Mapping the global endemicity and clinical burden of Plasmodium vivax, 2000–17: a spatial and temporal modelling study
Open accessAbstract
BACKGROUND: Plasmodium vivax exacts a significant toll on health worldwide, yet few efforts to date have quantified the extent and temporal trends of its global distribution. Given the challenges associated with the proper diagnosis and treatment of P vivax, national malaria programmes-particularly those pursuing malaria elimination strategies-require up to date assessments of P vivax endemicity and disease impact. This study presents the first global maps of P vivax clinical burden from 2000 to 2017. METHODS: In this spatial and temporal modelling study, we adjusted routine malariometric surveillance data for known biases and used socioeconomic indicators to generate time series of the clinical burden of P vivax. These data informed Bayesian geospatial models, which produced fine-scale predictions of P vivax clinical incidence and infection prevalence over time. Within sub-Saharan Africa, where routine surveillance for P vivax is not standard practice, we combined predicted surfaces of Plasmodium falciparum with country-specific ratios of P vivax to P falciparum. These results were combined with surveillance-based outputs outside of Africa to generate global maps. FINDINGS: We present the first high-resolution maps of P vivax burden. These results are combined with those for P falciparum (published separately) to form the malaria estimates for the Global Burden of Disease 2017 study. The burden of P vivax malaria decreased by 41·6%, from 24·5 million cases (95% uncertainty interval 22·5-27·0) in 2000 to 14·3 million cases (13·7-15·0) in 2017. The Americas had a reduction of 56·8% (47·6-67·0) in total cases since 2000, while South-East Asia recorded declines of 50·5% (50·3-50·6) and the Western Pacific regions recorded declines of 51·3% (48·0-55·4). Europe achieved zero P vivax cases during the study period. Nonetheless, rates of decline have stalled in the past five years for many countries, with particular increases noted in regions affected by political and economic instability. INTERPRETATION: Our study highlights important spatial and temporal patterns in the clinical burden and prevalence of P vivax. Amid substantial progress worldwide, plateauing gains and areas of increased burden signal the potential for challenges that are greater than expected on the road to malaria elimination. These results support global monitoring systems and can inform the optimisation of diagnosis and treatment where P vivax has most impact. FUNDING: Bill & Melinda Gates Foundation and the Wellcome Trust.
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Most P. vivax cases are in geographic areas of the WHO Regional Offices for South-East Asia and Eastern Mediterranean.
“Most P. vivax cases are in geographic areas of the WHO Regional Offices for South-East Asia and Eastern Mediterranean [19]”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [19]
Since 2007 there have been decreases in the prevalence of P. falciparum and P. vivax, as well as global fertility rates, although absolute populations have grown at regional and global levels.
“Since 2007 there have been decreases in the prevalence of P. falciparum [12] and P. vivax [19], as well as global fertility rates [21, 22], although absolute populations have grown at regional and global levels.”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [19]
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- Authors
- Battle, K. E., Lucas, T. C. D., Nguyen, M., Howes, R. E., Nandi, A. K., Twohig, K. A., Pfeffer, D. A., Cameron, E., Rao, P. C., Casey, D., Gibson, H. S., Rozier, J. A., Dalrymple, U., Keddie, S. H., Collins, E. L., Harris, J. R., Guerra, C. A., Thorn, M. P., Bisanzio, D., Fullman, N., Huynh, C. K., Kulikoff, X., Kutz, M. J., Lopez, A. D., Mokdad, A. H., Naghavi, M., Nguyen, G., Shackelford, K. A., Vos, T., Wang, H., Lim, S. S., Murray, C. J. L., Price, R. N., Baird, J. K., Smith, D. L., Bhatt, S., Weiss, D. J., Hay, S. I., & Gething, P. W.
- Affiliations
- University of Oxford (GB)
- Charles Darwin University (AU)
- University of Washington (US)
- Public Health – Seattle & King County (US)
- Public Health England (GB)
- Medical Care Development International (US)
- University of Nottingham (GB)
- Imperial College London (GB)
- Corresponding author
- Gething, Peter W
- ORCID
- Battle, Katherine E
- Lucas, Tim C D
- Howes, Rosalind E
- Nandi, Anita K
- Twohig, Katherine A
- Pfeffer, Daniel A
- Cameron, Ewan
- Gibson, Harry S
- Rozier, Jennifer A
- Dalrymple, Ursula
- Keddie, Suzanne H
- Guerra, Carlos A
- Bisanzio, Donal
- Fullman, Nancy
- Kulikoff, Xie
- Mokdad, Ali H
- Naghavi, Mohsen
- Vos, Theo
- Wang, Haidong
- Lim, Stephen S
- Murray, Christopher J L
- Price, Ric N
- Baird, J Kevin
- Smith, David L
- Bhatt, Samir
- Weiss, Daniel J
- Hay, Simon I
- Gething, Peter W
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 394
- Issue
- 10195
- Pages
- 332-343
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC6675736
- OpenAlex
- W2950607694
- Cited by
- 409
- References
- 36
- Citations by year
- 2026: 31 · 2025: 41 · 2024: 63 · 2023: 69 · 2022: 59 · 2021: 83 · 2020: 49 · 2019: 14
- FWCI
- 47.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- Bill and Melinda Gates Foundation
- Wellcome Trust (200909/Z/16/Z, 200909)
- Medical Research Council (MR/R015600/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Travel-related health issues
- Keywords
- Plasmodium vivax, vivax malaria, malaria endemicity, clinical burden, Plasmodium falciparum, malaria elimination, global burden of disease, sub-Saharan Africa, Americas, Southeast Asia, western Pacific, socio-economic instability
- MeSH terms
- Africa, Americas, Asia, Southeastern, Bayes Theorem, Humans, Population Surveillance, Global Health, Malaria, Vivax, Endemic Diseases, Oceania, Spatio-Temporal Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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