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
Published online: 20 April 2015
Tantalising possibility of nationwide elimination of malaria in Solomon Islands
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.
Competing interests
No relevant disclosures.
References
- Bradbury RS, Robertson G, Norton RE, Taylor-Robinson AW. Missing malaria? Potential obstacles to diagnosis and hypnozoite eradication. Med J Aust 2014; 201: 630-631. 1
- Knope KE, Doggett SL, Kurucz N, et al. Arboviral diseases and malaria in Australia, 2011–12: annual report of the National Arbovirus and Malaria Advisory Committee. Commun Dis Intell Q Rep 2014; 38: E122-E142. 2
- Leder K, Torresi J, Brownstein JS, et al. Travel-associated illness trends and clusters, 2000–2010. Emerg Infect Dis 2013; 19: 1049-1073. 3
- Murray CJ, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 1005-1070. 4
- Betuela I, Rosanas-Urgell A, Kiniboro B, et al. Relapses contribute significantly to the risk of Plasmodium vivax infection and disease in Papua New Guinean children 1–5 years of age. J Infect Dis 2012; 206: 1771-1780. lefthere