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<jats:p>Migrants from Java arrive in hyperendemic Papua, Indonesia lacking exposure to endemic malaria. We evaluated records of evacuation to hospital with a diagnosis of severe malaria from a transmigration village in northeastern Papua. During the first 30 months, 198 residents with severe disease were evacuated (7·5 evacuations/100 person-years). During this period the risk of evacuation for adults (&gt;15 years of age) was 2·8. (95% CI=2·1–3·8; <jats:italic>P</jats:italic>&lt;0·0001) relative to children, despite apparently equal exposure to risk of infection. Relative risk (RR) for adults was greatest during the first 6 months (RR&gt;16; 95% CI[ges ]2·0–129; <jats:italic>P</jats:italic>=0·0009), and diminished during the second 6 months (RR=9·4; 95% CI=2·7–32·8; <jats:italic>P</jats:italic>&lt;0·0001) and the third 6 months (RR=3·7; 95% CI=1·7–7·9; <jats:italic>P</jats:italic>=0·0004). During the next two 6-month intervals, the RR for adults was 1·6 and 1·5 (95% CI range 0·8–2·6; <jats:italic>P</jats:italic>&lt;0·18). Adults lacking chronic exposure were far more likely to progress to severe disease compared to children during initial exposure, but not after chronic exposure to infection.</jats:p>

Original publication





Epidemiology and Infection


Cambridge University Press (CUP)

Publication Date





791 - 797