Key Knowledge Gaps for Plasmodium vivax Control and Elimination

Abstract

There is inadequate understanding of the biology, pathology, transmission, and control of Plasmodium vivax, the geographically most widespread cause of human malaria. During the last decades, study of this species was neglected, in part due to the erroneous belief that it is intrinsically benign. In addition, many technical challenges in culturing the parasite also hampered understanding its fundamental biology and molecular and cellular responses to chemotherapeutics. Research on vivax malaria needs to be substantially expanded over the next decade to accelerate its elimination and eradication. This article summarizes key knowledge gaps identified by researchers, national malaria control programs, and other stakeholders assembled by the World Health Organization to develop strategies for controlling and eliminating vivax malaria. The priorities presented in this article emerged in these technical discussions, and were adopted by expert consensus of the authors. All involved understood the priority placed upon pragmatism in this research agenda, that is, focus upon tools delivering better prevention, diagnosis, treatment, and surveillance of P. vivax.

A Plasmodium vivax experimental human infection model for evaluating efficacy of interventions

“…No serious AEs were reported in either trial. conventional vector control measures (7). Therefore, as well as treating asexual parasites to control clinical illness, P. vivax control strategies must also target hypnozoites, and block transmission to have a marked impact on control and elimination (8).…”

Immunogenicity of glycosylphosphatidylinositol-anchored micronemal antigen in natural Plasmodium vivax exposure

“…Plasmodium vivax has previously been considered benign; however, during the last few years, P. vivax is estimated to have been responsible for 3100 deaths [ 1 ]. Due to some specific characteristics that make it distinct from P. falciparum, such as the fact that the P. vivax hypnozoite can become reactivated, cause repeated clinical malaria attacks, and undergo onward transmission, emerging data indicate that P. vivax is very often associated with severe symptoms [ 2 , 3 ]. Developing a vaccine is considered to be one of several strategies to control and eradicate vivax malaria.…”

Ethnic Conflict as a Risk Amplifier for Resurgent P. Vivax Malaria in Temperate Zones: A Case Study from the Caucasus Region.

“…P. vivax, on the other hand, is a seasonal variant that remains dormant in human hosts during winter months, then re-emerges in transmissible form when mosquitos re-appear in the spring (6). While seasonal malaria is rarely fatal, it can produce signi cant population morbidity, especially in agricultural communities or immunologically naive populations (31). P. vivax is also the most globally prevalent form of malaria, with approximately 2.5 billion individuals at risk worldwide (32).…”

“…P. vivax is also the most globally prevalent form of malaria, with approximately 2.5 billion individuals at risk worldwide (32). There are potentially serious health complications, including anemia, jaundice and immune system dysfunction (33,34). Second order effects of widespread P. vivax infection include regional food shortages, poverty, economic burdens and delayed cognitive development in children (35).…”

“…Second order effects of widespread P. vivax infection include regional food shortages, poverty, economic burdens and delayed cognitive development in children (35). There is currently no vaccine against any form of malaria, and drug treatments for P. vivax can be complicated by ancestral genetic adaptations such as G6PD de ciency (1,33). Transmission dynamics, patterns of host immunity, and parasite life cycle variations of P. vivax are still not fully understood, and for these reasons some researchers have described P. vivax as a "neglected tropical disease of major global importance" (36).…”