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P. vivax is the most widespread of the malaria species. More than one-third of the world’s population, nearly 2.5 billion people, is at risk of infection with P. vivax malaria.[1] Due to its dormant liver phase, P. vivax can survive in colder climates than other species of malaria giving it a wider geographical range, including tropics, subtropics and temperate climates. The highest prevalence is in Latin America and Southeast Asia. According to 2018 WHO World Malaria Report, 74.1% of malaria cases in the Region of the Americas in 2017 resulted from P. vivax. While P. vivax endemicity overlaps significantly with that of P. falciparum in many parts of the world, there are several places in Southeast Asia such as South Korea where P. vivax is the exclusive cause of malaria infections.[1] A unique characteristic of the P. vivax parasite is that it requires the Duffy antigen on the surface of cells to invade red blood cells, which results in its prevalence being much lower than P. falciparum in Africa where the population has low expression of the Duffy antigen.[2] Classic teaching that the lack of Duffy antigen results in resistance to vivax malaria infection has been called into question by more recent studies have shown rare cases of P. vivax infection in Duffy-null Africans.[2][3] Acquisition of immunity to P. vivax occurs more rapidly than immunity to P. falciparum. Thus in endemic regions, morbidity tends to peak at an earlier age in P. vivax, and adults are more often asymptomatic when infected. Alternatively in low transmission settings risk of severe disease is not dependent on age
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