Asia – vivax and falciparum are fatal

To date the Roll Back Malaria Partnership has focused its attention of tackling the scourge of malaria in Africa, but the call has been growing for the Roll Back Malaria Partnership to give more attention to malaria in Asia and Latin America. About 40% of the malaria grants awarded to date from the Global Fund have been outside Africa, so attention is being paid to the need in some quarters. The US President’s Malaria Initiative has focused on 15 countries Africa, in part to achieve impact within focused population and financial limits, but USAID is also active in malaria control in the Mekong Region.

malaria-coverage-after-6-rounds-sm.jpgThree articles focusing on Indonesia and Papua New Guinea bring into focus the malaria control needs in parts of Asia. Poespoprodjo and colleagues explain that while, “Plasmodium falciparum infection exerts a considerable burden on pregnant women, but less is known about the adverse consequences of Plasmodium vivax infection.”

After studying over 3000 pregnant women with either falciparum, vivax or co-infection, they suggested that, “Malaria increases the risk of preterm delivery and stillbirth through fever and contribution to severe anemia rather than through parasitemia per se,” regardless of type of infection. They also debunked the myth that vivax infections are benign.

Drug resistance is increasing in both forms of malaria parasites, but as Tjitra and colleagues point out the myth of vivax being benign has led to some complacency. They found severe forms of the disease in both forms, and stressed that, P. vivax “is associated with severe and fatal malaria particularly in young children.”

Genton et al., with research support from both the US and Australian aid agencies, found the P. vivax and mixed infections resulted in severe malaria. They concluded that, “Interventions targeted toward P. falciparum only might be insufficient to eliminate the overall malaria burden, and especially severe disease, in areas where P. falciparum and P. vivax coexist.

In a commentary on the two PLoS articles Rogerson and Carter state that, “With calls for increased efforts to control malaria internationally, it will be important to ensure that P. vivax receives appropriate attention. We still lack reliable estimates of its global burden, and are only now starting to appreciate certain aspects of disease presentation of P. vivax malarial infection. The burden and severity of vivax in different settings requires further study.” They expressed hope in vaccine development but also highlighted the need for “more effective curative treatment and and better relapse prevention” because of the unique lifecycle of vivax.

Ultimately, malaria can never be eradicated without attention to its global spread.

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