Department of Epidemiology and Biostatistics, University of California, Berkeley School of Public Health, Berkeley, California, United States of America.
Global Health and Tropical Medicine (GHTM), institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.
PLoS Negl Trop Dis. 2023 Jan 12;17(1):e0011020. doi: 10.1371/journal.pntd.0011020. eCollection 2023 Jan.
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.
大量研究探讨了为什么在撒哈拉以南非洲地区，有些人经常发生恶性疟原虫疟疾，而有些人大部分时间都没有患病。相比之下，在以间日疟原虫为主的地区，疟疾风险异质性的研究却很少。在亚马逊等间日疟流行地区，反复感染的人只是运气不好吗？在这里，我们简要回顾了一些证据，表明人类遗传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的风险。五分之一的宿主占社区间日疟负担的 80%或更多，并不成比例地导致疾病传播，这是实现消除疟疾目标更强化干预的优先目标。重要的是，即使在疟疾传播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，他们可能构成一个很大但沉默的寄生虫库。
