Abstract
Placental malaria caused by Plasmodium falciparum infection constitutes a major health problem manifesting as severe disease and anaemia in the mother, impaired fetal development, low birth weight or spontaneous abortion. Prevention of placental malaria currently relies on two key strategies that are losing efficacy due to spread of resistance: long-lasting insecticide-treated nets and intermittent preventive treatment during pregnancy. A placental malaria vaccine would be an attractive, cost-effective complement to the existing control tools. Two placental malaria vaccine candidates are currently in Phase Ia/b clinical trials. During two workshops hosted by the European Vaccine Initiative, one in Paris in April 2014 and the other in Brussels in November 2014, the main actors in placental malaria vaccine research discussed the harmonization of clinical development plans and of the immunoassays with a goal to define standards that will allow comparative assessment of different placental malaria vaccine candidates. The recommendations of these workshops should guide researchers and clinicians in the further development of placental malaria vaccines.
Highlights
People living in malaria endemic areas gradually develop immunity to clinical manifestations of Plasmodium fal‐ ciparum infection, and severe malaria is unlikely above 5 years of age in areas of stable transmission [1]
Evaluation criteria In high P. falciparum transmission settings, women gradually acquire immunity to placental malaria following successive pregnancies [5] and primigravid women are at higher risk of developing placental malaria with more severe adverse consequences than multigravid women
Antibodies blocking the adhesion of placenta-derived P. falciparum infected erythrocytes to chondroitin sulphate A (CSA) have been shown to reduce the prevalence of placental malaria [23] and have been linked to improved pregnancy outcomes [26]
Summary
People living in malaria endemic areas gradually develop immunity to clinical manifestations of Plasmodium fal‐ ciparum infection, and severe malaria is unlikely above 5 years of age in areas of stable transmission [1]. During their first pregnancy, women become susceptible to placental malaria regardless of previous exposure to the parasite. Over 50 million women living in endemic areas are exposed every year to the risk of developing malaria during pregnancy. The currently recommended preventive strategies to reduce the risk of placental malaria are based on the Infected erythrocytes isolated from placentas of women (iRBCPM) present a unique adhesive phenotype. Chondroitin sulphate proteoglycans are present in the placental intervillous space by
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