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Missing malaria? Potential obstacles to diagnosis and hypnozoite eradication

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To the Editor: Bradbury and colleagues highlight some important challenges in managing Plasmodium vivax malaria when appropriate diagnostics and therapeutics are lacking.1

Their article, prompted by one of the authors acquiring P. vivax in Solomon Islands, should also prompt consideration of how these problems affect the populations of countries where our cases of imported malaria originate. The authors warn of increasing risks to Australians because of greater overseas travel. However, this is not actually happening here in Australia, where nationwide notifications have fallen dramatically in recent years2 — probably reflecting less exposure of travellers to endemic malaria as a result of significant global improvements in malaria control.3,4

Solomon Islands provides a good example of this — with Australian and international support, reductions of > 90% in malaria morbidity over the past 20 years have led to the tantalising possibility of complete elimination by 2030. However, P. vivax is problematic. In South Pacific populations, > 50% of cases arise from hypnozoite relapses, which constitute the major drivers of ongoing transmission.

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