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Malaria severity not determined solely by parasite levels in blood


NIH-funded study in tanzanian infants tracked risk of severe malaria over time


Although malaria kills some 600,000 African children each year, most cases of the mosquito-borne parasitic disease in children are mild. Repeated infection does generate some immunity, and episodes of severe malaria are unusual once a child reaches age 5. However, the relative contributions of such factors as the level of malaria-causing parasites in a person's blood—parasite density—to disease severity and to development of protective immunity are not well understood.

To clarify these issues, researchers from the United States and Tanzania regularly examined 882 Tanzanian children beginning at birth and continuing for an average of two years. No simple relationship between parasite density and malaria severity emerged.

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For example, 253 children had a total of 444 infections characterized by high parasite density and mild symptoms. Of the 102 children who did develop severe malaria at least once while enrolled in the study, almost two-thirds (67) had high parasite density but only mild disease either before or after the episode of severe malaria. Moreover, data from this study suggest that one or two mild episodes of malaria are not sufficient to eliminate the risk of severe malaria; a finding contrary to predictions made by some mathematical models.

The researchers note that this prospective study is the first to provide direct evidence that severe malaria risk is stable over several infections. The findings suggest a new approach to malaria vaccine development based on naturally acquired immunity. Such a vaccine would prevent severe disease and death in children, without necessarily reducing exposure to the malaria parasite.

The research team was led by Patrick E. Duffy, M.D., of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.


BP Gonçalves et al. Parasite burden and severity of malaria in Tanzanian children. NEJM DOI: 10.1056/NEJM 10.1056/NEJMoa1303944 (2014).


NIAID Director Anthony S. Fauci, M.D., is available to provide comment on this research. Dr. Duffy, Laboratory of Malaria Immunology and Vaccinology, NIAID, and corresponding author, is also available.



To schedule interviews, please contact Anne A. Oplinger, (301) 402-1663,

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

Anne A. Oplinger | Eurek Alert!

Further reports about: Allergy Health Malaria NEJM NIAID NIH diseases immunity infections levels parasite

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