Recent malaria does not substantially impact COVID-19 antibody response or rates of symptomatic illness in communities with high malaria and COVID-19 transmission in Mali, West Africa

Abstract

Malaria has been hypothesized as a factor that may have reduced the severity of the COVID-19 pandemic in sub-Saharan Africa. To evaluate the effect of recent malaria on COVID-19 we assessed a subgroup of individuals participating in a longitudinal cohort COVID-19 serosurvey that were also undergoing intensive malaria monitoring as part of antimalarial vaccine trials during the 2020 transmission season in Mali. These communities experienced a high incidence of primarily asymptomatic or mild COVID-19 during 2020 and 2021. In 1314 individuals, 711 were parasitemic during the 2020 malaria transmission season; 442 were symptomatic with clinical malaria and 269 had asymptomatic infection. Presence of parasitemia was not associated with new COVID-19 seroconversion (29.7% (211/711) vs. 30.0% (181/603), p=0.9038) or with rates of reported symptomatic seroconversion during the malaria transmission season. In the subsequent dry season, prior parasitemia was not associated with new COVID-19 seroconversion (30.2% (133/441) vs. 31.2% (108/346), p=0.7499), with symptomatic seroconversion, or with reversion from seropositive to seronegative (prior parasitemia: 36.2% (64/177) vs. no parasitemia: 30.1% (37/119), p=0.3842). After excluding participants with asymptomatic infection, clinical malaria was also not associated with COVID-19 serostatus or symptomatic seroconversion when compared to participants with no parasitemia during the monitoring period. In communities with intense seasonal malaria and a high incidence of asymptomatic or mild COVID-19, we did not demonstrate a relationship between recent malaria and subsequent response to COVID-19. Lifetime exposure, rather than recent infection, may be responsible for any effect of malaria on COVID-19 severity.

COVID-19 and malaria co-infection: a systematic review of clinical outcomes in endemic areas

“…Ecological research has demonstrated slightly earlier in the pandemic that COVID-19 infection rates and case fatality ratios tended to be lower in countries where malaria is endemic, and according to this research, COVID-19 treatment and prophylaxis may benefit from anti-malarial medications (such as hydroxychloroquine) ( Woodford et al, 2022 ). In March 2020, chloroqiune was added to the protocol of COVID-19 treatment by the National Health Committee (NHC) in China ( Woodford et al, 2022 ; Osei et al, 2022 ).…”

Protozoan co-infections and parasite influence on the efficacy of vaccines against bacterial and viral pathogens

“…There are several reports showing association between Neglected Infectious Diseases (NTDs) and SARS-CoV2, in terms of how they affect the severity of COVID-19 clinical outcomes, vice versa and the development of trained immunity as occurs for helminth infections and malaria (Ssebambulidde et al, 2020;Anyanwu, 2021;Gluchowska et al, 2021;Wilairatana et al, 2021;Achan et al, 2022;Hussein et al, 2022). Our review of literature indicate that the immunomodulatory effects of COVID-19 and parasitic co-infections brought insights not by direct investigations but based upon lessons learned from other co-infections systems (Fonte et al, 2020;Gluchowska et al, 2021;Akelew et al, 2022;Woodford et al, 2022). Briefly, helminth co-infection was suggested to cause immunomodulation in COVID-19 patients to result in reduction of disease severity (Bradbury et al, 2020).…”

“…One possible explanation for this phenomenon is that malaria patients generate anti-GPI antibodies which eventually identify SARS-CoV-2 glycoproteins developing a protective response against COVID-19 improving the disease prognostic (Hussein et al, 2020). Conflicting results from a Malian longitudinal cohort study showed no association between malaria and COVID-19 seroconversion or effect on the symptoms reported for COVID-19 (Woodford et al, 2022). The identification of immunomodulatory effects provoked by malaria and helminth infections could lead us to better understanding of the factors involved in improvement of vaccine efficacy.…”

The Missing Millions: Uncovering the Burden of Covid‐19 Cases and Deaths in the African Region

“…This explanation suggests that by decreasing the body's inflammatory response to SARS-CoV2, exposure to malaria may reduce severe disease caused by COVID-19 (Guha et al 2021). Newer work in a longitudinal cohort finds no effect of malaria infection on COVID-19 incidence or symptom severity (Woodford et al 2022). Other mechanisms of protection have been proposed and are under examination (Orish et al 2021).…”

“…Newer work in a longitudinal cohort finds no effect of malaria infection on COVID‐19 incidence or symptom severity (Woodford et al. 2022). Other mechanisms of protection have been proposed and are under examination (Orish et al.…”