VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy
Ana Maria Fonseca, Raquel González, Azucena Bardají, Chenjerai Jairoce, Maria Rupérez, Alfons Jiménez, Llorenç Quintó, Pau Cisteró, Anifa Vala, Charfudin Sacoor, Himanshu Gupta, Jennifer Hegewisch-Taylor, Joe Brew, Nicaise Tuikue Ndam, Simon Kariuki, Marta López, Carlota Dobaño, Chetan E. Chitnis, Peter Ouma, Michael Ramharter, Salim Abdulla, John J. Aponte, Achille Massougbodji, Valerie Briand, Ghyslain Mombo-Ngoma, Meghna Desai, Michel Cot, Arsenio Nhacolo, Esperança Sevene, Eusebio Macete, Clara Menéndez, and Alfredo Mayor
Author affiliations: ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain (A.M. Fonseca, R. González, A. Bardají, M. Rupérez, A. Jiménez, L. Quintó, P. Cisteró, H. Gupta, J. Hegewisch-Taylor, J. Brew, C. Dobaño, J.J. Aponte, C. Menéndez, A. Mayor); ICBAS–Universidade do Porto, Porto, Portugal (A.M. Fonseca); Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique (R. González, A. Bardají, C. Jairoce, M. Rupérez, A. Vala, C. Sacoor, C. Dobaño, J.J. Aponte, A. Nhacolo, E. Sevene, E. Macete, C. Menéndez, A. Mayor); Universidade Eduardo Mondlane, Maputo (E. Sevene); CIBER Epidemiología y Salud Pública, Madrid, Spain (R. González, A. Jiménez, A. Mayor, A. Bardají); Université d’Aboméy Calavi, Cotonou, Benin (N.T. Ndam, A. Massougbodji); Kenya Medical Research Institute, Kisumu, Kenya (S. Kariuki, P. Ouma); BCNatal–Barcelona Center for Maternal-Fetal and Neonatal Medicine–Hospital Clínic and Hospital Sant Joan de Deu, Barcelona (M. López); Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (J. Brew); MERIT, Institut de Recherche pour le Développement, Paris, France (N.T. Ndam, V. Briand, M. Cot); Institut Pasteur, Paris (C.E. Chitnis); Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany (G. Mombo-Ngoma); Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany (M. Ramharter, G. Mombo-Ngoma); University Medical Center Hamburg-Eppendorf, Hamburg (M. Ramharter); Ifakara Health Institute, Dar es Salaam, Tanzania (S. Abdulla); Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon (G. Mombo-Ngoma); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M. Desai)
Figure 1. Plasmodium falciparum VAR2CSA IgG in malaria-exposed and -nonexposed pregnant women. A) nMFI measured in pregnant women from Mozambique and Spain. Red dashed line represents the mean nMFI from bovine serum albumin + 3 SDs. B) Seroprevalence among pregnant women from Spain (blue) and Mozambique (black). Asterisks indicate antigens recognized by pregnant women from Mozambique at levels above IgG against bovine serum albumin + 3 SDs and above levels in pregnant women from Spain (q-value <0.05 by Simes procedure) and those antigens poorly recognized by pregnant women from Spain (seroprevalence <5%). C, D) Prevalence of P. falciparum infection in peripheral and placental blood by quantitative PCR (C) and nMFIs (D) among pregnant women from Mozambique delivering in 2004–2005 and 2010–2012. Red lines represent the geometric mean and T-bars the 95% CI. Asterisks indicate antigens recognized by IgG whose levels dropped between 2004 and 2012, as assessed by linear regression adjusted by intermittent preventive treatment during pregnancy, parity, age, and HIV status (q-value <0.05 by Simes procedure). nMFI, normalized median fluorescent intensity.
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