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    Research Letter
    January 6, 2020

    Malaria Antigen Shedding in the Breast Milk of Mothers From a Region With Endemic Malaria

    Author Affiliations
    • 1The University of Western Australia School of Molecular Sciences, Perth, Australia
    • 2inVIVO Global Network, Research Group of the Worldwide Universities Network, Leeds, United Kingdom
    • 3Uganda Human Milk and Lactation Center, Med Biotech Laboratories, Kampala, Uganda
    • 4Med Biotech Laboratories, Kampala, Uganda
    JAMA Pediatr. Published online January 6, 2020. doi:10.1001/jamapediatrics.2019.5209

    More than 200 million cases of malaria occur yearly, with most in Africa, where infants younger than 5 years account for two-thirds of all malaria deaths.1 This highlights the need for successful prevention of malaria infection, especially in early life. Breastfeeding is the most efficient way to prevent child morbidity and mortality attributable to respiratory and gastrointestinal tract infectious diseases.2 In contrast, there is conflicting evidence on malaria prevention by breastfeeding.3-5 Mouse and human data have shown that the presence of foreign antigens in breast milk, such as allergens or viral antigens, could elicit strong immune responses in offspring who are breastfed.6 Therefore, we propose what is to our knowledge an original hypothesis: the presence of malaria antigen in breast milk stimulates antimalarial immune defenses and reduces malaria risk in infants who are breastfed. Here, as a critical first step to address this hypothesis, we investigated whether Plasmodium falciparum histidine-rich protein 2 (pHRP-2) and lactate dehydrogenase (pLDH) are detectable in the breast milk of mothers from Uganda, a country with endemic malaria.1