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Clinical Microbiology Reviews, January 2009, p. 13-36, Vol. 22, No. 1
0893-8512/09/$08.00+0     doi:10.1128/CMR.00025-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Acquired Immunity to Malaria

Denise L. Doolan,1* Carlota Dobaño,2 and J. Kevin Baird3,4

Queensland Institute of Medical Research, The Bancroft Centre, 300 Herston Road, Post Office Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia,1 Barcelona Centre for International Health Research, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Spain,2 Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, Indonesia,3 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom4

Naturally acquired immunity to falciparum malaria protects millions of people routinely exposed to Plasmodium falciparum infection from severe disease and death. There is no clear concept about how this protection works. There is no general agreement about the rate of onset of acquired immunity or what constitutes the key determinants of protection; much less is there a consensus regarding the mechanism(s) of protection. This review summarizes what is understood about naturally acquired and experimentally induced immunity against malaria with the help of evolving insights provided by biotechnology and places these insights in the context of historical, clinical, and epidemiological observations. We advocate that naturally acquired immunity should be appreciated as being virtually 100% effective against severe disease and death among heavily exposed adults. Even the immunity that occurs in exposed infants may exceed 90% effectiveness. The induction of an adult-like immune status among high-risk infants in sub-Saharan Africa would greatly diminish disease and death caused by P. falciparum. The mechanism of naturally acquired immunity that occurs among adults living in areas of hyper- to holoendemicity should be understood with a view toward duplicating such protection in infants and young children in areas of endemicity.

* Corresponding author. Mailing address: Queensland Institute of Medical Research, The Bancroft Centre, 300 Herston Road, Post Office Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia. Phone: (61-7) 3362 0382. Fax: (61-7) 3362 0105. E-mail: Denise.Doolan{at}qimr.edu.au

Clinical Microbiology Reviews, January 2009, p. 13-36, Vol. 22, No. 1
0893-8512/09/$08.00+0     doi:10.1128/CMR.00025-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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