Analysis of the relapse of imported Plasmodium vivax and Plasmodium ovale in five provinces of China

Hui Yan, Shujiao Wei, Yuan Sui, Shenning Lu, Weiwei Zhang, Xiangyang Feng, Ying Liu, Tao Zhang, Wei Ruan, Jing Xia, Wen Lin, Benedikt Ley, Sarah Auburn, Shizhu Li, Jun Li, Duoquan Wang

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BACKGROUND: The global battle against malaria is facing formidable challenges, particularly in controlling Plasmodium vivax and Plasmodium ovale, whose cases have not been reduced as effectively as Plasmodium falciparum because of their relapse. This study investigates the current situation and underlying factors contributing to relapse or recrudescence of imported cases of P. vivax and P. ovale, and seeks to provide a reference for reducing relapse or recrudescence in malaria-free areas and offers a scientific basis for designing strategies to prevent imported re-transmission. 

METHODS: This study analysed imported P. vivax and P. ovale in Anhui, Zhejiang, Henan, Hubei, and Guangxi provinces during 2014-2021 by retrospective analysis. A case-control study was conducted on patients who experienced relapse or recrudescence. 

RESULTS: From 2014 to 2021, 306 cases of P.vivax and 896 cases of P.ovale were included in the study, while 75 cases had relapse or recrudescence, including 49 cases of P. ovale (65.33%) and 26 cases of P. vivax (34.67%). Within less than 5 weeks after returning to the country, 122 cases of P. vivax (39.87%, 122/306) and 265 cases of P. ovale (29.58%, 265/896) occurred. Within less than 53 weeks, the ratio of P. vivax was 94.77% (290/306), and that of P. ovale was 89.96% (806/896). Among the cases experiencing relapse or recrudescence, only 1 case of P. vivax (1/26 3.85%) and 3 cases of P. ovale (3/49 6.12%) occurred within less than 5 weeks after the first onset, whereas 21 cases of P. vivax (21/26 80.77%) and 42 cases of P. ovale (42/49 85.71%) occurred within less than 53 weeks after the first onset. The difference in relapse or recrudescence due to different drugs and medication regimens and medical activities at various levels of medical institutions was statistically significant. 

CONCLUSION: In areas where malaria has been eliminated, routine health screening in a scientific time frame for people returning from at-risk areas can effectively improve the efficiency of preventing re-transmission, thereby reducing prevention costs and disease burden. Preventing patients from self-treating and strengthening medication regulations in health facilities are key measures to reduce relapse or recrudescence.

Original languageEnglish
Article number209
Pages (from-to)1-11
Number of pages11
JournalMalaria Journal
Issue number1
Publication statusPublished - 13 Jul 2023

Bibliographical note

Funding Information:
The research is supported by China–Africa cooperation project on malaria control under the Project No. 2020-C4-0002-3 and the programme of the Chinese Center for Tropical Diseases Research (No. 131031104000160004) as well as UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Small Grant (WHO Reference 2021/1104003-0). This study was funded by the Scientific Research Project of the Guangxi Health and Family Planning Commission (220170131).

Publisher Copyright:
© 2023, The Author(s).


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