Treatment of Vivax Malaria in Vietnam

Nguyen, Hoang Chau (2020). Treatment of Vivax Malaria in Vietnam. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.00011543

Abstract

Globally, relapse caused by Plasmodium vivax malaria is estimated to contribute approximately 50% to the overall number of vivax infections. In South-East Asia, relapse rates commonly exceed 50%, making relapse as the main source of vivax illness. Recurrent episodes of febrile illness and hemolysis inflict a significant public health burden particularly in vulnerable groups such as pregnant women and young children. Multiple relapses may contribute substantially to the delayed morbidity and unappreciated mortality relative to falciparum malaria. Therefore, the radical cure of P. vivax malaria requires a combination of both blood schizontocides to achieve acute clinical cure, and hypnozoiticides to prevent relapses in the future. The World Health Organization (WHO) recommends the standard 14-day primaquine regimen in curing and preventing relapse from vivax malaria. Another 8-aminoquinoline derivative with prolonged elimination half-life, tafenoquine, also propose an alternative choice in radical therapy. The main research question is: what is the most effective treatment to achieve radical cure of Plasmodium vivax in Vietnam?

In order to answer this question a series of studies and clinical trials were conducted in Vietnam and our findings point to these conclusions:

1/ The short 7-day course of primaquine is an available, safe and highly efficacious antirelapse treatment that could improve the adherence of patients and hence the effectiveness of radical cure of vivax relapse.

2/ The single dose of 300 mg tafenoquine, an 8-aminoquinoline drug, has similar antirelapse activity compared to primaquine. When administered with chloroquine, this hypnozoiticidal agent is a potential candidate in the malaria elimination era.

3/ The prevalence and variants of G6PD deficiency determinants of hemolytic toxicity of 8-aminoquinolines in malaria endemic regions represent important factors to be considered when implementing radical cure of latent vivax malaria.

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