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Background  When both parasite species are co-endemic,  Plasmodium vivax  incidence peaks in younger children compared to  P. falciparum . To identify differences in the number of blood stage infections of these species and its potential link to acquisition of immunity, we have estimated the molecular force of blood-stage infection of  P. vivax  ( mol FOB, i.e. the number of genetically distinct blood-stage infections over time), and compared it to previously reported values for  P. falciparum .    Methods    P. vivax   mol FOB was estimated by high resolution genotyping parasites in samples collected over 16 months in a cohort of 264 Papua New Guinean children living in an area highly endemic for  P. falciparum  and  P. vivax . In this cohort,  P. vivax  episodes decreased three-fold over the age range of 1–4.5 years.    Results  On average, children acquired 14.0 new  P. vivax  blood-stage clones/child/year-at-risk. While the incidence of clinical  P. vivax  illness was strongly associated with   mol  FOB (incidence rate ratio (IRR) = 1.99, 95% confidence interval (CI95) [1.80, 2.19]),  mol FOB did not change with age. The incidence of  P. vivax  showed a faster decrease with age in children with high (IRR = 0.49, CI95 [0.38, 0.64] p<0.001) compared to those with low exposure (IRR = 0.63, CI95[0.43, 0.93] p = 0.02).    Conclusion    P. vivax   mol FOB is considerably higher than  P. falciparum   mol FOB (5.5 clones/child/year-at-risk). The high number of  P. vivax  clones that infect children in early childhood contribute to the rapid acquisition of immunity against clinical  P. vivax  malaria.

A High Force of Plasmodium vivax Blood-Stage Infection Drives the Rapid Acquisition of Immunity in Papua New Guinean Children