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American Journal of Epidemiology Vol. 133, No. 2: 177-184
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Assessment of the Protective Value of Antibodies to the Plasmodium falciparum Ring-infected Erythrocyte Surface Antigen (RESA): An Epidemiologic Study in Madagascar

Pascal Astagneau1, Jean Paul Lepers2, Claire Chougnet1, Claude Gaudebout1, Marie Danielle Andriarnangatiana-Rason2, Bernard Larouzé1 and Philippe Deloron1,

1INSERM Unité 13 and Institut de Médecine et dEp dérniologie At ncaines (IMEA), Hôpital claude Bernard Paris, France
2Unité de recherche sur le paludisme, tnstitut Pasteur de Madagascar, Antanananvo Madagascar

Reprint requests to: Dr. P. Deloron, INSERM Unité 13, Hôpital Claude Bernard, 10 av. de Ia Porte d'Aubervilliers, 75019 Paris, France

The ring-infected erythrocyte surface antigen (RESA), a Plasmodium faiciparum merozoite antigen, is a major vaccine candidate against falciparum malaria. To investi gate the protective role of antibodies to RESA and its 4-mar, 8-mar, and 11-mer repeated amino acid sequences under conditions of natural exposure, a case-control and a cohort study were carried out in 1988 in a rural community in Madagascar where malaria reappeared recently. Fifty cases with >1,000 P. falciparum per microliter of blood, and 45 controls with a negative blood smear were enrolled and sara were collected. Forty-one controls were followed for 20 weeks to identify malaria] attacks. Protection against dinical malaria was assessed by the absence of malarial attacks requiring therapy. At enrollment, positivity rates and reactivity levels to RESA or repeats were similar in cases and controls. The 11 -mer repeat antibody level was higher in the 26 controls who experienced at least one malarial attack during follow-up than in the 15 other controls (p < 0.01). Thus, antibodies to the 11 -mer repeat were predictors of the subsequent appearance of the disease. After adjustment for antibodies to the 11 -mar repeat, antibodies to whole RESA had a negative predictive value on the occurrence of malarial attacks (p = 0.04). Different epitopes within the RESA molecule may elicit production of antibodies with different activities. Am J Epidemiol 1991 ;1 33:177-84.

antibodies; immunity; retroviridae; longitudinal studies; malaria; Plasmodium falciparum


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