Biology Reference
In-Depth Information
not eliminate malaria. Relapsing malaria is a particular challenge. Because of
P. vivax
's adaptation to a wide-ranging human host, one can expect malaria
relapses for 3-5 years and perhaps longer even after a near-perfectly con-
ducted elimination program (
Kaneko et al., 2000
). See
Table 6.2
for charac-
teristics distinguishing vivax malaria control from elimination.
Better ways to deliver the drug to entire communities must be found.
Simple, easy-to-use solutions make a huge difference in being able to
Table 6.2
Differences Distinguishing Vivax Malaria Control from Elimination
Programs are Described; This Applies to Public Health Applications rather
than the Individual Patient
Intervention
Vivax Malaria Control
Vivax Malaria Elimination
Purpose of program Stopping vivax malaria
transmission
Destroying the last
remaining parasite
within a large popula-
tion
Use of ITN
Main intervention to break
current malaria transmis-
sion by killing night biting
Anopheles
Maintained in order to
prevent reintroduction
of vivax by immigrants
with hypnozoites
Use of mass drug
administration of
primaquine
Not appropriate until
transmission largely ended
Difficult but critical to
final elimination of
residual parasites from
population
Disease surveillance Relatively easy as laboratory
staff often find parasites in
blood smears
Difficult as vast majority
of blood smears will be
negative
Length of control
program
Usually 1-2 years of intense
operations
Probably more than
5 years of maintaining
program with few if any
symptomatic malaria
cases
Importance of
asymptomatic
persons
Unimportant compared to
those sick with vivax
Extremely important to
identify and treat this
residual parasite reser-
voir
Community
participation
Relatively easy as progress
visible by fewer sick
persons
Difficult as elimination
occurs when there is
little if any active disease
Political will and
resources
Relatively easy to maintain
as one can demonstrate
visible progress
Very difficult due to
competition from other
higher burden diseases
