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In addition, the 125G\u2192A substitution, rare in Africans, defines the Fya\/Fyb polymorphism that can modulate vivax malaria risk in Amazonians. The combined effect of these FY polymorphisms on P. vivax infection risk remains little explored at the population level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied a household-based random sample of 1737 Amazonians, with a well-balanced distribution of FY alleles, who were exposed to P. vivax transmission and contributed 7878.9 person-years of follow-up. We fitted a multivariable zero-inflated negative binomial model to incidence data, assuming that zero counts could arise from individuals at risk who remained uninfected over 5 years of follow-up (\u201csampling zeroes\u201d) or from not-at-risk individuals (\u201cstructural zeroes\u201d).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Plasmodium vivax infections were heterogeneously distributed in the population, with 0 to 11 cases per person (average incidence, 25.8 cases\/100 person-years at risk). We show that Fy-negativity remains a major malaria resistance trait in Amazonians and contributes significantly to the \u201cstructural zeroes\u201d observed in P. vivax incidence data. Moreover, the differences in P. vivax infection risk associated with the Fya\/Fyb polymorphism observed among young participants were attenuated with increasing age, most likely because more susceptible Fy(b+) individuals develop clinical immunity faster than less susceptible Fy(a+) individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FY polymorphism appears to modulate the rate at which immunity to P. vivax develops in Amazonians, with clear clinical and public health implications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf562","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T04:34:13Z","timestamp":1762662853000},"page":"e756-e765","source":"Crossref","is-referenced-by-count":0,"title":["How Duffy Blood Group (\n                    <i>FY<\/i>\n                    ) Polymorphism and Age Modulate Vivax Malaria Risk at the Community Level: A Population-based Retrospective Cohort Study in the Amazon"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3907-423X","authenticated-orcid":false,"suffix":"Jr.","given":"Carlos A","family":"Prete","sequence":"first","affiliation":[{"name":"Department of Parasitology, Institute of Biomedical Sciences, University of S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Department of Communications, School of Electrical and Computer Engineering, State University of Campinas , Campinas ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6874-9427","authenticated-orcid":false,"given":"Ta\u00eds N","family":"de Sousa","sequence":"additional","affiliation":[{"name":"Molecular Biology and Malaria Immunology Research Group, Ren\u00e9 Rachou Institute, Fiocruz , Belo Horizonte ,","place":["Brazil"]},{"name":"Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet , Solna ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabela M","family":"Naziazeno","sequence":"additional","affiliation":[{"name":"Molecular Biology and Malaria Immunology Research Group, Ren\u00e9 Rachou Institute, Fiocruz , Belo Horizonte ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2580-2275","authenticated-orcid":false,"given":"Maria Carolina S B","family":"Pu\u00e7a","sequence":"additional","affiliation":[{"name":"Molecular Biology and Malaria Immunology Research Group, Ren\u00e9 Rachou Institute, Fiocruz , Belo Horizonte ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5773","authenticated-orcid":false,"given":"Winni A","family":"Ladeia","sequence":"additional","affiliation":[{"name":"Department of Parasitology, Institute of Biomedical Sciences, University of 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