Volume 80, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 infections and operational research aimed at parasite pool elimination.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Mendis K, Sina BJ, Marchesini P, Carter R, 2001. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg 64 : 97–106. [Google Scholar]
  2. Rodríguez MH, Loyola EG, Betanzos AF, Villarreal C, Bown DN, 1994. Control focal. Tratamiento focal usando quimioprofilaxis y rociado intradomiciliar con insecticida para el control de la malaria en el sur de México. Gac Med Mex 130 : 313–319. [Google Scholar]
  3. Price RN, Tjira E, Guerra CA, Yeung S, White NJ, Anstey NM, 2007. Vivax malaria: neglected and not benign. Am J Trop Med Hyg 77 : 79–87. [Google Scholar]
  4. Adak T, Sharma VP, Orlov VS, 1998. Studies on the Plasmodium vivax relapse pattern in Delhi, India. Am J Trop Med Hyg 59 : 175–179. [Google Scholar]
  5. Boulos M, Amato-Neto V, Dutra AP, Di Santi SM, Shiroma M, 1991. Análise da freqüência de recaídas de malária por Plasmodium vivax em região não endémica (São Paulo, Brasil). Rev Inst Med Trop Sao Paulo 33 : 143–146. [Google Scholar]
  6. Contacos PG, Collins WE, Jeffery GM, Krotoski WA, Howard W, 1972. Studies on the characterization of Plasmodium vivax strains from Central America. Am J Trop Med Hyg 21 : 707–712. [Google Scholar]
  7. Gogtay NJ, Desai S, Kadam VS, Kamtekar KD, Dalvi SS, Kshirsagar NA, 1999. Relapse pattern of Plasmodium vivax in Mumbai: a study of 283 cases of vivax malaria. J Assoc Physicians India 48 : 1085–1086. [Google Scholar]
  8. Chanon KE, Méndez-Galván JF, Galindo-Jaramillo JM, Olguin-Bernal H, Borja-Aburto VH, 2003. Cooperative actions to achieve malaria control without the use of DDT. Int J Hyg Environ Health 206 : 387–394. [Google Scholar]
  9. Rodriguez MH, 2006. Malaria and dengue vector biology and control in Latin America. Bridging Laboratory and Field Research for Genetic Control of Disease Vectors. Series: Wageningen UR Frontis Series, Vol. 11. Knols BGJ, Louis C, Bogers RJ, eds. Dordrecht, The Netherlands: Springer, pp 129–141.
  10. Alving AS, Johnson CF, Tarlov AR, Brewer GJ, Kellermeyer RW, Carson PE, 1960. Mitigation of the haemolytic effect of primaquine and enhancement of its action against exoerytrocytic forms of the Chesson strain of Plasmodium vivax by intermittent regimens of drug administration: a preliminary report. Bull World Health Organ 22 : 621–631. [Google Scholar]
  11. Méndez-Galván JF, Guerrero-Alvarado J, González-Mora M, Pérez-Landa M, Quintero-Cabanillas R, 1984. Evaluación de un esquema alternativo de tratamiento para el control del paludismo. Salud Publica Mex 26 : 561–572. [Google Scholar]
  12. Cedillos RA, Warren M, Jeffery GM, 1978. Field evaluation of primaquine in the control of Plasmodium vivax. Am J Trop Med Hyg 27 : 466–472. [Google Scholar]
  13. Arnold J, Alving AS, Hockwald RS, Clayman CB, Dern RJ, Beutler E, Jeffery GM, 1954. The effect of continuous and intermittent primaquine therapy on the relapse rate of Chesson strain vivax malaria. J Lab Clin Med 44 : 429–438. [Google Scholar]
  14. Bunnang DB, Karbwang J, Thanavibul A, Chittamas S, Ratanapongse Y, Korbsiri C, Banchang KN, Harinasuta T, 1994. High dose primaquine in primaquine resistant vivax malaria. Trans R Soc Trop Med Hyg 88 : 218–219. [Google Scholar]
  15. Krotoski WA, 1985. Discovery of the hypnozoite and a new theory of malarial relapse. Trans R Soc Trop Med Hyg 79 : 1–11. [Google Scholar]
  16. Krotoski WA, Collins WE, Bray RS, Garnham PCCC, Cogdwell FB, Gwatz R, Killick-Kendrick R, Wolf RH, Sinden R, Koontz LC, Stanfill PS, 1982. Demonstration of hypnozoites in sporozoite transmitted Plasmodium vivax infection. Am J Trop Med Hyg 31 : 1291–1293. [Google Scholar]
  17. Fernández-Salas I, Roberts DR, Rodriguez MH, Marina-Fernandez CF, 1994. Bionomics of larval populations of Anopheles pseudopunctipennis in the Tapachula foothills area, southern México. J Am Mosq Control Assoc 10 : 477–485. [Google Scholar]
  18. Mason J, 1975. Patterns of Plasmodium vivax recurrences in a high-incidence coastal area of El Salvador, CA. Am J Trop Med Hyg 24 : 581–585. [Google Scholar]
  19. Chadee DD, Kitron U, 1999. Spatial and temporal patterns of imported malaria cases and local transmission in Trinidad. Am J Trop Med Hyg 61 : 513–517. [Google Scholar]
  20. Feighner BH, Pak SI, Novakoski WL, Kelsey L, Strickman D, 1998. Reemergence of Plasmodium vivax malaria in the Republic of Korea. Emerg Infect Dis 4 : 295–297. [Google Scholar]
  21. Charoenlap P, Harinasuta T, 1973. Relapses of vivax malaria after conventional course of primaquine and chloroquine—report of 2 cases. Southeast Asian J Trop Med Public Health 4 : 131–137. [Google Scholar]
  22. Rombo L, Edawrads G, Ward SA, Eriksson G, Lindquist L, Lindberg A, Runehagen A, Bjorkman A, Hylander NO, 1987. Seven patients with relapses of Plasmodium vivax or P. ovale despite primaquine treatment. Trop Med Parasitol 38 : 49–50. [Google Scholar]
  23. Arias AE, Corredor A, 1989. Low response of Colombian strains of Plasmodium vivax to classical antimalarial therapy. Trop Med Parasitol 40 : 21–23. [Google Scholar]
  24. Collins WE, Jeffery GM, 1996. Primaquine resistance in Plasmodium vivax. Am J Trop Med Hyg 55 : 243–249. [Google Scholar]
  25. Baird JK, Hoffman SL, 2004. Primaquine therapy for malaria. CID 39 : 1336–1345. [Google Scholar]
  26. Gomez-Mendoza I, 1965. Comparative study of two regimens of radical treatment of vivax malaria in Mexico. Unpublished document. WHO/MAL/527.65.
  27. Dua VK, Sharma VP, 2001. Plasmodium vivax relapses after 5 days of primaquine treatment, in some industrial complexes of India. Ann Trop Med Parasitol 95 : 655–659. [Google Scholar]
  28. Villalobos-Salcedo JM, Tada MS, Kimura E, Menezes MJ, Pereirada-Silva LH, 2000. In-vivo sensitivity of Plasmodium vivax isolates from Rondônia nia (western Amazon region, Brazil) to regimens including chloroquine and primaquine. Ann Trop Med Parasitol 94 : 749–758. [Google Scholar]
  29. Gogtay NJ, Desai S, Kamtekar KD, Kadam VS, Dalvi SS, Kshirsakar NA, 1999. Efficacies of 5- and 14-day primaquine regimens in the prevention of relapses in Plasmodium vivax infections. Ann Trop Med Parasitol 93 : 809–812. [Google Scholar]
  30. Adak T, Valecha N, Sharma VP, 2001. Plasmodium vivax polymorphisms in a clinical drug trial. Clin Diagn Lab Immunol 8 : 891–894. [Google Scholar]
  31. Arias AE, Corredor A, 1989. Low response of Colombian strains of Plasmodium vivax to classical antimalarial therapy. Trop Med Parasitol 40 : 21–23. [Google Scholar]
  32. Baird JK, Hoffman SL, 2004. Primaquine therapy for malaria. Clin Infect Dis 39 : 1336–1345. [Google Scholar]
  33. Warhurst DC, 1984. Why are primaquine and other 8 aminoquino-lines particularly effective against the mature gametocytes and the hypnozoites of malaria? Ann Trop Med Parasitol 78 : 165. [Google Scholar]
  34. Danis-Lozano R, Rodriguez MH, Betanzos-Reyes AF, Hernández-Ávila JE, González-Cerón L, Méndez-Galván JF, Velázquez-Monroy OJ, Tapia-Conyer R, 2007. Individual risk factors for Plasmodium vivax: infection in the residual malaria transmission focus of Oaxaca, Mexico. Salud Publica Mex 49 : 199–209. [Google Scholar]
  35. Craig AA, Kain KC, 1996. Molecular analysis of strains of Plasmodium vivax paired primary and relapse infections. J Infect Dis 174 : 373–379. [Google Scholar]
  36. Schwartz E, Regev-Yochay G, Kurnik D, 2000. A consideration of primaquine dose adjustment for radical cure of Plasmodium vivax malaria. Am J Trop Med Hyg 62 : 393–395. [Google Scholar]

Data & Media loading...

  • Received : 03 Jun 2008
  • Accepted : 05 Feb 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error