Letters
Infectious diseases
Volume 202 - Issue 7

Missing malaria? Potential obstacles to diagnosis and hypnozoite eradication

Authors:  Harin Karunajeewa, Andreea Waltmann, Lyndes Wini and Ivo Mueller

Med J Aust 2015; 202 (7): 360. || doi: 10.5694/mja14.01760
Published online: 20 April 2015
Tantalising possibility of nationwide elimination of malaria in Solomon Islands
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To the Editor: Bradbury and colleagues highlight some important challenges in managing Plasmodium vivax malaria when appropriate diagnostics and therapeutics are lacking.1

Their article, prompted by one of the authors acquiring P. vivax in Solomon Islands, should also prompt consideration of how these problems affect the populations of countries where our cases of imported malaria originate. The authors warn of increasing risks to Australians because of greater overseas travel. However, this is not actually happening here in Australia, where nationwide notifications have fallen dramatically in recent years2 — probably reflecting less exposure of travellers to endemic malaria as a result of significant global improvements in malaria control.3,4

Solomon Islands provides a good example of this — with Australian and international support, reductions of > 90% in malaria morbidity over the past 20 years have led to the tantalising possibility of complete elimination by 2030. However, P. vivax is problematic. In South Pacific populations, > 50% of cases arise from hypnozoite relapses, which constitute the major drivers of ongoing transmission.5 Primaquine, recommended for routine case management, is rarely used in Solomon Islands, owing to nationwide unavailability of testing for glucose-6-phophate dehydrogenase deficiency. A suitably cheap, accurate, temperature-stable point-of-care test is urgently needed, as is ongoing research to determine the best way to deploy antirelapse therapy in this setting.

Successful elimination of malaria in Solomon Islands and neighbouring countries would be a historic achievement for the health of the peoples of our region, and it would also pay a dividend for Australia's own public health and biosecurity.

Authors

  • Harin Karunajeewa MB BS, FRACP, PhD1,2
  • Andreea Waltmann1
  • Lyndes Wini3
  • Ivo Mueller1
  • 1. Walter and Eliza Hall Institute, Melbourne, VIC.
  • 2. Western Health, Melbourne, VIC.
  • 3. Ministry of Health, Honiara, Solomon Islands.

Correspondence: karunajeewa.h@wehi.edu.au

Competing interests

No relevant disclosures.

References

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