RADICAL CURE FOR AYODHIA PITALOKA PASARIBU

VIVAX ELIMINATION Vice chair, National Malaria Expert

Committee for Diagnosis and
Management

1
 Malaria Situation in Indonesia in 2020

62% or 318 district/cities are malaria

free

80.4% Indonesian live in free malaria

zone

Stagnant

Malaria cases decrease between 2010-

2014 but stagnant afterwards, implies that malaria
control has reached its most difficult stage to reduce the
cases in high endemic areas and low endemic areas to
maintain as free zone.

2
Indonesia Plan for Malaria
Elimination in 2030

3
 Plasmodium
vivax
epidemiology

Katherine E Battle et al, Lancet 2019

4
 Challenges in vivax elimination

Chu CS et al, Plos Med 2021 5

6
Radical cure treatment

7
Baird et al. CID 2004 8
8-Aminoquinoline

9
Primaquine as anti-relapse • Primaquine (PQ)à 8-aminoquinoline à
mainstay radical therapy since 1950.
• The only drug widely use as anti-relapse.

• 14-day efficacy is not good à unless supervised

• Low compliance

• Way to improve compliance à shorten the

duration and increase the dose
• The radical curative efficacy of PQ depends
on total dose given

Krudsood S et al. AM J Trop Hyg 2008

Douglas et al. Plos Med 2017

10
Thriemer K et al. Malaria Journal 2017
Baird et al. CID 2004 11
7-day (1mg/kg/day) vs 14-day (0.5mg/kg/day) vs placebo
12
 Vietnam
Afghanistan • Dak-O
• Mehtarlam Hospital, Laghman • Bu Gia
• Kama District Hospital, Jalabad • Krong Pa

Coordinating Centres
• MORU, Bangkok
• Menzies, Darwin
• Eijkman, Jakarta

Indonesia
• Tanjung Leidong
• Hanura
Ethiopia
• Metehara
• Arba Minch 13
13
14
15
Role of Tafenaquine
• Tafenoquine (TQ), à an 8-aminoquinoline
that is eliminated much slower than PQ (14
to 28 days versus 4 to 6 hours).

• A single dose à cannot stop if hemolysis

occur

• TQ has been licensed for use in G6PD

normal patients, à defined as a G6PD
enzyme activity greater than 70%

• Strictly use above 16 years of

age
16
Cuentas AL et al. N Engl J 2019 17
 Hemolysis risk for G6PD deficient

Pfeffer et al. Plos Med 2020 18

Commons R et al. MJA 2020 19
 Choose most suitable drug regimen à PQ high
dose or single dose TQ

Which G6PD test required? à Qualitative or

Optimal quantitative test

radical cure Measures to ensure patient safety à

strategies supervision, adequate capacity for
pharmacovigilance
à The implementation will require commitment
from national and local stakeholders à target of
vivax elimination

20
Summary

• Plasmodium vivax has ability to form hypnozoites and causing relapses à

preventing relapse is the key for elimination

• To clear hypnozoites à short , high dose PQ or single dose TQ could be an

option

• New regimen of radical cure combined with appropriate G6PD test along
with adequate pharmacovigilance will be sufficient to achieve vivax
elimination in near future.

21
Thank You

22