Extensive genetic diversity in the HLA class II region of Africans; with a focally predominant allele; DRB1*1304

Molecular HLA class II typing of greater than 1700 individuals from The Gambia in West Africa and Malawi in South-Central Africa revealed a striking diversity of HLA DRB-DQB haplotypes as defined by restriction fragment length polymorphism (RFLP); this diversity is twice as extensive as that found in northern Europeans. Despite this diversity; sequence and PCR/oligonucleotide analysis showed that the recently described variant DRB1*1304 is the commonest DRB1 allele in The Gambia. The sequence; geographical distribution; and RFLP association of this allele; together with homozygosity test results; suggest that DRB1*1304 may have arisen from DRB1*1102 and have reached its remarkably high frequency as a result of recent directional selection. The prevalence of this unusual allele has implications for trials of subunit vaccines in this area. The extensive and distinctive HLA class II region polymorphism in sub-Saharan Africans is consistent with evidence from other genetic loci implying an African origin of modern Homo sapiens

Cerebral malaria [letter]

When young children are infected with P. falciparum; meningitis is often incidentally associated with parasitaemia and can be difficult to distinguish clinically from cerebral malaria. There is yet no clear evidence that lumbar puncture is dangerous in cerebral malaria and it is reasonable to do lumbar punctures to exclude bacterial meningitis in children with fever and coma in areas where malaria is endemic