Table 1 A summary of the obstacles and implications of eliminating & eradicating P. vivax malaria

Hypnozoite

P. vivax presents a challenge for malaria management and eradication because it can develop clinically quiet, undetected, dormant liver stages that subsequently reactivate (or relapse) to generate blood-stage infections. A portion of the parasites undergo sexual differentiation during blood stage replication, and when ingested by a blood-feeding anopheline mosquito, these gametocytes can start the insect's sporogony process. Therefore, contributed substantially to both clinical episodes and transmission [25, 32]

The puzzle of primaquine therapy

Poor treatment compliance and delaying radical cure for lactating women until their nursing infants are at least 6 months old and determined to be G6PD normal and the risk of hemolysis in G6PD-deficient individuals [73, 162]

Host genetics

Genetic variation in CYP2D6, a human cytochrome P-450 isoenzyme 2D6 (CYP2D6) is crucial for the conversion of primaquine to its active metabolites and for the hypnozoite killing process in hepatocytes [124]

The younger the reticulocytes, the better for P. vivax infection

The predilection of P. vivax for reticulocytes has implications for infection dynamics, parasite reservoirs, and potential parasite elimination strategies [184]

P. vivax is emerging and has evolved into Duffy-negative

Shape the epidemiology of P. vivax malaria: previously, it was believed that P. vivax malaria was uncommon or nonexistent in African populations that did not exhibit the Duffy blood group antigen. Recent research has, however, documented a number of P. vivax infections in Duffy-negative individuals in several African regions, including those where Duffy negativity is predominated. There are also more and more instances of P. vivax infection among Duffy-negative people in South America, which may affect the epidemiology of P. vivax malaria [75, 79112]

P. vivax submicroscopic

Low-density P. vivax infections are frequent, particularly in places that are close to elimination. Some malaria patients do not receive prompt treatment, causing the disease to spread [9]

sexual blood stages

keeps showing up early in the course of the disease, often before overt symptoms develop &increases the possibility of further transmission [6]

Temperature

Sporogony occurs at lower temperatures than for P. falciparum [145]

P. vivax populations are more genetically diverse

Wide genetic variety across parasite populations makes them more likely to evade host immune responses, complicate the development of a malaria vaccine, and possibly even reveal previously undiscovered invasion routes [94]