Microgeographical Differences of Plasmodium vivax Relapse and Re-Infection in the Peruvian Amazon

• Published in: The American journal of tropical medicine and hygiene Vol. 89; no. 2; pp. 326 - 338
• Main Authors: Chuquiyauri, Raul, Peñataro, Pablo, Brouwer, Kimberly C., Fasabi, Manuel, Calderon, Maritza, Torres, Sonia, Gilman, Robert H., Kosek, Margaret, Vinetz, Joseph M.
• Format: Journal Article
• Language: English
• Published: United States The American Society of Tropical Medicine and Hygiene 01.08.2013
• Subjects: Adolescent; Adult; Child; Child, Preschool; DNA, Protozoan - blood; Female; Genetic Markers; Genotype; Humans; Malaria, Vivax - epidemiology; Malaria, Vivax - parasitology; Male; Middle Aged; Molecular Epidemiology; Peru - epidemiology; Plasmodium vivax; Plasmodium vivax - classification; Plasmodium vivax - genetics; Plasmodium vivax - isolation & purification; Polymerase Chain Reaction; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Protozoan Proteins - genetics; Recurrence; Time Factors; Peru; South America, Amazonia; South America, Amazon R
• ISSN: 0002-9637; 1476-1645; 1476-1645
• DOI: 10.4269/ajtmh.13-0060

To determine the magnitude of Plasmodium vivax relapsing malaria in rural Amazonia, we carried out a study in four sites in northeastern Peru. Polymerase chain reaction-restriction fragment length polymorphism of PvMSP-3α and tandem repeat (TR) markers were compared for their ability to distinguish relapse versus reinfection. Of 1,507 subjects with P. vivax malaria, 354 developed > 1 episode during the study; 97 of 354 (27.5%) were defined as relapse using Pvmsp-3α alone. The addition of TR polymorphism analysis significantly reduced the number of definitively defined relapses to 26 of 354 (7.4%) ( P < 0.05). Multivariate logistic regression modeling showed that the probability of having > 1 infection was associated with the following: subjects in Mazan (odds ratio [OR] = 2.56; 95% confidence interval [CI] 1.87, 3.51), 15–44 years of age (OR = 1.49; 95% CI 1.03, 2.15), traveling for job purposes (OR = 1.45; 95%CI 1.03, 2.06), and travel within past month (OR = 1.46; 95% CI 1.0, 2.14). The high discriminatory capacity of the molecular tools shown here is useful for understanding the micro-geography of malaria transmission.