Plasmodium vivax infection: a major determinant of severe anaemia in infancy

Abstract

BackgroundMost malarious countries outside of Africa are co-endemic for Plasmodium falciparum and Plasmodium vivax. The comparative burden of anaemia in the community caused by these two species is incompletely characterized.MethodsA three-stage, cross-sectional, community survey was used to determine the proportion of moderate or severe anaemia (haemoglobin <7 g/dL) attributable to patent P. vivax, P. falciparum and mixed parasitaemia in Papua, Indonesia. Adjusted population-attributable fractions were calculated from multivariable logistic regression models. Eight hundred and twenty-five households were surveyed with a total of 5255 occupants, 3890 (74 %) of whom were present and provided a blood sample. Plasmodium falciparum parasitaemia was present in 8.1 % (n = 315) of participants, P. vivax in 6.4 % (n = 250) and mixed infections in 1.9 % (n = 72). Overall, P. falciparum was associated with a mean reduction in haemoglobin of 1.16 g/dL compared to those without patent parasitaemia [95 % confidence interval (95 % CI) 0.91, 1.41 g/dL]. The corresponding values for P. vivax and mixed infections were 0.66 g/dL (95 % CI 0.35, 0.96) and 1.25 g/dL (0.71, 1.80), respectively. Overall, 16.7 % (95 % CI 8.52, 24.2 %) of haemoglobin concentrations <7 g/dL in the community were estimated to be attributable to patent parasitaemia. The fractions for infants and 1–5 years old were 34.4 % (95 % CI −3.30, 58.3 %) and 23.2 % (95 % CI 3.34, 39.0 %), respectively. Plasmodium vivax was associated with a greater than threefold higher attributable fraction of anaemia in infants compared with P. falciparum [27.6 % (95 % CI −3.20, 49.2 %) versus 7.94 % (−5.87, 20.0 %)].ConclusionDespite comparatively low-level endemicity, malaria is associated with a significant proportion of all cases of community anaemia in southern Papua. Contrary to its benign reputation, P. vivax is an important and preventable risk factor for anaemia during infancy—a probable consequence of relapsing disease prior to the development of immunity.

Clinical Outcomes of Submicroscopic Infections and Correlates of Protection of VAR2CSA Antibodies in a Longitudinal Study of Pregnant Women in Colombia

“…Our findings reveal a novel association of P. falciparum and P. vivax mixed SMIs and adverse birth outcomes that is particularly relevant to regions outside Africa. While this result has not been reported previously in longitudinal studies of MiP, it is in keeping with findings from nonpregnant populations that mixed P. falciparum and P. vivax infections can have deleterious outcomes, including anemia in infants in Papua, Indonesia (33), and severe malaria in children in PNG (34). The mechanism underlying the pathogenesis of mixed infections is not known.…”

Anaemia and malaria

“…It is the cumulative impact of repeated illness from recurrent malaria that is the main cause. In areas where P. vivax is endemic frequently recurring illness caused by repeated relapse is the main contributor to malarial anaemia in childhood [ 8 , 9 ]. In areas where P. falciparum is endemic frequent infections or repeated treatment failure cause anaemia.…”

Hematological Profile of Children With Malaria in Sorong, West Papua, Indonesia

“…Anemia is also a common manifestation, particularly in infants with P. vivax and in children with P. knowlesi infection [44][45][46]. Anemia is one of the most common complications in malaria infection, especially in younger children and pregnant women in high transmission areas [41,47].…”