Despite inadequacy in preventing
vivax malaria after travel, suppressive
chemoprophylaxis has dominated travel medicine strategy since the advent of
chloroquine in 1946. The lethal threat of
falciparum malaria versus the perceived benign consequence of
vivax malaria underpins this strategic posture. Recent evidence demonstrating
vivax malaria as often pernicious should prompt reconsideration of that posture. Causal prophylaxis kills early developing forms of plasmodia in the liver, thus preventing attacks of falciparum and
vivax malaria during travel and delayed onset
vivax malaria following travel.
Primaquine is the only available
drug for this application, and has good evidence of safety, tolerability and efficacy in non-pregnant, G6PD-normal travelers. The
primaquine label, however, carries no such indication. Risk of pernicious
vivax malaria from all across the endemic regions of the globe, including much of sub-Saharan Africa, should raise consideration of daily
primaquine during travel as the preferred front-line option for
chemoprophylaxis against
malaria in travelers.