Volume 95 Number 6_Suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Endemic malaria occurs across much of the vast Indonesian archipelago. All five species of known to naturally infect humans occur here, along with 20 species of mosquitoes confirmed as carriers of malaria. Two species of plasmodia cause the overwhelming majority and virtually equal shares of malaria infections in Indonesia: and . The challenge posed by is especially steep in Indonesia because chloroquine-resistant strains predominate, along with Chesson-like strains that relapse quickly and multiple times at short intervals in almost all patients. Indonesia's hugely diverse human population carries many variants of glucose-6-phosphate dehydrogenase (G6PD) deficiency, most of them exhibiting severely impaired enzyme activity. Therefore, the patients most likely to benefit from primaquine therapy by preventing aggressive relapse, may also be most likely to suffer harm without G6PD deficiency screening. Indonesia faces the challenge of controlling and eventually eliminating malaria across > 13,500 islands stretching > 5,000 km and an enormous diversity of ecological, ethnographic, and socioeconomic settings, and extensive human migrations. This article describes the occurrence of in Indonesia and the obstacles faced in eliminating its transmission.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Elyazar IR, Gething PW, Patil AP, Rogayah H, Sariwati E, Palupi NW, Tarmizi SN, Kusriastuti R, Baird JK, Hay SI, , 2012. Plasmodium vivax endemicity in Indonesia in 2010. PLoS One 7: e37325.[Crossref] [Google Scholar]
  2. Baird JK, , 2013. Evidence and implications of mortality associated with acute Plasmodium vivax malaria. Clin Microbiol Rev 26: 3657.[Crossref] [Google Scholar]
  3. Elyazar IR, Sinka ME, Gething PW, Tarmidzi SN, Surya A, Kusriastuti R, Winarno Baird JK, Hay SI, Bangs MJ, , 2013. The distribution and bionomics of Anopheles malaria vector mosquitoes in Indonesia. Adv Parasitol 83: 173266.[Crossref] [Google Scholar]
  4. Francisca L, Kusnanto JH, Satoto TB, Sebayang B, Supriyanto Andriyani E, Bangs MJ, , 2015. Comparison of rapid diagnostic test for Plasmotec-3, microscopy, and quantitative real time PCR for diagnoses of Plasmodium falciparum and Plasmodium vivax infections in Mimika Regency, Papua, Indonesia. Malar J 14: 103.[Crossref] [Google Scholar]
  5. Hill E, Amatuzio DS, , 1949. Southwest Pacific vivax malaria: clinical features and observations concerning duration of clinical activity. Am J Trop Med Hyg 29: 203214. [Google Scholar]
  6. Price RN, von Seidlein L, Valecha N, Nosten F, Baird JK, White NJ, , 2014. Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis. Lancet Infect Dis 14: 982991.[Crossref] [Google Scholar]
  7. Sutanto I, Tjahjono B, Basri H, Taylor WR, Putri FA, Meilia RA, Setiabudy R, Nurleila S, Ekawati LL, Elyazar I, Farrar J, Sudoyo H, Baird JK, , 2013. Randomized, open-label trial of primaquine against vivax malaria relapse in Indonesia. Antimicrob Agents Chemother 57: 11281135.[Crossref] [Google Scholar]
  8. Satyagraha AW, Sadhewa A, Baramuli V, Elvira R, Ridenour C, Elyazar I, Noviyanti R, Coutrier FN, Harahap AR, Baird JK, , 2015. G6PD deficiency at Sumba in eastern Indonesia is prevalent, diverse and severe: implications for primaquine therapy against relapsing vivax malaria. PLoS Negl Trop Dis 9: e0003602.[Crossref] [Google Scholar]
  9. Takken W, Snellen WB, Verhave JP, Knols BGJ, Asmosoedjonon S, , 1990. Environmental Measures for Malaria Control in Indonesia: An Historical Review on Species Sanitation. Wageningen University Papers. Wageningen, The Netherlands: Wageningen Agricultural University. [Google Scholar]
  10. Elyazar IR, Hay SI, Baird JK, , 2011. Malaria distribution, prevalence, drug resistance and control in Indonesia. Adv Parasitol 74: 41175.[Crossref] [Google Scholar]
  11. Syafruddin D, Krisin Asih P, Sekartuti Dewi RM, Coutrier F, Rozy IE, Susanti AI, Elyazar IR, Sutaminhardja A, Rahmat A, Kinzer M, Rogers WO, , 2009. Seasonal prevalence of malaria in West Sumba district, Indonesia. Malar J 8: 8.[Crossref] [Google Scholar]
  12. Douglas NM, Nosten F, Ashley EA, Phaiphun L, van Vugt M, Sinhasivanon P, White NJ, Price RN, , 2011. Plasmodium vivax recurrence following falciparum and mixed species malaria: risk factors and effect of antimalarial kinetics. Clin Infect Dis 52: 612620.[Crossref] [Google Scholar]
  13. Baird JK, , 2011. Radical cure: the case for anti-relapse therapy against all malarias. Clin Infect Dis 27: 1116. [Google Scholar]
  14. Doolan DL, Dobano C, Baird JK, , 2009. Acquired immunity to malaria. Clin Microbiol Rev 22: 1336.[Crossref] [Google Scholar]
  15. Kaisar MM, Supali T, Wiria AE, Hamid F, Wammes LJ, Sartono E, Luty AJ, Brienen EA, Yazdanbakhsh M, van Lieshout L, Verweij JJ, , 2013. Epidemiology of Plasmodium infections in Flores Island, Indonesia using real-time PCR. Malar J 12: 169.[Crossref] [Google Scholar]
  16. Tadesse FG, Pett H, Baidjoe A, Lanke K, Grignard L, Sutherland C, Hall T, Drakeley C, Bousema T, Mamo H, , 2015. Submicroscopic carriage of Plasmodium falciparum and Plasmodium vivax in a low endemic area in Ethiopia where no parasitemia was detected by microscopy or rapid diagnostic test. Malar J 14: 303.[Crossref] [Google Scholar]
  17. Baird JK, Sismadi P, Ramzan A, Purnomo BW, Sekartuti Tjitra E, Rumoko BW, Arbani PR, , 1996. A focus of endemic malaria in Central Java. Am J Trop Med Hyg 54: 98104. [Google Scholar]
  18. Barcus MJ, Laihad F, Sururi M, Sismadi P, Marwoto H, Bangs MJ, Baird JK, , 2002. Epidemic malaria in the Menoreh Hills of Central Java. Am J Trop Med Hyg 66: 287292. [Google Scholar]
  19. Nelwan E, Ekawati LL, Tjahjono B, Sutanto I, Chand K, Ekasari T, Djoko D, Basri H, Taylor RW, Duparc S, Subekti D, Elyazar I, Noviyanti R, Sudoyo H, Baird JK, , 2015. Randomized trial of primaquine hypnozoitocidal efficacy when administered with artemisinin-combined blood schizontocides for radical cure of Plasmodium vivax in Indonesia. BMC Med 13: 294.[Crossref] [Google Scholar]
  20. Battle KE, Karhunen MS, Bhatt S, Gething PW, Howes RE, Golding N, van Boeckel TP, Messina JP, Shanks GD, Smith DL, Baird JK, Hay SI, , 2014. Geographical variation in Plasmodium vivax relapse. Malar J 13: 144.[Crossref] [Google Scholar]
  21. Pukrittayakamee S, Chantra A, Simpson JA, Vanijanonta S, Clemens R, Looareesuwan S, White NJ, , 2000. Therapeutic responses to different antimalarial drugs in vivax malaria. Antimicrob Agents Chemother 44: 16801685.[Crossref] [Google Scholar]
  22. Betuela I, Rosanas-Urgell A, Kiniboro B, Stanisic DI, Samol L, de Lazzari E, Del Portillo HA, Siba P, Alonso PL, Bassat Q, Mueller I, , 2012. Relapses contribute significantly to the risk of Plasmodium vivax infection and disease in Papua New Guinea children 1–5 years of age. J Infect Dis 206: 17711780.[Crossref] [Google Scholar]
  23. Howes RE, Dewi M, Piel FB, Monteiro WM, Battle KE, Messina JP, Sakuntabhai A, Satyagraha AW, Williams TN, Baird JK, Hay SI, , 2013. Spatial distribution of G6PD deficiency variants across malaria-endemic regions. Malar J 12: 418.[Crossref] [Google Scholar]
  24. Ratcliff A, Siswantoro H, Kenangalem E, Wuwung M, Brockman A, Edstein MD, Laihad F, Ebsworth EP, Anstey NM, Tjitra E, Price RN, , 2007. Therapeutic response of multidrug-resistant Plasmodium falciparum and P. vivax to chloroquine and sulfadoxine-pyrimethamine in southern Papua, Indonesia. Trans R Soc Trop Med Hyg 101: 351359.[Crossref] [Google Scholar]
  25. Ratcliff A, Siswantoro H, Kenangalem E, Maristela R, Wuwung RM, Laihad F, Ebsworth EP, Anstey NM, Tjitra E, Price RN, , 2007. Two fixed-dose artemisinin combinations for drug-resistant falciparum and vivax malaria in Papua, Indonesia: an open-label randomized comparison. Lancet 369: 757765.[Crossref] [Google Scholar]
  26. Hasugian AR, Purba HL, Kenagnalem E, Wuwung RM, Ebsworth EP, Maristela R, Penttinen PM, Laihad F, Anstey NM, Tjitra E, Price RN, , 2007. Dihydro-artemisinin-piperaquine versus artesunate-amodiaquine: superior efficacy and posttreatment prophylaxis against multidrug-resistant Plasmodium falciparum and Plasmodium vivax malaria. Clin Infect Dis 44: 10671074.[Crossref] [Google Scholar]
  27. Poespoprodja JR, Fobia W, Kengangalem E, Lampah DA, Sugiarto P, Tjitra E, Anstey NM, Price RN, , 2014. Dihydroartemisinin-piperaquine treatment of multidrug-resistant falciparum and vivax malaria in pregnancy. PLoS One 9: e84967. [Google Scholar]
  28. Gogtay N, Kannan S, Thatte UM, Olliaro PL, Sinclair D, , 2013. Artemisinin-based combination therapy for treating uncomplicated Plasmodium vivax malaria. Cochrane Database Syst Rev 10: CD008492. [Google Scholar]
  29. Harijanto PN, , 2010. Malaria treatment using artemisinin in Indonesia. Acta Med Indones 42: 5156. [Google Scholar]
  30. World Health Organization (WHO), 2015. Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: WHO. [Google Scholar]
  31. Rieckmann KH, Davis DR, Hutton DC, , 1989. Plasmodium vivax resistance to chloroquine? Lancet 2: 11831184.[Crossref] [Google Scholar]
  32. Collins WE, Sullivan JS, Fryauff DJ, Kendall J, Jennings V, Galland GG, Morris CL, , 2000. Adaptation of a chloroquine-resistant strain of Plasmodium vivax from Indonesia to New World monkeys. Am J Trop Med Hyg 62: 491495. [Google Scholar]
  33. Collins WE, Schwartz IK, Skinner JC, Morris C, Filipski VK, , 1992. The susceptibility of the Indonesian I/CDC strain of Plasmodium vivax to chloroquine. J Parasitol 78: 344349.[Crossref] [Google Scholar]
  34. Sutanto I, Endawati D, Ling LH, Laihad F, Setiabudy R, Baird JK, , 2010. Evaluation of the chloroquine therapy for vivax and falciparum malaria in southern Sumatra, western Indonesia. Malar J 9: 52.[Crossref] [Google Scholar]
  35. Kusriastuti R, Surya A, , 2012. New treatment policy of malaria as part of malaria control program in Indonesia. Acta Med Indones 44: 265269. [Google Scholar]
  36. Ingram RJ, Crenna-Darusallam C, Soebianto S, Noviyanti R, Baird JK, , 2014. The clinical and public health problem of relapse despite primaquine therapy: a case review of repeated relapses of Plasmodium vivax acquired in Papua New Guinea. Malar J 13: 488.[Crossref] [Google Scholar]
  37. John GK, Douglas NM, von Seidlein L, Nosten F, Baird JK, White NJ, Price RN, , 2012. Primaquine radical cure of Plasmodium vivax: a critical review of the literature. Malar J 11: 280.[Crossref] [Google Scholar]
  38. World Health Organization (WHO), 2015. Control and Elimination of Plasmodium vivax Malaria: A Technical Brief. Geneva, Switzerland: WHO, 64. [Google Scholar]
  39. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile FO, , 2010. Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study. PLoS Med 7: e1000221.[Crossref] [Google Scholar]
  40. Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Hasanuddin A, Warikar N, Sugiarto P, Tjitra E, Anstey NM, Price RN, , 2009. Vivax malaria: a major cause of morbidity in early infancy. Clin Infect Dis 48: 17041712.[Crossref] [Google Scholar]
  41. Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Warikar N, Seal A, McGready R, Sugiarto P, Tjitra E, Anstey NM, Price RN, , 2008. Adverse pregnancy outcomes in an area where multidrug-resistant Plasmodium vivax and Plasmodium falciparum infections are endemic. Clin Infect Dis 46: 13741381.[Crossref] [Google Scholar]
  42. McGready R, Lee SJ, Wiladphaingern J, Ashley EA, Rijken MJ, Boel M, Simpson JA, Paw MK, Pimanpanarak M, Mu O, Singhasivanon P, White NJ, Nosten F, , 2012. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study. Lancet Infect Dis 12: 388396.[Crossref] [Google Scholar]
  43. World Health Organization (WHO), 2015. World Malaria Report 2014. Geneva, Switzerland: WHO. [Google Scholar]
  44. Elyazar IR, Gething PW, Patil AP, Rogayah H, Kusriastuti R, Wismarini DM, Tarmizi SN, Baird JK, Hay SI, , 2011. Plasmodium falciparum endemicity in Indonesia 2010. PLoS One 6: e21315.[Crossref] [Google Scholar]
  45. Price RN, Tjitra E, Guerra CA, Yeung S, White NJ, Anstey NM, White NJ, , 2007. Vivax malaria: neglected and not benign. Am J Trop Med Hyg 77 (Suppl): 7987. [Google Scholar]
  46. Dhingra N, Jah P, Sharma VP, Cohen AA, Jotkar RM, Rodriguez PS, Bassani DG, Suraweera W, Laxminaryan R, Peto R, , 2010. Adult and child mortality in India. Lancet 376: 17681774.[Crossref] [Google Scholar]
  47. Nurleila S, Syafruddin D, Elyazar IR, Baird JK, , 2012. Serious and fatal illness associated with falciparum and vivax malaria among patients admitted to hospital at West Sumba in eastern Indonesia. Am J Trop Med Hyg 87: 4149.[Crossref] [Google Scholar]
  48. Tjitra E, Anstey NM, Sugiarto P, Warikar N, Kenangalem E, Karyana M, Lampah DA, Price RN, , 2008. Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. PLoS Med 5: e128.[Crossref] [Google Scholar]

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  • Received : 07 Feb 2016
  • Accepted : 07 Mar 2016
  • Published online : 28 Dec 2016

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