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The Participation of Secondary Clinical Episodes in the Epidemiology of Vivax Malaria during Pre- and Post-Implementation of Focal Control in the State of Oaxaca, Mexico

The participation of vivax malaria secondary clinical was researched in a retrospective cohort of 33,414 confirmed cases occurring between 1994 and 2005 in the state of Oaxaca, Mexico. Secondary episodes occurred in 23.4% of all primary cases. An increase in secondary episodes was associated with primary cases occurring during the dry seasons (risk ratio [RR] = 1.68, 95% CI: 1.45–1.96). The incidence of secondary episodes peaked at an older age, occurred similarly in men and women mostly during low mosquito abundance, and had a uniform distribution among localities. A reduction in secondary episodes was associated with the administration of an increased dose and early administration of primaquine (RR = 0.32, 95% CI: 0.26–0.38). However, limitations to distinguish relapses from re-infections impede assessment of the new treatment effect on relapses and its contribution to malaria control in the area. These findings highlight the need for new therapeutic schemes to radical cure of P. vivax infections and operational research aimed at parasite pool elimination.

Received June 3, 2008. Accepted for publication February 5, 2009.

Acknowledgments: The support for obtaining data from the Health State Services and the Sanitary Jurisdiction IV of the Coast in the State of Oaxaca is acknowledged.

Financial support: This study was supported by the National Center of Epidemiologic Surveillance and Control of Diseases of the Undersecretary of Prevention and Promotion of Health and the representation in Mexico of the Pan-American Health Organization/ World Health Organization.

^* Address correspondence to Mario H. Rodriguez, Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos 62508, Mexico. E-mail: mhenry{at}insp.mx

Authors’ addresses: Mario H. Rodriguez, Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos 62508, Mexico, Tel: 52-777-329-30, Fax: 52-777-311-24, E-mail: mhenry{at}insp.mx. Ángel F. Betanzos-Reyes, Horacio 1855 piso 3 Oficina 305, Col. Los Morales, Polanco Mexico DF 11510, Tel: 52-55-5980-0806, Fax: 52-55-5395-5681, E-mail: abetanzos{at}insp.mx. Juan E. Hernández-Ávila, Dirección de Informática y Geografía Médica, Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos 62508, Mexico, Tel: 52-777-101-2960, Fax: 52-777-311-3788, E-mail: juan_eugenio{at}insp.mx. Jorge F. Méndez-Galván, Hospital Infantil de México, Dr. Marquez 162, Col. Doctores, México DF 06720, Tel: 52-55-5761-6772, E-mail: mmegajf{at}aol.com. Rogelio Danis-Lozano, Centro Regional de Investigación en Salud Pública, Instituto Nacional de Salud Pública, 4a Av. Norte Esq. 19 Poniente S/N, Col. Centro, Tapachula, Chiapas 30700, Mexico, Tel: 52-962-626-2219, Fax: 52-962-626-5782, E-mail: rdanis{at}insp.mx. Armando Altamirano-Jiménez, Secretaría de Salud, Miguel Cabrera 514, Col Centro Oaxaca de Juárez, Oaxaca 68000 Mexico, Tel/Fax: 52-951-1141, E-mail: armando_altamirano{at}hotmail.com.