratios differed significantly between gametocyte carriers. Variation in sex ratio was not related to the probability that a gametocyte carrier was infective. Among infective people whose sex ratio estimates were based on a reasonable number of gametocytes, sex ratio significantly predicted the proportion of infected mosquitoes and mean oocyst load, with infectivity rising as the proportion of the male gametocytes increased towards 50%. There was no indication that infectivity reached a peak at some intermediate sex ratio, as would be expected if random mating of gametes was the primary determinant of fertilization success. These results raise 2 interesting questions: why should higher sex ratios be more infective, and why is the observed population sex ratio lower than that which produces the greatest infectivity?

Effect of the sickle cell trait status of gametocyte carriers of Plasmodium falciparum on infectivity to anophelines

Insect-reared Anopheles gambiae were experimentally fed with the blood of naturally infected human volunteers carrying gametocytes of Plasmodium falciparum. Infection of at least one mosquito was successful in 86 experiments. For these gametocyte carriers, the hemoglobin types studied were AA (normal, n = 77), AS (heterozygous sickle cell, n = 8), and SS (homozygous sickle cell, n = 1). The mean of the percentages of infected mosquitoes by gametocyte carriers of AS hemoglobin was almost double that of carriers of AA: 30.4% versus 17.5%. The genetic protection in humans conferred by the beta(s) gene in its heterozygous form seems to be associated with an increasing effect on P. falciparum transmission from humans to mosquitoes. The epidemiologic and evolutionary aspects of this finding are discussed.

Inhibition of Plasmodium berghei liver schizont development and reduction of cytokine production capacity in rats by dietary fish oil supplementation

Experimental primary infection with Plasmodium berghei in rats is known to be influenced by several cytokines. Dietary supplementation of n-3 fatty acids has been shown to influence cytokine production capacity and to protect mice from cerebral malaria. We investigated the effect of dietary fish oil (FO) supplementation on cytokine and nitric oxide production and liver schizont development in male brown Norway rats. Control groups were fed either a corn oil-supplemented diet (CO) or standard lab chow (LC). After six weeks on either diet, rats given supplementary FO had a significantly lower production of interleukin-1 (IL-1) and IL-6 after stimulation with lipopolysaccharide, and also had significantly lower numbers of liver schizonts compared with CO- or LC-fed animals. We conclude that in rats, an FO-supplemented diet reduces the production capacity of IL-1 and IL-6 and inhibits schizont development after intravenous inoculation of P. berghei sporozoites. Fish oil did not influence nitric oxide production by peritoneal macrophages.

Detection of falciparum malarial forms in naturally infected anophelines in Cameroon using a fluorescent anti-25-kD monoclonal antibody

Anopheles gambiae s.s. and An. funestus were sampled in houses located in a Plasmodium falciparum-holoendemic site in southern Cameroon. The midguts of female mosquitoes in half-gravid or gravid stages of blood digestion were incubated with a fluorescent monoclonal antibody directed against the P. falciparum zygote/ookinete surface protein Pfs25 and examined using a fluorescent light microscope. Malarial forms were detected in 11.6% of the half-gravid mosquitoes and in 0.0% of the gravid ones (P = 0.012). No difference in infections or the occurrence of malarial forms between An. gambiae and An. funestus was observed. Overall, 127 malarial forms were counted and distributed among round forms, retorts, and ookinetes in 77.2%, 9.5%, and 13.4%, respectively. Round forms include macrogametes, activating microgametocytes, and zygotes. The mean number of malarial forms per infected midgut was 2.16 and the maximum number observed was 13. In four anophelines, round forms, retorts, and ookinetes were simultaneously observed. Sporozoite rates were 5.7% for An. gambiae and 3.8% for An. funestus. In the human population, the gametocyte index for P. falciparum was 38% with a mean density of 1.11 gametocytes per microliter of blood. Differences concerning malarial forms in mosquito midguts were observed between houses (range percentage = 4.7--21.3%; mean range of forms per positive anopheline = 1.1--3.1). In each house, relationships existed between infected vectors and the gametocyte reservoir of their inhabitants. The role in transmission of people with very low gametocytemia, approximately one per microliter, as a reservoir of falciparum malaria in highly endemic areas, is emphasized.

Early sporogonic development in local vectors of Plasmodium falciparum in rural Cameroon

In ongoing studies on experimental transmission of Plasmodium falciparum in the city of Yaounde gametocyte carriers are daily being identified among dispensary patients with malaria-like complaints. This species comprises 93% of all parasitemias and because of the selection criteria most patients have it as a recent infection. 17% of all P. falciparum-positives carry detectable gametocytes with little difference between youngsters and adults. Blood of adult carriers is taken and infection of Anopheles gambiae mosquitoes is attempted by membrane feeding; the establishment of infection is judged by the presence of oocysts.

Malaria transmission-blocking activity in experimental infections of Anopheles gambiae from naturally infected Plasmodium falciparum gametocyte carriers

Experimental infections of anopheline mosquitoes were carried out with Plasmodium falciparum gametocytes from 65 naturally infected patients in Cameroon. A comparison was made between infections with blood containing autologous plasma and blood in which the plasma was replaced with plasma from a donor without previous malaria exposure. A lower infection rate was observed in 50 of 65 autologous plasma samples. Transmission was significantly blocked in 3 infections. This indicates that, in a population living in an area endemic for malaria, blood plasma factor(s) can reduce the transmission capacity of gametocyte carriers to mosquitoes.

Experimental infections of Anopheles gambiae with Plasmodium falciparum of naturally infected gametocyte carriers in Cameroon: factors influencing the infectivity to mosquitoes

Factors which could influence the success of experimental infections of Anopheles gambiae with Plasmodium falciparum were investigated in Cameroon. 139 experimental infections with different gametocyte carriers were performed. 86 (62%) gave rise to mosquito infection after dissection of at least 20 mosquitoes. Among succeeding infections, the mean percentage of infected mosquitoes was 18.6% and mean oocyst load per positive midgut was 2.56. Only gametocyte density was identified as a factor which determined the success and the level of mosquito infection. No significant influence was found for sex and age of the gametocyte carrier, body-temperature, presence of asexual erythrocyte stages, rhesus factor, blood group and use of antimalarial drugs (chloroquine and amodiaquine).

Comparison of serological tests and bio-assay for malaria transmission blocking capacity in field sera

Competition ELISAs have been developed for natural transmission blocking antibodies. Approximately 50% of the sera blocking in the conventional mosquito feeding experiments, gave positive results in these competition ELISAs. Attempts to adapt competition ELISAs to a field application have been partly successful.

Malaria transmission-blocking activity in the plasma of Plasmodium falciparum gametocyte carriers in Cameroon

Experimental infections of Anopheles gambiae were carried out with Plasmodium falciparum gametocytes from 65 naturally infected patients in Cameroon. A comparison was made between infections with blood containing autologous plasma and blood in which the plasma was replaced by plasma from donors without previous malaria exposure. A lower mosquito-infection rate was observed in 50 out of 65 autologous plasma samples. The transmission was completely blocked in 8 infections, whilst belonging exposures to heterologous plasma led to infected mosquitoes. Evidence is shown that blood plasma factors of gametocyte carriers from a population living in a malaria-endemic area are able to reduce transmission capacity.

Kupffer cell elimination enhances development of liver schizonts of Plasmodium berghei in rats

We investigated the development of exoerythrocytic forms (EEF) of Plasmodium berghei in livers of normal and macrophage-depleted Brown Norway rats. Macrophages were depleted by use of liposome-encapsulated dichloromethylene diphosphonate. Upon inoculation of sporozoites, macrophage-depleted rats had significantly larger numbers of EEF than untreated rats. We also investigated the effect of macrophage impairment by silica treatment on the development of EEF and confirmed that silica induces a significant reduction of EEF development. Intravenous administration of silica induced high levels of interleukin-6 in plasma within a few hours. The seemingly contradictory results for EEF development may be explained by our previous observation that interleukin-6 strongly inhibits sporozoite penetration and EEF development in vivo. We conclude that in experimental infections with sporozoites, Kupffer cells inhibit rather than enhance EEF development.

Cytokines inhibit the development of liver schizonts of the malaria parasite Plasmodium berghei in vivo

The effect of induction of an acute-phase response and its mediators on the development of liver schizonts of the rodent malaria parasite Plasmodium berghei was investigated in Brown Norway rats. Subcutaneous injection of turpentine oil 24 h or 5 min before inoculation of sporozoites resulted in 80% and 35% reduction of schizont development, respectively. Turpentine oil induced high plasma levels of interleukin-6 (IL-6). Intraperitoneal administration of IL-1, IL-6 or both, significantly reduced liver schizont development. This reduction was also present if IL-6 had been administered 24 h after sporozoite inoculation. Inhibition induced by IL-1 could be prevented by simultaneous administration of polyclonal anti-IL-6. Administration of polyclonal anti-IL-6 without IL-1 resulted in a 40% increase of liver schizonts compared to control animals. We conclude that induction of an acute-phase response during experimental Plasmodium berghei infections in Brown Norway rats, strongly inhibits liver schizont development and that IL-6 is a key mediator in this process.

Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: results of a randomized trial

To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights, a randomized trial was carried out in 1987 and 1988 in Banfora, Burkina Faso (West Africa). Seven hundred forty-five randomly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment. In spite of an unquestionable effect of chloroquine in preventing placental infection (4.1% infected placentas in the treated group versus 19.0% in the controls), the mean difference in birth weights between the two groups (6 g) was not significant. The difference in the proportion of low birth weight (LBW) newborn babies in two groups (16.3% versus 16.4%) was also not significant. However, there was a strong relationship between placental infection and birth weight (the mean birth weight difference between infected and uninfected placentas was 113 g, and the proportion of LBW babies was 26.0% in infected placentas versus 14.8% in uninfected placentas). The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group. It may also indicate that malaria is only one of several risk factors responsible for LBW. The relatively small increase in birth weight, the expected poor acceptance of mass prophylaxis, and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women. It might be worth considering to limit prophylaxis to primigravidae.

Phase I clinical trial of a recombinant malaria vaccine consisting of the circumsporozoite repeat region of Plasmodium falciparum coupled to hepatitis B surface antigen

R16HBsAg is an experimental recombinant malaria vaccine consisting of 16 repeats of a four amino acid sequence (Asn-Ala-Asn-Pro or NANP) of the circumsporozoite (CS) protein of Plasmodium falciparum expressed as a fusion protein with the recombinant hepatitis B virus surface antigen (HBsAg) produced by yeast cells. Twenty male volunteers were experimentally vaccinated with the product, as well as with two doses of the commercial recombinant HBsAg vaccine Engerix B (Smith Kline Beecham Biologicals, Rixensart, Belgium) at intervals during a period of 18 months. No serious side effects were observed. Circulating antibodies to recombinant CS antigen (R32tet32) developed in all volunteers and persisted in most cases over ten months. Anti-HBs antibody production was poor initially, but a single dose of the commercial hepatitis B vaccine was sufficient to elevate these titers to high levels in all but two volunteers.

Identification of plasma membrane proteins involved in the hepatocyte invasion of Plasmodium falciparum sporozoites

To determine whether surface proteins of hepatocytes might be involved in the sporozoite invasion, plasma membrane proteins were prepared from human livers with CHAPS (3-[(3-cholamidopropyl)-dimethylammonio]-1-propanesulphonate) and radiolabelled with 125I (Iodogen; 1,3,4,6-tetrachloro-3 alpha,6 alpha-diphenylglycoluril). The labelled proteins were incubated with Plasmodium falciparum sporozoites and cross-linked with DSP (dithio-bis-succinimidylpropionate). Radiolabelled proteins released by reduction after repeated washing of the sporozoite-complex were separated by SDS-PAGE and autoradiographed. Two human hepatocyte membrane proteins of 20 and 55 kDa were found to be involved in the initial binding of P. falciparum sporozoites. The electrophoretically purified 20- and 55-kDa proteins both inhibited the binding of the corresponding radiolabelled proteins to P. falciparum sporozoites and reduced the invasion of sporozoites in an in vitro assay. We propose that these 20-kDa and 55-kDa proteins represent putative human hepatocyte receptors for P. falciparum sporozoite invasion.

Plasmodium falciparum and P. malariae epidemiology in a West African village

Transmission of Plasmodium falciparum and P. malariae was studied in a village in Burkina Faso. Consecutive captures of mosquitos were organized twice a month over a year and the species of the mosquitos identified. Also, the prevalences and densities of Plasmodium spp. were determined every 2 months in a sample of children who lived in the village. Anopheles gambiae, A. funestus, and A. nili were the local vectors, but only the first two played a predominant role in both P. falciparum and P. malariae transmission. The parasitological sporozoite index (SI) was 4.48% for A. gambiae and 4.22% for A. funestus. The immunological SIs were higher: 5.82% of A. gambiae were infected with P. falciparum and only 0.16% with P. malariae; the corresponding proportions for A. funestus were 6.45% and 0.41%. Transmission of Plasmodium spp. by A. gambiae was important during the rainy season (July-October) and by A. funestus at the beginning of the dry season (September-November). Each child in the study village could receive about 396 P. falciparum-infected bites per year but only 22 of P. malariae. The P. falciparum parasite indices were maximum during the middle of the rainy season (August), while those for P. malariae reached a peak during the dry season (February).

Use of a tuberculin purified protein derivative--Asn-Ala-Asn-Pro conjugate in bacillus Calmette-Guérin primed mice overcomes H-2 restriction of the antibody response and avoids the need for adjuvants

Because of its immunodominancy, and because it is conserved in different geographical isolates of Plasmodium falciparum, the repetitive sequence of the circumsporozoite protein, (Asn-Ala-Asn-Pro)n [(NANP)n], has been envisaged for the development of an anti-falciparum malaria subunit vaccine. However, the murine immune response to (NANP)n peptides, either carrier-free or coupled to carrier proteins, was shown to be inducible only by using strong (e.g., Freund's) adjuvants. Furthermore, response to the carrier-free peptide, administered in adjuvant, is genetically restricted to I-Ab mice. In the present paper, we report that high titers of antibodies against the NANP repetitive epitope were obtained in responder C57BL/6 (H-2b) mice when they were primed with live BCG (bacillus Calmette-Guérin Mycobacterium tuberculosis var. bovis) and immunized once with the synthetic peptide (NANP)40 coupled to tuberculin purified protein derivative (PPD) without the use of any adjuvant. This approach also led to the production of high titers of anti-NANP antibodies in ASW (H-2s), B10.RIII (H-2r), BALB/c (H-2d), C3H/He (H-2k), and DBA/1 (H-2q) nonresponder mice after two injections of the conjugate. In both cases, BCG priming was obligatory for the induction of antibodies reacting with the synthetic peptide. The levels of anti-NANP antibodies in nonresponder BALB/c mice were demonstrated to be comparable to the levels induced after PPD-(NANP)40 immunization in Freund's complete or incomplete adjuvant. The antibodies induced were also capable of recognizing P. falciparum sporozoites in immunofluorescence assays and, furthermore, these antibodies inhibited the penetration of live sporozoites into human hepatocytes in vitro. This system functioned independently of the subjects' resistance or susceptibility to BCG infection. Given the widespread natural exposure to mycobacterial antigens and the extensive use of BCG and PPD in the human population, this approach might be envisaged for vaccination with malaria peptides.

Delayed-type hypersensitivity and protection in mice following immunization with Plasmodium berghei sporozoites

The measurement of footpad swelling (FPS) following the inoculation of sporozoite antigen (Ag) into the hind footpad (HFP) of outbred mice was used as an in vivo test of delayed-type hypersensitivity (DTH) to attenuated sporozoite immunization. An attempt was made to correlate DTH with protective antisporozoite immunity. The optimum time for testing DTH following a single intravenous immunization was four days. The optimum sensitizing dose was 1 x 10(5) attenuated sporozoites. A single immunization gave a greater FPS than multiple immunizations. Mice immunized with irradiation-attenuated sporozoites could be protected from a lethal challenge with nonattenuated sporozoites. The FPS response to mosquito debris Ag was minimal in mice sensitized by bites from infected mosquitos. Nude mice failed to develop an FPS response and could not mount a protective immunity with attenuated sporozoites. However, splenectomized mice did have an FPS response following sensitization. Mice infected with blood-stage parasites had negligible FPS response to sporozoite Ag. The FPS response to sporozoite Ag proved to be a correlate of DTH in mice sensitized with sporozoites.

[Bladder schistosomiasis in school children; random study in the Ketu district, Ghana]

In 2 periods 1986/'87 and 1987/'88 1193 school children (5-19 years) from 13 randomly selected villages in the Ketu district, Ghana, were examined for Schistosoma haematobium (SH) in the urine. For the egg count the quantitative urine filtration technique was used and besides 3 indirect indicators of SH infection were evaluated. An arbitrary division was made into areas of high and low endemicity, showing SH prevalence rates of 54.3-23.0% and 2.3-16.0%, respectively. The condition of the "dams' in the different areas seemed to influence the infection rates. For all areas both prevalence and intensity of infection were both higher in boys than in girls. In the area of high endemicity it was possible to detect 99% of the heavily infected children (greater than or equal to 100 eggs/10 ml urine) by using the 3 indirect indicators combined.

Immunogold determination of Plasmodium falciparum circumsporozoite protein in Anopheles stephensi salivary gland cells

The distribution of circumsporozoite (CS) proteins of Plasmodium falciparum sporozoites was observed during the passage of mature sporozoites in the hemocoel of Anopheles stephensi and during their entrance and sojourn in the salivary gland cells (SGC). The CS protein was visualized using a monoclonal antibody (3SP2) and immunogold labeling on ultrathin cryosections. In the hemocoel the sporozoites cease synthesizing CS protein, and some of it is shedded resulting in a patchy labeling pattern on the outer pellicular membrane. No internal labeling was observed. The sporozoites enter the SGC by puncturing the basal or lateral membrane. Inside the SGC, CS protein synthesis is turned on again; the Golgi system, nuclear envelope and all 3 pellicular membranes contain CS immunoreactivity. In the last phase of maturation, micronemes display abundant CS immunoreactivity. Rhoptries also show some immunogold labeling, but not as much as the micronemes.

Comparative analysis of ELISAs employing repetitive peptides to detect antibodies to Plasmodium falciparum sporozoites

In the last few years, a number of different recombinant and synthetic peptides consisting of the repetitive sequence of the Plasmodium falciparum circumsporozoite protein (NANP)n have been produced and used to develop immunoassays for the detection of antibodies against P. falciparum sporozoites in human sera. A comparative study of three enzyme-linked immunosorbent assays (ELISAs) that employed different (NANP)n peptides (the synthetic peptides (NANP)3 and (NANP)40 as well as the recombinant peptides R32tet32 and R32LR) was carried out using serum samples from individuals who were living in different malaria-endemic areas. The results obtained for these peptide-based ELISAs were compared with those obtained for an immunofluorescence assay (IFA) that used glutaraldehyde-fixed sporozoites. All the methods tested exhibited 100% specificity on sera from persons not exposed to malaria, good reproducibility (coefficients of variation ranged from 3% to 15% for peptide-based ELISAs), and good sensitivity. Reproducibility and sensitivity were lower for the IFA than for the peptide-based ELISAs, perhaps because of the subjective element in the interpretation of the results which is inherent in the IFA method. ELISAs based on peptides that contain a higher number of (NANP) repeats, i.e., (NANP)40 and R32tet32 or R32LR, gave results which correlated better with each other than with those obtained with the ELISA that employed a shorter (NANP)3 peptide. (NANP)n-based ELISAs are relatively simple and inexpensive methods for the detection of anti-P. falciparum sporozoite antibodies and can readily be used in epidemiological research in the field. These assays could contribute to a better understanding of the natural history of the host-parasite relationship in malaria research.

Malaria sporozoite penetration. A new approach by double staining

To determine, whether a sporozoite is outside the hepatocyte membrane or internalized, a double staining test was carried out using, successively, antibody labeled with peroxidase and fluorescein. This test permits the quantification of sporozoite entry and outline sporozoite-hepatocyte interactions.

Study of the distribution of circumsporozoite antigen in Anopheles gambiae infected with Plasmodium falciparum, using the enzyme-linked immunosorbent assay

Anopheles gambiae, experimentally infected with Plasmodium falciparum, were dissected 14 days later for microscopical detection of sporozoites and oocysts. The head, salivary glands, thorax, midgut, legs, ovaries, Malpighian tubules, the remainder of the abdominal tissues and the dissection fluid of each mosquito were examined by a two-site enzyme-linked immunosorbent assay (ELISA) for the detection and quantification of circumsporozoite antigen (CS ag). 19 mosquitoes had CS ag in at least one of the specimens examined. Very large individual variability was observed in the presence and/or quantity of CS ag in the various parts. 7 mosquitoes were ELISA-positive in all 9 specimens; the salivary glands and thorax contained most CS ag, whereas the Malpighian tubules and ovaries contained the least; all the thoraces contained CS ag, even that of one mosquito of which the salivary glands lacked both sporozoites and CS ag; of 17 ELISA-positive salivary glands, 15 were found to contain sporozoites. The existence of free antigen associated with sporozoites, and the limitations of the ELISA technique in demonstrating the infectivity of a malaria vector, are discussed.

Immunogold localization of circumsporozoite protein of the malaria parasite Plasmodium falciparum during sporogony in Anopheles stephensi midguts

The occurrence of the circumsporozoite (CS) proteins of Plasmodium falciparum sporozoites was monitored during sporogonic development in Anopheles stephensi mosquitoes. Using a monoclonal anti-CS protein antibody (3Sp2) and immunogold labeling on ultrathin cryosections it was found that CS protein is synthesized in immature oocysts from day 6 onwards when there are not yet signs of sporozoite formation. The CS protein is rapidly incorporated in the oocyst plasmalemma, which subsequently invaginates into the parasite. In the oocyst only the external sporozoite membrane contains CS protein. The inner pellicle membranes, rhoptries and micronemes do not react with monoclonal antibody (MoAb) 3Sp2.

The biotin-streptavidin system in a two-site ELISA for the detection of plasmodial sporozoite antigen in mosquitoes

A two-site ELISA has been designed for the detection of sporozoite antigen in mosquitoes. Biotin-labelled monoclonal antibodies against sporozoites and a streptavidin-biotin-peroxidase complex were used to visualize the antigen. Evaluation of the sensitivity and specificity of the procedure was carried out and background levels of reactivity on the basis of negative mosquitoes were calculated. The test has been deliberately kept as simple as possible for use in the tropics and was designed using Anopheles stephensi infected with in vitro cultivated Plasmodium falciparum gametocytes. A minimum of about 100-350 sporozoites could be detected in mature salivary gland infections; in addition sporozoite antigen was detected in mosquitoes several days before the entry of sporozoites into the salivary glands. No reaction was demonstrable either with bloodstage or ookinete antigens of P. falciparum, or with mosquitoes carrying sporozoites of other plasmodial species. The number of sporozoites in positive mosquitoes and the generating capacity of a single oocyst could be assessed by the use of a calibration curve based on dilution data of a known sporozoite suspension. It was found that a single oocyst can produce about 10,000 sporozoite equivalents.

Cellular response against exoerythrocytic forms of Plasmodium berghei in rats

Rats were infected with Plasmodium berghei sporozoites, and 47, 51, and 57 hr later exoerythrocytic parasites were examined by electron microscopy. At 47 hr, approximately 30% of nearly mature exoerythrocytic parasites were degenerating and were surrounded by a cellular infiltrate of Kupffer cells, monocytes, monocyte-derived macrophages, and neutrophils. Neutrophils appeared to be actively ingesting electron-dense fuzzy parasite material which was normally present in the parasitophorous vacuole. By 51 hr other mononuclear cells penetrated with filopodia between the host hepatocyte and exoerythrocytic parasite, and directly into the exoerythrocytic parasite. Exoerythrocytic parasites that formed merozoites at 51 hr lacked any notable cellular infiltration.

The Dutch school of malaria research

An epidemic of tertian malaria in some coastal areas of The Netherlands resulted in the setting up of official measures in 1920. A scientific and a propaganda commission were charged with control. Efforts were made to reduce mosquito populations by adult and larval spraying. After the discovery that infected mosquitoes were to be found only inside houses, control operations were focussed against adult mosquitoes. Some later discoveries resulted in a more effective control. a) Spraying ditches with Paris green did not prevent adult mosquitoes from entering the control area. b) Anopheles maculipennis turned out to be a complex of species, with A. atroparvus as the vector. The latter preferred brackish water and did not go into full hibernation. The closing of the Zuyder Sea and the expected desalinization gave hope for less suitable conditions for the vector. c) Plasmodium vivax normally had an incubation period of 8 months. d) Pyrethrum was an effective but short-lasting insecticide. e) Healthy parasite carriers could infect mosquitoes. This knowledge was applied through an extensive system of investigation, including spleen examination of schoolchildren. Suspected houses were sprayed bimonthly from August to November, during which period infected mosquitoes were likely to be present. This system worked extremely well, and during the next epidemic from 1943 to 1947 the thus treated towns remained virtually free of malaria! DDT became available and was either sprayed in suspected houses as before, or through wide-spread coverage of all houses. The epidemic subsided whatever method employed and not only due to the use of DDT. The number of cases even went down to the point of no return and the last case of Dutch malaria was recorded in 1959. The wealth of experience on house-spray control, parasite and mosquito biology and experimental malaria of the Dutch malariologists has had its impact on the international bodies engaged in the battle against malaria.