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Open Access Research article

Age-adjusted Plasmodium falciparum antibody levels in school-aged children are a stable marker of microgeographical variations in exposure to Plasmodium infection

Shona Wilson1*, Mark Booth1, Frances M Jones1, Joseph K Mwatha2, Gachuhi Kimani2, H Curtis Kariuki3, Birgitte J Vennervald4, John H Ouma5, Eric Muchiri3 and David W Dunne1

Author Affiliations

1 Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QP, UK

2 Kenya Medical Research Institute, Nairobi, Kenya

3 Division of Vector Borne Diseases, Kenyan Ministry of Health, PO Box 54840, Nairobi, Kenya

4 DBL – Institute for Health Research and Development, Jægersborg Alle 1D, 2920 Charlottenlund, Denmark

5 Maseno University, Kisumu, Kenya

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BMC Infectious Diseases 2007, 7:67  doi:10.1186/1471-2334-7-67

Published: 29 June 2007

Abstract

Background

Amongst school-aged children living in malaria endemic areas, chronic morbidity and exacerbation of morbidity associated with other infections are often not coincident with the presence or levels of Plasmodium parasitaemia, but may result from long-term exposure to the parasite. Studies of hepatosplenomegaly associated with Schistosoma mansoni infection and exposure to Plasmodium infection indicate that differences that occur over 1–2 km in levels of Plasmodium transmission are related to the degree of exacerbation of hepatosplenomegaly and that Plasmodium falciparum schizont antigen (Pfs)-IgG3 levels may be a marker for the differing levels of exposure.

Methods

To investigate the validity of Pfs-IgG3 measurements as a tool to assess these comparative exposure levels on a microgeographical scale, cross-sectional community surveys were conducted over a 10 × 6 km study site in Makueni District, Kenya, during low and high malaria transmission seasons. During both high and low malaria transmission seasons, thick blood smears were examined microscopically and circulating Pfs-IgG3 levels measured from dried blood spot elute. GIS techniques were used to map prevalence of parasitaemia and Pfs-IgG3 levels.

Results

Microgeographical variations in prevalence of parasitaemia were observed during the high but not the low transmission season. Pfs-IgG3 levels were stable between high and low transmission seasons, but increased with age throughout childhood before reaching a plateau in adults. Adjusting Pfs-IgG3 levels of school-aged children for age prior to mapping resulted in spatial patterns that reflected the microgeographical variations observed for high season prevalence of parasitaemia, however, Pfs-IgG3 levels of adults did not. The distances over which age-adjusted Pfs-IgG3 of school-aged children fluctuated were comparable with those distances over which chronic morbidity has previous been shown to vary.

Conclusion

Age-adjusted Pfs-IgG3 levels of school-aged children are stable and when mapped can provide a tool sensitive enough to detect microgeographical variations in malaria exposure, that would be useful for studying the aetiology of morbidities associated with long-term exposure and co-infections.