Modeling the Effects of Relapse in the Transmission Dynamics of Malaria Parasites

Often regarded as “benign,”Plasmodium vivaxinfections lay in the shadows of the much more virulentP. falciparuminfections. However, about 1.98 billion people are at risk of both parasites worldwide, stressing the need to understand the epidemiology ofPlasmodium vivax, particularly under the scope of decreasingP. falciparumprevalence and ecological interactions between both species. Two epidemiological observations put the dynamics of both species into perspective: (1) ACT campaigns have had a greater impact onP. falciparumprevalence. (2) Complete clinical immunity is attained at younger ages forP. vivax, under similar infection rates. We systematically compared two mathematical models of transmission for both Plasmodium species. Simulations suggest that an ACT therapy combined with a hypnozoite killing drug would eliminate both species. However,P. vivaxelimination is predicted to be unstable. Differences in age profiles of clinical malaria can be explained solely byP. vivax's ability to relapse, which accelerates the acquisition of clinical immunity and serves as an immunity boosting mechanism.P. vivaxtransmission can subsist in areas of low mosquito abundance and is robust to drug administration initiatives due to relapse, making it an inconvenient and cumbersome, yet less lethal alternative toP. falciparum.