Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Ticks, Mexico (original) (raw)

several years after initial infection (1). Issues with primaquine (i.e., CYP2D6-poor metabolizers or hemolysis risk in patients with glucose-6-phosphate dehydrogenase deficiency) complicate treatment of dormant hypnozoites that cause relapse (1). A new treatment, tafenoquine, which still causes hemolysis in glucose-6-phosphate dehydrogenase deficiency, was recently approved in the United States as a single dose for prevention of P. vivax malaria relapse (10), although this medication might not reach at-risk groups in South America. Ecuador and Peru currently follow the Pan American Health Organization guidelines regarding primaquine use (https://www.paho.org/hq/dmdocuments/2011/ TreatmentGuidelines-2nd-ed-2010-eng.pdf). Local ministries of health responded quickly to these cases and implemented case surveillance. However, reductions in resources after elimination of local malaria transmission in 2011-2012 severely limited malaria control efforts in Ecuador and Peru. Imported cases of malaria at the Ecuador-Peru border region pose a serious threat of continued resurgence in local transmission. We urge international solutions for Venezuela's humanitarian crisis and augmentation of infectious disease surveillance and control along migration routes and in surrounding regions.