## Epidemiology of Malaria in India **Key Point:** Plasmodium vivax is the most common cause of malaria in India, accounting for approximately 50–60% of all malaria cases, followed by P. falciparum (30–40%). ### Geographic Distribution - **P. vivax**: Predominates in plains and sub-Himalayan regions; endemic across most of India - **P. falciparum**: More common in forested and tribal areas (Chhattisgarh, Jharkhand, Odisha) - **P. malariae** (Quartan malaria): Rare in India; <1% of cases - **P. ovale**: Extremely rare; not endemic in India ### Clinical Features Comparison | Feature | P. vivax | P. falciparum | P. malariae | |---------|----------|---------------|-------------| | **Fever pattern** | Tertian (48 h) | Irregular/quotidian | Quartan (72 h) | | **Severity** | Mild to moderate | Severe (cerebral, renal) | Mild | | **Relapse** | Yes (hypnozoites) | No | No | | **Prevalence in India** | 50–60% | 30–40% | <1% | **High-Yield:** P. vivax causes *tertian fever* (fever every 48 hours) due to synchronous RBC rupture. Despite being the most common, it is generally less severe than P. falciparum. **Clinical Pearl:** P. vivax has a dormant liver stage (hypnozoites) that can reactivate weeks to months later, causing relapse. This is why primaquine (a tissue schizonticide) is essential for radical cure. ### Why P. vivax Dominates 1. Anopheles culicifacies and A. stephensi are efficient vectors for P. vivax in India 2. P. vivax prefers cooler climates (temperate and subtropical zones) 3. Widespread distribution across diverse ecosystems [cite:Park 26e Ch 8]
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