{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T22:53:16Z","timestamp":1772751196718,"version":"3.50.1"},"posted":{"date-parts":[[2023,1,5]]},"group-title":"Epidemiology","reference-count":45,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,1,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>\n                  A signature remains elusive of naturally-acquired immunity against\n                  <jats:italic>Plasmodium falciparum<\/jats:italic>\n                  . We identified\n                  <jats:italic>P. falciparum<\/jats:italic>\n                  in a 14-month cohort of 239 people in Kenya, genotyped at immunogenic parasite targets expressed in the pre-erythrocytic (circumsporozoite protein, CSP) and blood (apical membrane antigen 1, AMA-1) stages, and classified into epitope type based on variants in the DV10, Th2R, and Th3R epitopes in CSP and the c1L region of AMA-1. Compared to asymptomatic index infections, symptomatic malaria was associated with a reduced reinfection by parasites bearing homologous CSP-Th2R (adjusted hazard ratio [aHR]:0.63; 95% CI:0.45\u20130.89; p=0.008) CSP-Th3R (aHR:0.71; 95% CI:0.52\u20130.97; p=0.033), and AMA-1 c1L (aHR:0.63; 95% CI:0.43\u20130.94; p=0.022) epitope types. The association of symptomatic malaria with reduced risk of homologous reinfection was strongest for rare epitope types. Symptomatic malaria more effectively promotes functional immune responses. The phenotype represents a legible molecular epidemiologic signature of naturally-acquired immunity by which to identify new antigen targets.\n                <\/jats:p>","DOI":"10.1101\/2023.01.04.23284198","type":"posted-content","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T16:35:10Z","timestamp":1672936510000},"source":"Crossref","is-referenced-by-count":0,"title":["Symptomatic malaria enhances protection from reinfection with homologous\n                  <i>Plasmodium falciparum<\/i>\n                  parasites"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5742-8847","authenticated-orcid":false,"given":"Christine F.","family":"Markwalter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens E. 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