Plasmodium vivaxrelapse, reinfection and recrudescence estimation using genetic data

Malaria is a major public health concern. Among the two most important causes of human malaria, Plasmodium vivax is the hardest to eliminate, owing largely to its ability to relapse (cause recurrent blood-stage infection following the activation of dormant liver-stage parasites called hypnozoites). Recurrent vivax malaria can also follow a failure to treat a preceding blood-stage infection (recrudescence) and, in endemic settings, a new infectious mosquito bite (reinfection). Understanding the cause of recurrent vivax malaria is critical for disease control efforts, e.g., to estimate the efficacy of a hypnozoiticidal drug, relapse needs to be separated from reinfection and recrudescence. In this report we describe the Pv3R statistical model designed to estimate using P. vivax genetic data the probability that a recurrent P. vivax blood-stage infection is a relapse, reinfection or recrudescence (the Pv 3Rs).