Antimalarial resistance: is vivax left behind?

908 www.thelancet.com/infection Vol 14 October 2014 Despite the necessary and major goal of containment of artemisinin resistance in Plasmodium falciparum, not all malaria is caused by P falciparum and outside of Africa the greatest malaria burden is attributable to Plasmodium vivax. In The Lancet Infectious Diseases, Ric Price and colleagues report a systematic review of the resistance of P vivax to chloroquine, examining published studies from 1960 to 2014. They conclude that chloroquine-resistant P vivax is now present across most of vivax-endemic regions. In addition to containing their high-quality analysis, their Article proposes a set of methods to explore resistance to antimalarial drugs in vivax malaria and highlights a surprising scarcity of data and methods available to work on P vivax. post-exposure prophylaxis to more than 10 000 people. In Europe, active vaccination against hepatitis A is currently recommended mainly for travelers visiting countries endemic for hepatitis A virus. International travel is a risk factor, accounting for about a third of cases in Austria and Germany. In 2013, 80 cases of hepatitis A were statutorily reported in Austria and 779 in Germany, of which 25 in Austria and 278 in Germany were imported infections. By contrast with Germany, the Austrian national vaccination plan since 2008 has included a recommendation of hepatitis A virus vaccination for all seronegative food handlers in food production and gastronomy companies. According to Sprenger, the recent foodborne outbreaks of hepatitis A in Europe raise the question whether the member states should consider options for even broader vaccination recommendations against hepatitis A. However, the ultimate aim should be food product safety—ie, to secure the absence of hepatitis A virus from food. Viral contamination of food can occur anywhere in the production process, but most foodborne viral infections can be traced back to infected people who handled food that is not heated or otherwise treated afterwards. Experimental studies have shown that the virus can be transferred from contaminated hands to food and surfaces. Appropriate and regular hand hygiene practices are the mostly eff ective measure to prevent transmission of hepatitis A virus. Ensuring adequate hygiene in the countries producing the food will be a major challenge in the endeavor to prevent foodborne hepatitis A. In the meantime, physicians and public health offi cers should consider hepatitis A infections as possibly foodborne until proven otherwise. Routine collection and preservation of serum and stool samples from all patients with hepatitis A within 28 days of the date of symptom onset would