In some reports, comorbidities have not
been addressed adequately, and, in areas where prevalence
is high (eg, New Guinea) the possibility that P vivax was
incidental to a diff erent disease process was not excluded.
In a study done in the Indonesian province of Papua,
where transmission of both P vivax and P falciparum is
high, the risk of coma was estimated to be one in 29 486
(no deaths) in P vivax mono infections and one in 1276 in
P falciparum infections (18·5% mortality).92 More detailed
prospective clinical epidemiological studies are needed to
establish whether the increase in the past 5 years of reports
of severe manifestions of vivax malaria (other than severe
anaemia and acute pulmonary oedema) are a result of
multifocal emergence of virulent strains, pre viously
underestimated severity, or over-reporting
In some reports, comorbidities have notbeen addressed adequately, and, in areas where prevalenceis high (eg, New Guinea) the possibility that P vivax wasincidental to a diff erent disease process was not excluded.In a study done in the Indonesian province of Papua,where transmission of both P vivax and P falciparum ishigh, the risk of coma was estimated to be one in 29 486(no deaths) in P vivax mono infections and one in 1276 inP falciparum infections (18·5% mortality).92 More detailedprospective clinical epidemiological studies are needed toestablish whether the increase in the past 5 years of reportsof severe manifestions of vivax malaria (other than severeanaemia and acute pulmonary oedema) are a result ofmultifocal emergence of virulent strains, pre viouslyunderestimated severity, or over-reporting
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