Abstract
Severe malaria is a major cause of childhood mortality in sub-Saharan Africa but the factors predisposing children to severe forms of malaria have not been fully elucidated. In a case-control study of over 1,200 Gambian children hepatitis B virus carriage was significantly increased amongst cases of severe malaria compared to matched controls. We suggest that this association may relate to impaired clearance of liver stage parasites in the presence of the reduced level of HLA class I antigen expression on hepatocytes infected by hepatitis B virus. If this association is causal and viral carriage predisposes to severe malaria, widespread vaccination against hepatitis B virus may reduce mortality from severe malaria.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Greenwood, B.M., Marsh, K. & Snow, R.W. Why do some African children develop severe malaria. Parasitology Today. 7, 277–281 (1991).
Hill, A.V.S. et al. Common West African HLA antigens are associated with protection from severe malaria. Nature 352, 595–600 (1991).
McGuire, W., Hill, A.V.S., Allsopp, C.E.M., Greenwood, B.M. & Kwiatkowski, D. A polymorphism in the TNFα gene is associated with human cerebral malaria. Nature 371, 508–511 (1994).
Ryder, R.W. Screening for hepatitis B virus markers is not justified in West African transfusion centres. Lancet. ii, 449–52 (1984).
Thursz, M.R. et al. Association between an HLA Class 11 allele and clearance of hepatitis B virus in The Gambia. New Engl. J. Med. (in the press).
Decker, R. Hepatitis B virus: Diagnosis. In Viral Hepatitis. Scientific Basis and Clinical Management. (eds Zuckerman, A J. & Thomas, H.C.) (Churchill Livingstone, London 1993).
Grumayer, E.R., Panzer, S., Ferenci, P. & Gadner, H. Recurrence of hepatitis B in children with serologic evidence of past hepatitis B virus infection undergoing anti-leukaemic chemotherapy. J. Hepatol. 8, 232–235 (1989).
Hill, A.V.S. et al. Molecular analysis of the association of HLA-B53 and resistance to severe malaria. Nature 360, 434–439 (1992).
Alonso, P.L. et al. A malaria control trial using insecticide treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, West Africa. 6. The impact of the interventions on mortality and morbidity from malaria. Trans. Roy Soc. Med. Hyg. 87 (suppl.), 37–44 (1993).
Ikeda, T., Lever, A.M.L. & Thomas, H.C. Evidence for a deficiency of interferon production in patients with chronic hepatitis B virus infection acquired in adult life. Hepatology. 6, 963–965 (1986).
Foster, G.R. et al. Expression of the terminal protein of hepatitis B virus is associated with failure to respond to interferon therapy. Hepatology 17, 757–762 (1993).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thursz, M., Kwiatkowski, D., Torok, M. et al. Association of hepatitis B surface antigen carriage with severe malaria in Gambian children. Nat Med 1, 374–375 (1995). https://doi.org/10.1038/nm0495-374
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/nm0495-374
This article is cited by
-
Prevalence of and risk factors for Plasmodium spp. co-infection with hepatitis B virus: a systematic review and meta-analysis
Malaria Journal (2020)
-
Tolerance and immunity to pathogens in early life: insights from HBV infection
Seminars in Immunopathology (2017)
-
Trained immunity in newborn infants of HBV-infected mothers
Nature Communications (2015)
-
The immune tolerant phase of chronic HBV infection: new perspectives on an old concept
Cellular & Molecular Immunology (2015)
-
Hepatocyte growth factor and its receptor are required for malaria infection
Nature Medicine (2003)