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Vivax Malaria: Neglected and Not Benign

Plasmodium vivax threatens almost 40% of the world’s population, resulting in 132–391 million clinical infections each year. Most of these cases originate from Southeast Asia and the Western Pacific, although a significant number also occurs in Africa and South America. Although often regarded as causing a benign and self-limiting infection, there is increasing evidence that the overall burden, economic impact, and severity of disease from P. vivax have been underestimated. Malaria control strategies have had limited success and are confounded by the lack of access to reliable diagnosis, emergence of multidrug resistant isolates, the parasite’s ability to transmit early in the course of disease and relapse from dormant liver stages at varying time intervals after the initial infection. Progress in reducing the burden of disease will require improved access to reliable diagnosis and effective treatment of both blood-stage and latent parasites, and more detailed characterization of the epidemiology, morbidity, and economic impact of vivax malaria. Without these, vivax malaria will continue to be neglected by ministries of health, policy makers, researchers, and funding bodies.

Received October 25, 2006. Accepted for publication February 24, 2007.

Acknowledgments: We thank Simon Hay, Kathryn Maitland, and Bob Snow for their helpful comments on the manuscript. RP is funded by a Wellcome Trust Career Development Award (074637). CAG is supported by a Wellcome Trust Project grant (#076951) attached to the Malaria Atlas Project (MAP, http://www.map.ox.ac.uk). NJW is a Wellcome Trust Principal Fellow. NA is supported by an NHMRC Practitioner Fellowship.

^* Address correspondence to Ric Price, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811 Australia. E-mail: rnp{at}menzies.edu.au

No conflict of interests declared.

Authors’ addresses: Ric Price and Nicholas Anstey, Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811 Australia, Tel: (61) 8 8922 8197, Fax: (61) 8 8922 8429, E-mail rnp{at}menzies.edu.au. Emiliana Tjitra, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia. Carlos A. Guerra, Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Tinbergen Building, South Parks Road, Oxford, OX1 3PS, UK. Shunmay Yeung, London School of Tropical Medicine, London, UK, Tel: (44) 7927-2146, E-mail: shunmay.yeung{at}lshtm.ac.uk. Nicholas White, Centre for Vaccinology & Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, UK.

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