Biology and Epidemiology of Malaria Recurrence: Implication for Control and Elimination

Abstract

Malaria recurrence not only increases its clinical episodes, but also sustains transmission. It significantly contributes to a high burden of malaria and impedes elimination. Malaria recurrence can be due to reinfection, relapse, or recrudescence. Based on the type of recurrence, parasites exhibit similar or dissimilar genotypes compared to the genotype involved in initial infection. This review aimed at showing a comprehensive overview of malaria recurrence. Molecular techniques, such as real-time polymerase chain reaction (PCR), nested PCR, multiplex PCR, and sequencing, help to characterize malaria recurrence. However, these tools are hardly accessible in malaria-endemic areas and are unable to detect liver hypnozoites. Moreover, PCR is unable to adequately differentiate between relapse and reinfection of P. vivax. Recurrent malaria, particularly relapse, accounts for major portion of malaria prevalence. Through renewed parasitemia, recurrence remained as a daunting public health problem. More works remain to overcome the challenges of recurrence in efforts to control and eliminate malaria. Limited understanding of malaria recurrence impedes the development of robust tools and strategies for effective mitigation. Continued biological and epidemiological studies help unravel the persistent complexities of malaria recurrence and develop ideal tool to fight malaria.