Treating and Eliminating Plasmodium vivax – Where Are and What Might be Next?

Walter RJ Taylor1,2,3 and Podjanee Jittamala4

1 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
2 Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom
3 Service de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève, La Suisse
4 Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Correspondence to Walter RJ Taylor (FRCP),
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Ratchathewi, Bangkok, 10400, Thailand. Email:


Plasmodium vivax has a unique life cycle in that the hypnozoite is key to the continuing cycle of blood infections called relapses. Treating the liver hypnozoites is an essential step to realising the elimination of P. vivax.
Just two drugs are available currently for killing hypnozoites: primaquine, which is about 60 years old, and the newly registered tafenoquine. Both cause acute haemolytic anaemia in glucose-6-phosphate dehydrogenase deficiency (G6PDd) and this is a major stumbling block to deployment primaquine and tafenoquine.
Herein, we summarise the current status of the global vivax burden, discuss the challenges in treating vivax-infected patients and what can be done to overcome these hurdles to take elimination forward.

Keywords: Plasmodium vivax, primaquine, tafenoquine, hypnozoite