Cambodia is the epicentre of the emergence of Plasmodium falciparum drug resistance. Much less is known regarding the drug susceptibility of the co-endemic Plasmodium vivax. Only in vitro drug assays can determine the parasite’s intrinsic susceptibility, but these are challenging to implement for P. vivax and rarely performed.
Since 2012, single low dose of primaquine (SLDPQ, 0.25mg/kg) has been recommended with artemisinin-based combination therapies, as first-line treatment of acute uncomplicated Plasmodium falciparum malaria, to interrupt its transmission, especially in low transmission settings of multidrug, including artemisinin, resistance. Policy makers in Cambodia have been reluctant to implement this recommendation due to primaquine safety concerns and lack of data on its efficacy.
In “Hemolytic Dynamics of Weekly Primaquine Antirelapse Therapy Among Cambodians With Acute Plasmodium vivax Malaria With or Without Glucose-6-Phosphate Dehydrogenase Deficiency” by Taylor et al [J Infect Dis 2019; 220(11): 1750–60], P values should be P < 0.001 where 0.000 is written. This has been updated in the article.
The authors regret these errors.
Adding 8-aminoquinoline to the treatment of falciparum, in addition to vivax malaria, in locations where infections with both species are prevalent could prevent vivax reactivation. The potential risk of haemolysis under a universal radical cure policy using 8-aminoquinoline needs to be weighed against the benefit of preventing repeated vivax episodes. Estimating the frequency of sequential Plasmodium vivax infections following either falciparum or vivax malaria episodes is needed for such an assessment.
The ongoing spread of artemisinin resistant Plasmodium falciparum malaria is a major threat to global health. In response, countries in the Greater Mekong Sub-region, including Cambodia, have declared ambitious goals to eliminate malaria. Major challenges include the lack of information on the at-risk population-individuals who live or work in or near the forest where the malaria vectors are found, including plantation workers. This study aimed to address this knowledge gap through a cross-sectional survey conducted in rubber plantations in Cambodia in 2014.
The Malaria Consortium has published ‘Moving towards malaria elimination: developing innovative tools for malaria surveillance in Cambodia‘ as part of their ‘Learning Paper’ series.
Most of us that have worked in the field of malaria for a few decades have gone through periods where we suddenly noticed changes in drug policy. When chloroquine was replaced by sulfadoxine-pyremethamine as a first-line drug, later to be replaced by artemisinin combination therapies (ACTs).
But the world is now faced with a new challenge. That of preventing artemisinin resistance from escaping south-east Asia. Without anything to replace it (yet), this is a looming catastrophe, according to Joel Breman in an interview with TropIKA.net. It may still be confined to the Thai-Cambodia border, although nobody really nows have far it has spread.