Malaria preventive therapy in pregnancy and its potential impact on immunity to malaria in an area of declining transmission

Andrew Teo, Wina Hasang, Louise M Randall, Holger W Unger, Peter M Siba, Ivo Mueller, Graham V Brown, Stephen J Rogerson, Andrew Teo, Wina Hasang, Louise M Randall, Holger W Unger, Peter M Siba, Ivo Mueller, Graham V Brown, Stephen J Rogerson

Abstract

Background: Regular anti-malarial therapy in pregnancy, a pillar of malaria control, may affect malaria immunity, with therapeutic implications in regions of reducing transmission.

Methods: Plasma antibodies to leading vaccine candidate merozoite antigens and opsonizing antibodies to endothelial-binding and placental-binding infected erythrocytes were quantified in pregnant Melanesian women receiving sulfadoxine-pyrimethamine (SP) with chloroquine taken once, or three courses of SP with azithromycin.

Results: Malaria prevalence was low. Between enrolment and delivery, antibodies to recombinant antigens declined in both groups (p<0.0001). In contrast, median levels of opsonizing antibodies did not change, although levels for some individuals changed significantly. In multivariate analysis, the malaria prevention regimen did not influence antibody levels.

Conclusion: Different preventive anti-malarial chemotherapy regimens used during pregnancy had limited impact on malarial-immunity in a low-transmission region of Papua New Guinea.

Trial registrations: NCT01136850.

Figures

Fig. 1
Fig. 1
Levels of immunoglobulin G (IgG) antibody in PNG pregnant women against Plasmodium falciparum antigens over the course of one pregnancy. White bars- pregnant women recruited at first antenatal visit, grey bars pregnant women at delivery. Pregnant women on sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) [N = 304], and on SP and azithromycin (AZ) [N = 277]. a Levels of IgG antibodies to schizont extract, PfRh2, MSP2, MSP3 and measles antigen presented as arbitrary units. b Levels of opsonising IgG antibodies to variant surface antigens of placental-binding and endothelial-binding IEs, presented as percentage of THP-1 cells that have ingested IESs (percentage phagocytosis). Wilcoxon signed-rank test, ****p < 0.0001. Columns represents IQR and error bars shows 95 % CI

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Source: PubMed

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