International Journal of Epidemiology, Vol 28, 793-798, Copyright © 1999 by International Epidemiological Association
JY Le Hesran, I Personne, P Personne, N Fievet, B Dubois, M Beyeme, C Boudin, M Cot and P Deloron
BACKGROUND: Individuals may be homozygous (SS) or heterozygous (AS) sickle
cell gene carriers or have normal adult haemoglobin (AA). Haemoglobin S
could have a protective role against malaria but evidence is sparse and the
operating mechanisms are poorly known. METHODS: We followed two cohorts of
children. The first was enrolled at birth (156 newborn babies) and the
second at 24-36 months old (84 children). Both cohorts were followed for 30
months; monthly for parasitological data and half yearly for immunological
data. RESULTS: In the first cohort, 22%, and in the second 13% of children
were AS. Whatever their age parasite prevalence rates were similar in AA
and AS individuals. Mean parasite densities increased less rapidly with age
in AS than in AA children, and were significantly lower in AS than in AA
children >48 months old. The AA children tended to be more often
admitted to hospital than AS children (22% versus 11%, NS). Both
anti-Plasmodium falciparum and anti-Pfl55/RESA antibody rates increased
more rapidly in AA than in AS children. Conversely, the prevalence rate of
cellular responders to the Pfl55/RESA antigen was similar in AA and AS
children during the first 2 years of life, then it was higher in AS than in
AA children. CONCLUSIONS: Sickle cell trait related antimalarial protection
varies with age. The role of the modifications of the specific immune
response to P. falciparum in explaining the protection of AS children
against malaria is discussed.
ARTICLES
Longitudinal study of Plasmodium falciparum infection and immune responses in infants with or without the sickle cell trait
Institut National de la Sante et de la Recherche Medicale, Unite 13 Institut de Medecine et d'Epidemiologie Africaine, Paris, France.
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