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REGIONAL DIFFERENCES IN THE RESPONSE OF PLASMODIUM VIVAX MALARIA TO PRIMAQUINE AS ANTI-RELAPSE THERAPY

We used logistic regression to assess effectiveness of primaquine as Plasmodium vivax anti-relapse therapy using data extracted from studies of P. vivax relapses in Brazil, India, and Thailand. The risk of relapse in Thailand was 10 times that in India and twice that in Brazil. In comparison with no primaquine treatment, the risk of relapse decreased by approximately 80% for a total adult primaquine regimen of 210 mg and by 95% for regimens of 315 mg and 420 mg. In addition, we used logistic regression to estimate the risk of P. vivax relapse according to weight-based primaquine dose using data from case studies. There was a three-fold increase in the likelihood of successful treatment of each additional milligram of primaquine per kilogram of body weight. Tailoring primaquine therapy to a region requires consideration of factors including body weight, natural relapse rates, and local response to primaquine.

Received August 14, 2006. Accepted for publication October 24, 2006.

Acknowledgments: We thank the Victorian Public Health Training Scheme for providing the opportunity to undertake a placement at Melbourne University and to collaborate with the World Health Organization on this project. We also thank Sonia Caruana for expert advice on laboratory methods and malaria parasites, Mirella Ozols for administrative assistance, and Priscilla Robinson and Dianne Beck for discussing the results.

^* Address correspondence to Jane L. Goller, Centre for Epidemiology and Population Health Research, Burnet Institute, 85 Commercial Road, Prahan 3181, Victoria, Australia. E-mail: jane{at}burnet.edu.au

Authors’ addresses: Jane L. Goller, Centre for Epidemiology and Population Health Research, Burnet Institute, 85 Commercial Road, Prahan 3181, Victoria, Australia, Telephone: 61-3-8506-2310, Fax: 61-3-9282-2138, E-mail: jane{at}burnet.edu.au. Damien Jolley, Monash Institute of Health Services Research, Locked Bag 29, Clayton 3168, Victoria, Australia, Telephone: 61-3-9594-7509, Fax: 61-3-9594-7554, E-mail: damien.jolley{at}med.monash.edu.au. Pascal Ringwald, Global Malaria Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland, Telephone: 41-22-791-3469, Fax: 41-22-791-4824, E-mail: ringwaldp{at}who.int. Beverley-Ann Biggs, Department of Medicine (RMH/WH), The University of Melbourne, PO Royal Melbourne Hospital, Parkville 3050, Australia, Telephone: 61-3-8344-3257, Fax: 61-3-9347-1863, E-mail: babiggs{at}unimelb.edu.au.

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