Treatment of Chronic Asymptomatic Plasmodium falciparum Infection Does Not Increase the Risk of Clinical Malaria Upon Reinfection.

: Chronic asymptomatic Plasmodium falciparum infections are common in endemic areas and are thought to contribute to the maintenance of malaria immunity. Whether treatment of these infections increases the subsequent risk of clinical episodes of malaria is unclear. : In a 3-year study in Mali, asymptomatic individuals with or without P. falciparum infection at the end of the 6-month dry season were identified by polymerase chain reaction (PCR), and clinical malaria risk was compared during the ensuing 6-month malaria transmission season. At the end of the second dry season, 3 groups of asymptomatic children were identified: (1) children infected with P. falciparum as detected by rapid diagnostic testing (RDT) who were treated with antimalarials (n = 104), (2) RDT-negative children whose untreated P. falciparum infections were detected retrospectively by PCR (n = 55), and (3) uninfected children (RDT/PCR negative) (n = 434). Clinical malaria risk during 2 subsequent malaria seasons was compared. Plasmodium falciparum-specific antibody kinetics during the dry season were compared in children who did or did not harbor asymptomatic P. falciparum infections. : Chronic asymptomatic P. falciparum infection predicted decreased clinical malaria risk during the subsequent malaria season(s); treatment of these infections did not alter this reduced risk. Plasmodium falciparum-specific antibodies declined similarly in children who did or did not harbor chronic asymptomatic P. falciparum infection during the dry season. : These findings challenge the notion that chronic asymptomatic P. falciparum infection maintains malaria immunity and suggest that mass drug administration during the dry season should not increase the subsequent risk of clinical malaria.<br/

Understanding the impact of initial COVID-19 restrictions on physical activity, wellbeing and quality of life in shielding adults with end-stage renal disease in the United Kingdom Dialysing at home versusIn-Centre and their experiences with telemedicine

Early in the coronavirus-2019 (COVID-19) containment strategy, people with end-stage renal disease (ESRD) were identified as extremely clinically vulnerable and subsequently asked to ‘shield’ at home where possible. The aim of this study was to investigate how these restrictions and the transition to an increased reliance on telemedicine within clinical care of people living with kidney disease impacted the physical activity (PA), wellbeing and quality of life (QoL) of adults dialysing at home (HHD) or receiving in-centre haemodialysis (ICHD) in the UK. Individual semistructured telephone interviews were conducted with adults receiving HHD (n = 10) or ICHD (n = 10), were transcribed verbatim and, subsequently, thematically analysed. As result of the COVID-19 restrictions, PA, wellbeing and QoL of people with ESRD were found to have been hindered. However, widespread support for the continued use of telemedicine was strongly advocated and promoted independence and satisfaction in patient care. These findings highlight the need for more proactive care of people with ESRD if asked to shield again, as well as increased awareness of safe and appropriate PA resources to help with home-based PA and emotional wellbeing

Screening for pulmonary tuberculosis: an acceptable intervention for antenatal care clients and providers?

SETTING: Five purposively sampled health facilities in Kasungu District, Malawi. OBJECTIVES: To explore 1) the acceptability of introducing pulmonary tuberculosis (PTB) screening into antenatal care (ANC) clinics amongst ANC clients and ANC service providers; and 2) the acceptability of tuberculosis (TB) treatment during and after pregnancy among women registered for TB treatment. METHODS: Fourteen focus group discussions and 40 indepth interviews with ANC clients (15), ANC service providers (10) and women registered for TB treatment (15). RESULTS: Most clients found the introduction of PTB screening into ANC clinics acceptable. Some expressed concern at submitting a second sputum specimen, citing transportation/distance as the main obstacle. Other concerns were stigma and fear relating to the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) and taking TB treatment during pregnancy and breast-feeding. All ANC service providers supported the idea, but were concerned about increased workload. CONCLUSION: PTB screening in the ANC setting would be an acceptable intervention and could serve to increase PTB case notification in Malawi. However, alternative diagnostic strategies need to be explored. The negative associations with HIV/AIDS and some of the misconceptions surrounding TB treatment need to be addressed to avoid PTB screening becoming a potential barrier to seeking ANC. The main challenge will be whether overstretched staff will be able to cope with this additional service

Factors associated with decreased Plasmodium falciparum infection risk in Malian children.

Malaria control efforts remain suboptimal for many reasons including knowledge gaps in malaria epidemiology and immunology. To better understand the epidemiologic and immunologic factors associated with risk of P. falciparum infection and clinical malaria, we conducted a longitudinal cohort study of 695 individuals aged 3 months to 25 years in the rural village of Kalifabougou, Mali. We did bi-weekly active surveillance for P. falciparum infection by PCR and weekly active clinical surveillance for clinical malaria. Nearly all adults and children over four years of age became infected during the malaria season at a rate that was independent of age (log-rank test, p =.37), indicating that sterile immunity to P. falciparum infection is not acquired through natural exposure; and as expected, the risk of clinical malaria decreased with increasing age (logrank test, p =.0038). Surprisingly, we observed that children under 4 years of age were less likely to be infected with P. falciparum compared to older subjects (p <0.0001), and indeed, 24% of children under 4 years of age remained PCR negative throughout the intense 6-month malaria season. Exposure was measured by antibody response to gSG6, an Anopheles gambiae specific salivary protein, and results indicate that uninfected children were less likely to have serologic evidence of exposure to the mosquito vector over the course of the malaria season. Self-reported bed net use was not different between infected and uninfected children. Because evidence of decreased exposure did not fully explain decreased infection risk in young children, we are taking several approaches to test the hypothesis that uninfected children have enhanced pre-erythrocytic immunity and/or that developmental differences render young children less permissive to P. falciparum infection. Findings from this study may help inform strategies to prevent P. falciparum infection in malaria endemic areas