Relationship between the entomologic inoculation rate and the force of infection for Plasmodium falciparum malaria.

We propose a stochastic model for the relationship between the entomologic inoculation rate (EIR) for Plasmodium falciparum malaria and the force of infection in endemic areas. The model incorporates effects of increased exposure to mosquito bites as a result of the growth in body surface area with the age of the host, naturally acquired pre-erythrocytic immunity, and the reduction in the proportion of entomologically assessed inoculations leading to infection, as the EIR increases. It is fitted to multiple datasets from field studies of the relationship between malaria infection and the EIR. We propose that this model can account for non-monotonic relationships between the age of the host and the parasite prevalence and incidence of disease. It provides a parsimonious explanation for the faster acquisition of natural immunity in adults than in children exposed to high EIRs. This forms one component of a new stochastic model for the entire transmission cycle of P. falciparum that we have derived to estimate the potential epidemiologic impact of malaria vaccines and other malaria control interventions

A model for natural immunity to asexual blood stages of Plasmodium falciparum malaria in endemic areas.

Most mathematical models for acquired immunity to Plasmodium falciparum consider effects of immunity on duration of infection and infectiousness, but do not consider the most evident effect of immunity, which is to reduce parasite densities. Few attempts have been made to fit such models to field data. We propose a stochastic simulation model to predict the distributions of P. falciparum parasite densities in endemic areas, in which acquired immunity acts by reducing parasite densities. We have fitted this model to age-specific prevalence and geometric mean densities from settings in Ghana, Nigeria, and Tanzania. The model appears to reproduce reasonably well the parasitologic patterns seen in malariologic surveys in endemic areas and is appropriate for predicting the impact of interventions such as vaccination in the context of continual exposure to P. falciparum

Malaria transmission-blocking vaccines—how can their development be supported?

Malaria is a disease of poor countries. The development of malaria vaccines requires considerable investment, for which there is little commercial interest, particularly for transmission-blocking vaccines that have the public health objective of protecting communities from the spread of malaria rather than protecting individuals from the disease. Here, Carter et al. summarize the report of a committee of experts on the relevance and prospects for these vaccines