Table 6. G6PD deficiency prevalence, testing, and primaquine policies in American malaria-endemic countries.
| Country | Estimated G6PD deficiency prevalence for common variants* | Is primaquine given as DOT?** | Single-dose primaquine for Pf** | Primaquine use for Pv** |
|---|---|---|---|---|
| Brazil° | >3%–7% [24] 0%–12.9% [40] G6PD A-, Mediterranean, Santamaria, Amazonia, Ananindeau, Belem, Crispim, Chatham, Farroupilha, Bahia, Lages, Seattle, Seattle‐like |
No | Single dose on first day to change soon from 0.75 mg/kg to SLD 0.25 mg/kg | CQ and PQ at 0.50 mg/kg/day for 7 days; upcoming guidelines will include a recommendation for G6PD deficiency testing, for a Pv diagnosis, before PQ; G6PDd cases to be treated with PQ at 0.75 mg/kg/week for 8 weeks |
| Colombia° | >3%–7% [24] 1.4%–15.4% [40] 6.56%, only A and A- variants found [82,83] |
No | PQ 0.75 mg/kg, single dose (guidelines updated recently) | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Peru° | >0%–1% [24] 0%–0.7% [40] |
Yes | PQ 0.75 mg/kg single dose on the last day of ACT, since 2015 [84] | CQ and PQ at 0.50 mg/kg/day for 7 days |
| Venezuela | >7%–10% [24] 0%–3.5% [40] In eastern areas (N = 664), a quantitative method showed overall 24 (3.6%) G6PD deficiency (4.5 ± 1.2 U/g Hb activity), with A- (202A/376G) variant in 17 (70.8%) individuals: 13 males, 4 heterozygous females [84] |
No | Single dose | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Bolivia | >0%–1% [24] 0.7%–1.5% [40] |
Yes | Single dose but not implemented | CQ and PQ at 0.5 mg/kg/day for 7 days since 2001 |
| Panama° | >0%–1% [24] G6PD A- and Mediterranean |
Yes | Single dose on the first day with AL, since 2012 | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Guatemala° | >1%–3% [24] | Yes | Used but not as a single dose; instead given daily for 3 days (15 mg each for 45 mg total or 0.75 mg/kg) | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Nicaragua | >1%–3% [24] | Yes | Single dose on the first day of CQ, since 2013 | CQ and PQ at 0.5 mg/kg/day for 7 days |
| Haiti° | >7%–10% [24] | Pf single dose is given DOT at health centres | Single dose 0.75 mg/kg on the first day of CQ | CQ and PQ at 0.25 mg/kg/day for 14 days; PQ contraindicated in G6PDd patients |
| Honduras | >1%–3% [24] N = 398 archival DNA samples of malaria patients [86]. G6PD A- assessed by PCR–RFLP and a commercial kit. Overall frequency 16.08%; A- was 11.9% (4.1% males; 1.5% homozygous and 6.3% heterozygous females). One Santamaria [85] |
No | 0.75 mg/kg as single dose the first day of treatment | According to national guidelines, malaria treatment administration of both CQ and PQ at 0.25 mg/kg/day for 14 days |
| Suriname° |
>0%–1% [24] |
No | Single dose 0.75 mg/kg with AL since 2004, when possible on first day of treatment | CQ and PQ at 0.25 mg/kg/day for 14 days since 2004; considering to increase to 0.50 mg/kg/day 14 days |
| French Guiana | >0%–1% [24] |
No | Not used | With CQ, regimen not specified; G6PD deficiency test required |
| Ecuador | >3%–7% [24] 9.3%–12.8% [40] |
No | Single dose with AL | CQ and PQ at 0.50 mg/kg/day for 7 days |
| Guyana° | >3%–7% [24] |
No | Single dose on first day of treatment; 0.75 mg/kg single dose for Pf and recently updated guidelines include same treatment for P. malariae | CQ and PQ at 0.25 mg/kg/day for 14 days |
| El Salvador, Paraguay° |
>3%–7% [24] 2.4% El Salvador [40] |
El Salvador only | Single dose on first day of treatment; | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Mexico°, Belize°, Dominican Republic° |
>1%–3% [24] 0%–12.7% Mexico [40] G6PD A-, Santamaria, Union, Valladolid, Vanua Lava, Viangchan, Mexico City, Seattle |
Yes, except for Belize | Single dose on day 1; Belize: 0.75 mg/kg for Pf on first day of CQ [87]; Dominican Republic: 0.75 mg/kg | CQ and PQ at 0.25 mg/kg/day for 14 days; Mexico: a 7-day course of CQ and PQ (0.5 mg/kg on all 7 days; Belize: either 14 (0.25 mg/kg) or 7 (0.5 mg/kg) days for Pv [87]; Dominican Republic: only has imported cases of Pv |
| Argentina | >0%–1% [24] 0.3%–0.4% (males) [40] |
Yes | Single dose | CQ and PQ at 0.25 mg/kg/day for 14 days |
| Costa Rica | >0%–1% [24] 0.4%–12.6% [39] G6PD A-, Santamaria |
Yes | Single dose | CQ and PQ at 0.25 mg/kg/day for 14 days or 0.5 mg/kg/day for 7 days |
Abbreviations: Pv, Plasmodium vivax; Pf, Plasmodium falciparum; CQ, chloroquine; PQ, primaquine; AL, artemether-lumefantrine; DOT, directly observed treatment; SLD, single low dose (0.25mg/kg); G6PD, Glucose-6-phosphate dehydrogenase; ACT, Artemisinin combination therapy; PCR-RFLP, polymerase chain reaction-restriction fragment length polymorphism.
*Prevalences shown from reference [24] correspond to national-level allele frequencies modelled as described therein; other estimates shown are mostly from G6PD quantitative surveys.
**Policies from WHO World Malaria Report 2016 [27] were updated with the WHO 2017 report after this paper was reviewed [28]. Primaquine is contraindicated in infants and pregnant and breastfeeding women; ‘single dose’ refers to a dose of either 0.25 mg/kg or 0.75 mg/kg, and SLD refers to 0.25 mg/kg dose only. G6PD deficiency testing not required before primaquine treatment in the Americas except in French Guiana.
° Policies from the WHO 2016 report were checked with these countries; corresponding updates are shown in italics.
Cells shaded in grey indicate countries are in the elimination phase.