First malaria infection in infants on islands in Melanesia

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Aneityum, the southernmost island in Vanuatu, is located at the south-east edge of the malaria extension in the Pacific. To examine the feasibility of malaria elimination, an integrated program, combining mass drug administration (MDA) and vector control, was initiated on Aneityum in 1991. Microscopy showed Plasmodium falciparum immediately disappeared whereas P. vivax disappeared from 1996 onwards. Since 1991 community-based surveillance and vector control measures were continuously maintained. Eight years later, it was concluded that malaria can be eliminated from isolated islands if there is a high degree of community commitment. An epidemic of P. vivax on Aneityum in 2002 provided us with an opportunity to investigate resurgence. Adults born before elimination had considerably fewer episodes of parasitemia than children born after elimination, indicating that protective immunity against P. vivax infections persists for a long time after the initiation of malaria elimination.