Individual variation in Plasmodium vivax malaria risk: Are repeatedly infected people just unlucky?

Individual variation in Plasmodium vivax malaria risk: Are repeatedly infected people just unlucky?
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DOI:
10.1371/journal.pntd.0011020
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发表时间:
2023-01
影响因子:
3.8
通讯作者:
--
中科院分区:
医学2区
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--
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广泛的研究已经调查了为什么在撒哈拉以南非洲地区一些人经常患恶性疟原虫疟疾,而另一些人却在大多数时间里没有患病。相比之下,在间日疟原虫为优势种的地区,疟疾风险异质性的研究仍然很少。在亚马逊等间日疟疾地区反复感染的人只是运气不好吗?在这里,我们简要回顾了人类基因多态性和反复接触寄生虫后获得的免疫力可以以可预测的方式调节间日疟原虫感染和疾病风险的证据。五分之一的宿主占全社区间日疟疾负担的 80% 或以上,并且对继续传播做出了不成比例的贡献,这是为实现消除疟疾而采取更强化干预措施的优先目标。重要的是,即使在疟疾传播率非常低或残留的地区,高风险个体最终也会产生临床免疫力,并可能构成一个巨大但沉默的寄生虫库。
Extensive research has examined why some people have frequent Plasmodium falciparum malaria episodes in sub-Saharan Africa while others remain free of disease most of the time. In contrast, malaria risk heterogeneity remains little studied in regions where P. vivax is the dominant species. Are repeatedly infected people in vivax malaria settings such as the Amazon just unlucky? Here, we briefly review evidence that human genetic polymorphism and acquired immunity after repeated exposure to parasites can modulate the risk of P. vivax infection and disease in predictable ways. One-fifth of the hosts account for 80% or more of the community-wide vivax malaria burden and contribute disproportionally to onward transmission, representing a priority target of more intensive interventions to achieve malaria elimination. Importantly, high-risk individuals eventually develop clinical immunity, even in areas with very low or residual malaria transmission, and may constitute a large but silent parasite reservoir.
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