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Allied soldiers suffered repeated relapses of Plasmodium vivax malaria during and immediately after the Second World War. This surprised many military medical officers who had underestimated the huge casualties produced by P. vivax malaria. Tropical (Philippines) strains of P. vivax were known to relapse more frequently than those from temperate regions (the United States). Intense exposure to mosquito infection likely increased the absolute number of hypnozoites in soldiers’ livers. Both quinine and quinacrine were used as chemosuppressive agents, but their inconsistent use until at least 1943 promoted intermittent parasitological failures. Fear of hemolytic reactions after a mass casualty event in 1943 engendered fear and avoidance of the only 8-aminoquinoline pamaquine then available to cure relapses. Variable chemosuppression likely prevented acquisition of effective parasitological immunity. Unexpectedly high relapse rates in soldiers were likely an indirect measure of the high hypnozoite burden and suggest how difficult it will be to eliminate P. vivax malaria from endemic areas.
Financial support: G. D. S. is an employee of the Australian Defence Organization and a retired U.S. Army Medical Corps Officer. No specific funding was given for this epidemiological study.
Disclaimer: The opinions expressed are those of the author and do not necessarily reflect those of the Australian Defence Force or the U.S. Department of Defense.
Author’s address: G. Dennis Shanks, Australian Defence Force Malaria and Infectious Diseases Institute, Enoggera, Australia, and University of Queensland, School of Public Health, Brisbane, Australia, E-mail: firstname.lastname@example.org.