Towards the elimination of Plasmodium vivax malaria: Implementing the radical cure

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 24 Apr 2021)

 

Towards the elimination of Plasmodium vivax malaria: Implementing the radical cure
Kamala Thriemer, Benedikt Ley, Lorenz von Seidlein
Collection Review | published 23 Apr 2021 PLOS Medicine
https://doi.org/10.1371/journal.pmed.1003494
Summary points
:: Efforts to control Plasmodium vivax malaria have been less successful than for Plasmodium falciparum, resulting in higher prevalence of P. vivax malaria in most coendemic regions. One of the key differences between the 2 species is the ability of P. vivax to form hypnozoites causing relapses which facilitate transmission. Preventing P. vivax relapses is key for the elimination of P. vivax malaria.
:: The widescale use of the radical cure to clear hypnozoites has been underutilized in most endemic countries. Two breakthroughs have increased the likelihood that the radical cure will be rolled out in P. vivax endemic regions: To clear hypnozoites, primaquine can be administered in short, high-dose regimens or a single dose of the recently licensed tafenoquine is administered. Novel technologies allow measurement of glucose-6-phosphate dehydrogenase (G6PD) activity at the point of care. Identifying patients with low G6PD activity, not eligible for these novel regimens, is a precondition for their safe administration.
:: Novel approaches to P. vivax elimination such as mass drug administrations of antimalarial drugs including 8-aminoquinolines require considerable resources and carry safety risks.
:: A safe and protective P. vivax vaccine would be an asset in the elimination of P. vivax malaria but is unlikely to be available in the near future.
:: Case management that includes a radical cure is currently the most promising approach to P. vivax elimination. New regimens for radical cure and the possibility to minimise the risk of haemolysis through novel G6PD tests bring up operational challenges, but if deployed wisely could have sufficient impact to eliminate if not eradicate P. vivax malaria.