Infants Younger Than 24 Months With Severe Malaria Have a Serologic Profile of Active Infection With Epstein-Barr Virus.

BACKGROUND

Primary Epstein-Barr virus (EBV) infection occurs during late adolescence and is characterized by the symptomatic manifestation of infectious mononucleosis. Asymptomatic primary EBV infection in malaria-endemic areas often occurs in young children by the age of 2 years. Resulting in humoral immune suppression to unrelated antigenic challenges for approximately 4 weeks.

METHODS

We undertook a cross-sectional study of 195 infants aged 6 to 24 months in Cameroon. The EBV infection status of each child was determined by a standard serologic classification system, and the magnitude, breadth, and invasion-blocking capacity of the anti-Plasmodium falciparum antibody response were quantified.

RESULTS

An overall 24% of children were serologically positive for active EBV infection, and the highest proportion of severe malaria cases was in children with active EBV. An elevated magnitude and breadth of the antibody response with increased in vitro invasion-blocking capacity were observed in children with active EBV, but circulating parasitemia in vivo was similar.

CONCLUSIONS

Primary EBV infection may be a risk factor for developing severe malaria in children aged 6 to 24 months. Targeting EBV infection in young children may be beneficial in protecting against the development of severe falciparum malaria in children living in malaria-endemic areas.