Plasmodium vivax in the Era of the Shrinking P. falciparum Map
Plasmodium vivax infection is present across most of the malaria-endemic world.
P. vivax relapses, arising from dormant liver stages, cause recurrent episodes of malaria that are the main determinant of significant morbidity, mortality, and ongoing transmission.
In coendemic areas, where intense malaria-control activities have reduced the burden of P. falciparum, there has been a rise in the proportion of malaria attributable to P. vivax.
There is an increased risk of P. vivax after the treatment of P. falciparum in coendemic regions, suggesting potential benefit of universal radical cure for both parasites in some areas.
Novel host and parasite diagnostics, single-dose tafenoquine, and short-course primaquine regimens offer hope for safer and more effective radical cure to eliminate the parasite.
Plasmodium vivax is an important cause of malaria, associated with a significant public health burden. Whilst enhanced malaria-control activities have successfully reduced the incidence of Plasmodium falciparum malaria in many areas, there has been a consistent increase in the proportion of malaria due to P. vivax in regions where both parasites coexist. This article reviews the epidemiology and biology of P. vivax, how the parasite differs from P. falciparum, and the key features that render it more difficult to control and eliminate. Since transmission of the parasite is driven largely by relapses from dormant liver stages, its timely elimination will require widespread access to safe and effective radical cure.