Geographical variation in Plasmodium vivax relapse

Battle, Katherine E, Karhunen, Markku S, Bhatt, Samir, Gething, Peter W, Howes, Rosalind E, Golding, Nick, Van Boeckel, Thomas P, Messina, Jane P, Shanks, G Dennis, Smith, David L, Baird, Kevin and Hay, Simon I (2014) Geographical variation in Plasmodium vivax relapse. Malaria Journal, 13 1: 144.1-144.16. doi:10.1186/1475-2875-13-144

Author Battle, Katherine E
Karhunen, Markku S
Bhatt, Samir
Gething, Peter W
Howes, Rosalind E
Golding, Nick
Van Boeckel, Thomas P
Messina, Jane P
Shanks, G Dennis
Smith, David L
Baird, Kevin
Hay, Simon I
Title Geographical variation in Plasmodium vivax relapse
Formatted title
Geographical variation in Plasmodium vivax relapse
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2014-04
Year available 2014
Sub-type Article (original research)
DOI 10.1186/1475-2875-13-144
Open Access Status DOI
Volume 13
Issue 1
Start page 144.1
End page 144.16
Total pages 16
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Formatted abstract
Plasmodium vivax has the widest geographic distribution of the human malaria parasites and nearly 2.5 billion people live at risk of infection. The control of P. vivax in individuals and populations is complicated by its ability to relapse weeks to months after initial infection. Strains of P. vivax from different geographical areas are thought to exhibit varied relapse timings. In tropical regions strains relapse quickly (three to six weeks), whereas those in temperate regions do so more slowly (six to twelve months), but no comprehensive assessment of evidence has been conducted. Here observed patterns of relapse periodicity are used to generate predictions of relapse incidence within geographic regions representative of varying parasite transmission.

A global review of reports of P. vivax relapse in patients not treated with a radical cure was conducted. Records of time to first P. vivax relapse were positioned by geographic origin relative to expert opinion regions of relapse behaviour and epidemiological zones. Mixed-effects meta-analysis was conducted to determine which geographic classification best described the data, such that a description of the pattern of relapse periodicity within each region could be described. Model outputs of incidence and mean time to relapse were mapped to illustrate the global variation in relapse.

Differences in relapse periodicity were best described by a historical geographic classification system used to describe malaria transmission zones based on areas sharing zoological and ecological features. Maps of incidence and time to relapse showed high relapse frequency to be predominant in tropical regions and prolonged relapse in temperate areas.

The results indicate that relapse periodicity varies systematically by geographic region and are categorized by nine global regions characterized by similar malaria transmission dynamics. This indicates that relapse may be an adaptation evolved to exploit seasonal changes in vector survival and therefore optimize transmission. Geographic patterns in P. vivax relapse are important to clinicians treating individual infections, epidemiologists trying to infer P. vivax burden, and public health officials trying to control and eliminate the disease in human populations.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Public Health Publications
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Created: Mon, 05 May 2014, 09:48:15 EST by Ms Kate Rowe on behalf of School of Public Health