Plasmodium vivax malaria: status in the Republic of Korea following reemergence - PubMed (original) (raw)

Review

Plasmodium vivax malaria: status in the Republic of Korea following reemergence

Jae-Won Park et al. Korean J Parasitol. 2009 Oct.

Abstract

The annual incidence of Plasmodium vivax malaria that reemerged in the Republic of Korea (ROK) in 1993 increased annually, reaching 4,142 cases in 2000, decreased to 864 cases in 2004, and once again increased to reach more than 2,000 cases by 2007. Early after reemergence, more than two-thirds of the total annual cases were reported among military personnel. However, subsequently, the proportion of civilian cases increased consistently, reaching over 60% in 2006. P. vivax malaria has mainly occurred in the areas adjacent to the Demilitarized Zone, which strongly suggests that malaria situation in ROK has been directly influenced by infected mosquitoes originating from the Democratic People's Republic of Korea (DPRK). Besides the direct influence from DPRK, local transmission within ROK was also likely. P. vivax malaria in ROK exhibited a typical unstable pattern with a unimodal peak from June through September. Chemoprophylaxis with hydroxychloroquine (HCQ) and primaquine, which was expanded from approximately 16,000 soldiers in 1997 to 200,000 soldiers in 2005, contributed to the reduction in number of cases among military personnel. However, the efficacy of the mass chemoprophylaxis has been hampered by poor compliance. Since 2000, many prophylactic failure cases due to resistance to the HCQ prophylactic regimen have been reported and 2 cases of chloroquine (CQ)-resistant P. vivax were reported, representing the first-known cases of CQ-resistant P. vivax from a temperate region of Asia. Continuous surveillance and monitoring are warranted to prevent further expansion of CQ-resistant P. vivax in ROK.

Keywords: Plasmodium vivax; Republic of Korea; chemoprophylaxis; chloroquine-resistance; demilitarized zone; local transmission; malaria; reemergence; unstable malaria.

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Figures

Fig. 1

Proportion of P. vivax malaria ROK patients after reemergence. Data are from references [7-10].

Fig. 2

Distribution of reported P. vivax malaria cases among ROK military personnel and civilians in malaria-risk areas during 1993-2007. Data and figures are from references [7-10]. (a) Administrative boundaries of the malaria-risk areas in ROK. DMZ represents the Demilitarized Zone. (b) Annual malaria cases among military personnel (left panels) and civilians (right panels). Large dots represent 100 cases, medium dots 10 cases, and small dots 1 case. The asterisk in the 1993 military personnel map represents the first case. Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003].

Fig. 2

Fig. 3

Number of P. vivax malaria cases of civilians, reported at 10-day intervals, 1999-2007, ROK. Data and figures are from references [7-10]. Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003; 73, 604-608, 2005; 76, 865-868, 2007; 81, 605-610, 2009].

Fig. 4

Date of diagnosis for ROK military personnel without previous exposure to malaria the preceding year. The y-axis of each graph represents the number of patients. Data and figure are from reference [7]. Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 69, 159-167, 2003].

Fig. 5

Number of the first late primary attack cases of P. vivax malaria among veterans discharged from the military between May, 2003 and April, 2006, during 2 consecutive malaria-transmission seasons after their discharge. Data and figure are from reference [10]. Copyright © The American Society of Tropical Medicine and Hygiene [American Journal of Tropical Medicine and Hygiene, 81, 605-610, 2009].

Fig. 6

Ten-day incident cases of malaria involving soldiers and civilians in ROK, January 1999 through December 2002. Arrows represent the starting point of chemoprophylaxis in each year. Data and figures are from reference [16]. Copyright © The Korean Academy of Medical Sciences [Journal of Korean Medical Science, 20, 707-712, 2005].

Fig. 7

Comparison of the actual plasma concentrations of HCQ in 61 soldier patients infected with malaria parasites despite chemoprophylaxis for longer than 4 weeks to the simulated plasma time-concentration profiles of HCQ after oral administration of HCQ sulfate with a prophylactic dose of 400 mg/week. Data and figure are from reference [17]. Copyright © American Society for Microbiology [Antimicrobial Agents and Chemotherapy, 53, 1468-1475, 2009]

Fig. 8

Official report of annual incidence of P. vivax malaria in DPRK. Data and figure are from reference [20]. Copyright © Ajou Institute of Korean Unification and Health Care, [Korean Unification and Health Care, 6, 31-58, 2007]

Fig. 9

Monthly incidence of P. vivax malaria in DPRK, January 2001 through December 2002. Data and figure are from reference [20]. Copyright © Ajou Institute of Korean Unification and Health Care, [Korean Unification and Health Care, 6, 31-58, 2007].

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Plasmodium vivax malaria: status in the Republic of Korea following reemergence - PubMed (original) (raw)