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

Mario H. Rodriguez Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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Ángel F. Betanzos-Reyes Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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Juan E. Hernández-Ávila Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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Jorge F. Méndez-Galván Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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Rogelio Danis-Lozano Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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Armando Altamirano-Jiménez Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Regional Center for Research in Public Health, National Institute of Public Health, Tapachula, Chiapas, Mexico; Pan-American Health Organization/World Health Organization Representation, Mexico City, Mexico; Department of Informatics and Medical Geography, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Children’s Hospital of Mexico, Mexico City, Mexico; Secretariat of Health of the State of Oaxaca, Oaxaca City, Oaxaca, Mexico

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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.

Author Notes

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