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By analysing data on the age distribution of cerebral malaria among sites of different transmission intensities, we conclude that the most plausible explanation for the epidemiological patterns seen is that (i) cerebral malaria is caused by a distinct set of Plasmodium falciparum antigenic types; (ii) these antigenic types or 'CM strains' are very common and induce strong strain-specific immunity; and (iii) the postnatal period of protection against cerebral malaria is much longer than the period of protection against other forms of severe disease. The alternative hypothesis that cerebral malaria may be caused by any 'strain' of P. falciparum is compatible with the data only if a single exposure is sufficient to protect against further episodes. This is not consistent with observations on the history of exposure of patients with cerebral malaria. Finally, it is clear that although the delayed peak in incidence of cerebral malaria (with age) can be generated by assuming that subsequent exposures carry a higher risk of disease, such an explanation is not compatible with the observation that severe disease rates are low among infants and young children in areas of high transmissibility.

Original publication

DOI

10.1098/rspb.1999.0600

Type

Journal article

Journal

Proceedings. Biological sciences

Publication Date

01/1999

Volume

266

Pages

33 - 38

Addresses

Wellcome Trust Centre for Epidemiology of Infectious Disease, Department of Zoology, University of Oxford, UK.

Keywords

Animals, Humans, Plasmodium falciparum, Malaria, Cerebral, Risk Factors, Age Factors, Species Specificity, Models, Biological, Child, Child, Preschool, Infant, Infant, Newborn, Africa South of the Sahara