## Epidemiology of Malaria in India **Key Point:** Plasmodium vivax is the most common cause of malaria in India, accounting for approximately 60–70% of all malaria cases, despite P. falciparum being responsible for the majority of severe and fatal cases. ## Geographic and Temporal Distribution | Plasmodium Species | Prevalence in India | Geographic Distribution | Clinical Severity | | --- | --- | --- | --- | | **P. vivax** | 60–70% | Pan-India, especially North & Northeast | Mild to moderate | | **P. falciparum** | 25–35% | South & Central India, endemic zones | Severe, high mortality | | **P. malariae** | <5% | Sporadic, focal areas | Chronic, mild | | **P. ovale** | <1% | Rare in India | Mild | **High-Yield:** P. vivax dominates the epidemiological landscape in India due to: - Anopheles stephensi and A. culicifacies (primary vectors for vivax) are widespread - Hypnozoite formation allows relapse even after primary treatment - Lower threshold for gametocyte formation (more transmissible) ## Clinical Clues in the Stem **Clinical Pearl:** The presence of **Schüffner's stippling** on RBCs is pathognomonic for P. vivax (and P. ovale). Ring forms (trophozoites) are seen in early erythrocytic stages of all species, but the stippling pattern is diagnostic. **Mnemonic:** **RVFOM** — Ring forms in all; Vivax and ovale show stippling; Falciparum shows maurer clefts; Ovale is rarest; Malariae causes quartan fever. ## Why P. vivax Remains Most Common 1. **Vector competence:** A. stephensi thrives in urban and semi-urban areas across India 2. **Relapse potential:** Hypnozoites in liver cause relapses months to years later, increasing case counts 3. **Transmission efficiency:** Lower parasitaemia threshold for gametocyte formation [cite:Park 26e Ch 8]
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