## Epidemiology of Malaria in India **Key Point:** Plasmodium vivax is the predominant malaria parasite in India, accounting for approximately 60–70% of all malaria cases, followed by P. falciparum (25–35%). ### Geographic Distribution | Plasmodium Species | Prevalence in India | Key Characteristics | | --- | --- | --- | | P. vivax | 60–70% | Temperate zones, relapsing fever, lower mortality | | P. falciparum | 25–35% | Tropical zones, severe malaria, higher mortality | | P. malariae | <5% | Rare, quartan fever pattern | | P. ovale | <1% | Very rare in India, found in Africa/SE Asia | ### Clinical Significance of P. vivax Dominance 1. **Relapsing nature** — Hypnozoites in liver cause relapses weeks to months after initial infection. 2. **Lower mortality** — Generally milder than P. falciparum, but can cause severe disease. 3. **Transmission** — Anopheles stephensi and A. culicifacies are primary vectors in India. 4. **Drug resistance** — Emerging chloroquine resistance in some endemic areas. **High-Yield:** In India's malaria control programs, P. vivax elimination is a priority because of its relapsing nature and potential for sustained transmission even after initial treatment. **Clinical Pearl:** A patient with recurrent fever 2–3 weeks after treatment for malaria in India should raise suspicion for P. vivax relapse, necessitating primaquine therapy to eliminate hypnozoites.
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