title: Suppressive chemoprophylaxis invites avoidable risk of serious illness caused by Plasmodium vivax malaria.
abstract: Despite inadequacy in preventing vivax malaria after travel, suppressive chemoprophylaxis has dominated travel medicine strategy since the advent of chloroquine in 1946. The lethal threat of falciparum malaria versus the perceived benign consequence of vivax malaria underpins this strategic posture. Recent evidence demonstrating vivax malaria as often pernicious should prompt reconsideration of that posture. Causal prophylaxis kills early developing forms of plasmodia in the liver, thus preventing attacks of falciparum and vivax malaria during travel and delayed onset vivax malaria following travel. Primaquine is the only available drug for this application, and has good evidence of safety, tolerability and efficacy in non-pregnant, G6PD-normal travelers. The primaquine label, however, carries no such indication. Risk of pernicious vivax malaria from all across the endemic regions of the globe, including much of sub-Saharan Africa, should raise consideration of daily primaquine during travel as the preferred front-line option for chemoprophylaxis against malaria in travelers.
authors: Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta 10430, Indonesia. kbaird@eocru.org
authors: J Kevin
authors: JK
authors: Baird
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D018890:Chemoprevention; D005260:Female; D006801:Humans; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D010966:Plasmodium vivax / Q000187:drug effects*; D011247:Pregnancy; D011319:Primaquine / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D057236:Travel Medicine / Q000379:methods
chemical_list: D000962:Antimalarials; D011319:Primaquine