Primaquine treatment and relapse inPlasmodium vivaxmalaria

Abstract

The relapsing peculiarity of Plasmodium vivax is one of the prime reasons for sustained global malaria transmission. Global containment of P. vivax is more challenging and crucial compared to other species for achieving total malaria control/elimination. Primaquine (PQ) failure and P. vivax relapse is a major global public health concern. Identification and characterization of different relapse strains of P. vivax prevalent across the globe should be one of the thrust areas in malaria research. Despite renewed and rising global concern by researchers on this once 'neglected' species, research and development on the very topic of P. vivax reappearance remains inadequate. Many malaria endemic countries have not mandated routine glucose-6-phosphate dehydrogenase (G6PD) testing before initiating PQ radical cure in P. vivax malaria. This results in either no PQ prescription or thoughtless prescription and administration of PQ to P. vivax patients by healthcare providers without being concerned about patients' G6PD status and associated complications. It is imperative to ascertain the G6PD status and optimum dissemination of PQ radical cure in all cases of P. vivax malaria across the globe. There persists a compelling need to develop/validate a rapid, easy-to-perform, easy-to-interpret, quality controllable, robust, and cost-effective G6PD assay. High-dose PQ of both standard and short duration appears to be safe and more effective for preventing relapses and should be practiced among patients with normal G6PD activity. Multicentric studies involving adequately representative populations across the globe with reference PQ dose must be carried out to determine the true distribution of PQ failure. Study proving role of cytochrome P450-2D6 gene in PQ metabolism and association of CYP2D6 metabolizer phenotypes and P. vivax relapse is of prime importance and should be carried forward in multicentric systems across the globe.

Dengue in Bali: Clinical characteristics and genetic diversity of circulating dengue viruses

“…In this study, we did not find the other DENV-1 genotype (Genotype IV) known to circulate in Bali in 2010 [38] and other cities in Indonesia as well as in imported cases to other countries. The absence of Genotype IV in Bali together with genotype replacement is similar to that seen with the Jambi dengue outbreak [30], and other cities of Indonesia [18,29]. Altogether, our data suggest the ongoing replacement of DENV-1 Genotype IV by Genotype I in Bali.…”

Use and disuse of malaria bed nets in an internally displaced persons camp in the Democratic Republic of the Congo: A mixed-methods study

“…In this study, we investigated barriers to bed net use among IDPs in a region with ongoing human insecurity. Despite a high burden of malaria and free distribution of bed nets, only 29% of IDP households owned a bed net, compared to 16–75% in other studies in IDP camps in Eastern DRC and 8–90% in community-based surveys and surveillance data from sub-Saharan Africa [ 9 , 11 , 13 , 14 , 35 ]. In our survey of an IDP camp in Eastern DRC, 20% of individuals slept under a bed net the previous night, compared to 16–25% in another IDP camp [ 9 ] and 6–70% in other African studies [ 36 ].…”

“…The incidence of malaria in the DRC is estimated to be over 6 million cases annually, and malaria is the leading cause of childhood mortality in the country. We and others have previously reported that the burden of malaria is disproportionately high in Congolese IDP camps, and that bed nets are under-utilized [ 9 , 13 , 14 ]. The purpose of this study was to explore the factors influencing bed net ownership and use in an IDP camp with universal free bed net distribution using mixed qualitative and quantitative methods.…”

Population-level estimates of the proportion of Plasmodium vivax blood-stage infections attributable to relapses among febrile patients attending Adama Malaria Diagnostic Centre, East Shoa Zone, Oromia, Ethiopia

“…However, many malaria endemic countries have not mandated routine glucose-6-phosphate dehydrogenase (G6PD) testing before initiating PQ for radical cure of patients infected by P. vivax malaria. This has led to the absence of PQ prescription or inconsiderate prescription and administration of PQ to P. vivax patients without being concerned about patients’ G6PD status and associated complications [ 31 ]. Indeed, the single greatest obstacle to PQ prescription is the rational fear of complications associated with this drug in G6PD deficient patients.…”