Epidemiology of Latency and Relapse in Plasmodium Vivax Malaria

Abstract

Malaria is a major contributor to morbidity and mortality globally. Historically, it has been thought Plasmodium vivax was not a major contributor to disease burden on a global scale. This paradigm is being rigorously re-evaluated, and evidence from diverse settings now suggests that infections with P. vivax can be both severe and fatal.

This increasing awareness has highlighted a critical gap: the vast majority of research has been directed towards P. falciparum, and so there has been a decades-long neglect of epidemiological and clinical studies of P. vivax. There exists a large body of historical data on human experimental infections with P. vivax from two major sources: pre antibiotic-era treatment for neurosyphilis (`malariotherapy?), and antimalarial drug trials in prison volunteers. In this thesis, portions of this evidence base have been re-examined and extended using modern epidemiological analyses with two primary main aims: to critically examine this accumulated knowledge base, and to inform current research agendas towards global malaria elimination.