Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-graduação em Ciências e Tecnologias em Saúde, 2016. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2017-02-08T18:28:57Z No. of bitstreams: 1 2016_DéboraCristinadeFaria.pdf: 3806625 bytes, checksum: 83e616865d981b3ff1f94cc727bdb2c7 (MD5) / Approved for entry into archive by Raquel Viana(raquelviana@bce.unb.br) on 2017-03-09T15:00:44Z (GMT) No. of bitstreams: 1 2016_DéboraCristinadeFaria.pdf: 3806625 bytes, checksum: 83e616865d981b3ff1f94cc727bdb2c7 (MD5) / Made available in DSpace on 2017-03-09T15:00:44Z (GMT). No. of bitstreams: 1 2016_DéboraCristinadeFaria.pdf: 3806625 bytes, checksum: 83e616865d981b3ff1f94cc727bdb2c7 (MD5) / A triagem neonatal (TN), popularmente conhecida como “teste do pezinho”, permite realizar um pré-diagnóstico de desordens genéticas, congênitas e metabólicas de forma precoce, além de auxiliar na garantia de sobrevivência e melhora das condições de vida de muitas crianças. No Distrito Federal, desde 2008 é realizada a triagem neonatal ampliada, que também detecta a deficiência da enzima Glicose-6-fosfato-desidrogenase(G6PD). Essa deficiência é responsável pelo aumento da morbidade no período neonatal e pela possibilidade de aumentar o risco de desenvolvimento de Kernicterus, uma lesão neurológica associada ao aumento exacerbado de bilirrubinas. Este estudo teve como objetivo descrever o perfil, manifestações clínicas e as implicações da triagem neonatal de crianças com deficiência de G6PD, atendidas em um hospital da rede pública no Distrito Federal. Trata-se de um estudo com abrangência transversal, do tipo exploratório e descritivo, de natureza quantitativa, a partir de fonte secundária de dados, realizado na unidade de pronto atendimento pediátrico. Foram realizados, no período de agosto a dezembro de 2015, 24.856 atendimentos, destes, foram identificadas 20 crianças com deficiência de G6PD. A amostra foi constituída por 16 crianças com registro de diagnóstico da deficiência, todas eram do sexo masculino, idade entre 7 e 44 meses no momento da observação. As manifestações clínicas e laboratoriais mais frequentes foram: febre (87,5%), diarreia (50%), icterícia (50%), reticulocitose (37,5%), vômitos (37,5%), hiperbilirrubinemia (31,3%), tosse (31,3%), anemia (18,8%), desidratação (12,5%), palidez (6,3%) e dispneia (6,3%). Constatou-se que em 56% dos registros em prontuário havia o relato de diagnóstico da deficiência a partir do teste do pezinho, isso coloca em evidência a importância do diagnóstico ainda na triagem neonatal, possibilitando orientação precoce e efetiva aos pais. Cabe destacar que o Distrito Federal é um caso que possui singularidades, considerando que a detecção da deficiência de G6PD, através do teste do pezinho, não ocorre nos outros municípios por meio do sistema único de saúde, o DF é um local onde está implantada a triagem neonatal ampliada. Nesta perspectiva, ressalta-se a importância que a TN ampliada seja incorporada em todo território nacional, além do DF, possibilitando intervenção precoce dos profissionais da equipe de saúde no sentido de melhorar as condições de vida destas crianças, e da morbidade no período neonatal. / Neonatal screening, popularly known as "foot test", allows pre-diagnosis of genetic, congenital and metabolic disorders in an early manner, as well as helping to guarantee the survival and improvement of the living conditions of many children. In Federal District, expanded neonatal screening, which also detects deficiency of Glucose-6-phosphate dehydrogenase (G6PD) enzyme, has been carried out since 2008. This deficiency is responsible for increased morbidity in neonatal period and the possibility of increasing the risk of developing Kernicterus, a neurological injury associated with an exacerbated increase in bilirubin. This study aimed to describe the profile, clinical manifestations and implications of neonatal screening of children with G6PD deficiency, attended at a public hospital in Federal District. This is a cross-sectional study, exploratory and descriptive, with quantitative nature, from a secondary source of data, performed at the pediatric prompt care unit. In the period from August to December 2015, 24,856 visits were performed, and 20 children with G6PD deficiency were identified. The final sample consisted of 16 children with diagnosis of the deficiency, all of whom were male, aged between 7 and 44 months at the time of observation. The most frequent clinical and laboratory manifestations were fever (87.5%), diarrhea (50%), jaundice (50%), reticulocytosis (37.5%), vomiting (37.5%), hyperbilirubinemia %), cough (31.3%), anemia (18.8%), dehydration (12.5%), pallor (6.3%) and dyspnea (6.3%). It was verified that in 56% of the records in the medical record there was the report of diagnosis of the deficiency through neonatal screening. This shows the importance of the diagnosis in neonatal screening, enabling early and effective guidance to parents. It should be noted that Federal District is a case that has singularities, considering that the detection of G6PD deficiency, through neonatal screening, does not occur in other municipalities through Brazil´s public health system, otherwise, it is a place where extended neonatal screening is applied. In this perspective, it is important to emphasize the importance of expanded neonatal screening throughout the national territory, in addition to Federal District, allowing early intervention of the health team, in order to improve living conditions of these children and morbidity in neonatal period.

A icterícia neonatal é geralmente benigna, mas desfechos desfavoráveis podem ocorrer e a identificação dos casos de maior risco seria muito útil. Alguns fatores de risco já conhecidos são prematuridade, desidratação, aleitamento materno, deficiência de G6PD e incompatibilidade sanguínea. As alterações na conjugação hepática de bilirrubina devido a polimorfismos da UGT1A1 também podem contribuir para esse maior risco. O objetivo deste estudo foi estimar a freqüência da deficiência de G6PD e/ou das variantes polimórficas da UGT1A1 como fatores de risco para hiperbilirrubinemia grave em neonatos com mais de 35 semanas de idade gestacional e peso superior a 2000g em uma Unidade Neonatal do Sul do Brasil. Estudo prospectivo, observacional, de casos e controles, que incluiu 243 recémnascidos admitidos para fototerapia no HCPA e 247 controles, entre março e dezembro de 2007. Foi realizada dosagem da atividade da G6PD e análises genético-moleculares do respectivo gene. Foi também realizado PCR para a UGT1A1 com eletroforese capilar em analisador genético ABI 3130xl e análise no programa GeneMapper®. Foram detectados genótipos polimórficos da UGT1A1 em 16% dos pacientes, com prevalência nos ictéricos de 13,5% e nos normais de 18,2%, diferença não significativa. Identificada maior prevalência dos polimorfismos em negros e pardos (25%) em relação aos brancos (13%) (p=0,014). A prevalência da deficiência de G6PD foi 4,6%, sem mostrar correlação com a icterícia. Concluímos que nesta amostra de recém-nascidos do sul do Brasil nem as variantes da UGT1A1, nem a deficiência de G6PD foram associadas à hiperbilirrubinemia grave, com prevalências semelhantes às verificadas em outras populações. Considerando a grande miscigenação presente nessa região, outros fatores e interações gênicas devem ser procurados, incluindo possivelmente o estudo de outros polimorfismos, identificando fatores de risco para explicar a doença, um importante problema de saúde a merecer a atenção dos pesquisadores. / Neonatal jaundice is usually benign, but unfavorable outcomes may happen; therefore, the identification of high-risk cases would be very useful. Some risk factors already known are prematurity, dehydration, breastfeeding, G6PD deficiency and blood incompatibility. Alterations in the hepatic conjugation of bilirubin due to UGT1A1 polymorphisms may also contribute to this higher risk. The objective of this study was to estimate the frequency of G6PD deficiency and the promoter region of UGT1A1 gene variants as risk factors to severe hyperbilirubinemia in newborns of over 35 weeks of gestational age and weighing above 2,000g in a Neonatal Service in Southern Brazil. This is a prospective and observational study of cases and controls which included 243 newborns admitted for phototherapy at HCPA and 247 controls, between March and December, 2007. G6PD activity was determined and the deficient cases were investigated by genetic analysis. PCR for the UGT1A1 variants was also performed, followed by capillary electrophoresis in genetic analyzer ABI 3130xl and the analysis in GeneMapper® program. Polymorphic genotypes were detected in 16% of the patients, prevalence in icteric patients was 13,5% and in normal individuals was 18,2%, a difference which was not significant. A higher prevalence of polymorphisms in blacks and mulattos (25%) was identified when compared to whites (13%) (p=0,014). A prevalence of 4,6% of G6PD deficiency was found, without association to jaundice. We concluded that in this sample of newborns from the South of Brazil, polymorphic variants of UGT1A1 were not associated to severe hyperbilirubinemia as well as G6PD deficiency; being the prevalence similar to those found in other populations. Considering the high miscegenation that occurs in this area of Brazil, perhaps other factors and genic interactions should be sought in order to identify genetic risk factors, possibly including the study of further polymorphisms, as neonatal jaundice remains an important health problem to be approached by investigators.

We describe a patient who developed hemolysis and methemoglobinemia due to rasburicase (RBU) and was found to have glucose-6-phosphate dehydrogenase (G6PD) deficiency. This is a rare clinical scenario that provides valuable insight into complex diagnosis and management of these life-threatening complications. A 59-year-old male presented to the VA Medical Center with 11 days of epigastric abdominal pain radiating to the back and flank, associated with bloating and lower extremity edema. He was transferred to our facility for percutaneous nephrostomy tube (PCN) placement for renal dysfunction (creatinine 5.5). Computed tomography (CT) scan of the abdomen and pelvis revealed 17 cm retroperitoneal mass engulfing major vessels, involving right renal hilum and ureter with moderate-severe right hydronephrosis. CT guided biopsy of the mass showed intermediate-large malignant cells that were CD20, CD23, BCL2 and BCL6 positive; CD10 and MUM1 negative. Fluorescent in-situ hybridization resulted after discharge to reveal no MYC rearrangement, confirming a diagnosis of diffuse large B-cell lymphoma. Positron-emission tomography CT revealed extensive retroperitoneal lymphadenopathy with pelvic extension into internal and external iliac vessels, encasing aorta, inferior vena cava and anteriorly displacing pancreas and bowel and contiguous involvement of the right kidney with hypermetabolic activity. Moderate right sided pleural effusion was also seen. Creatinine improved with PCN. Uric acid was 10.3 with lactate dehydrogenase (LDH) 953. The patient received RBU for tumor lysis syndrome (TLS). However, pulse oximetry showed an oxygen saturation of 70-80%, though the patient had only mild dyspnea. CT pulmonary embolism (CTPE) showed segmental PE. Therapeutic lovenox was initiated. He underwent thoracentesis with symptomatic improvement but continued to desaturate on pulse oximetry. Arterial blood gas on 100% oxygen via non-rebreather revealed methemoglobin of 4.5% without hypoxemia. LDH worsened to 1668 with low haptoglobin and direct hyperbilirubinemia, suggestive of hemolysis. G6PD was deficient at 0.8 U/g. Treatment was conservative with cautious use of red cell transfusions and supplemental oxygen. Due to hyperbilirubinemia, chemotherapy was started with dose-adjusted etoposide, prednisone, oncovin, cyclophosphamide, and rituximab - with adriamycin withheld upfront. As hemolysis improved the patient received dose-reduced adriamycin. RBU is a recombinant urate oxidase used in managing TLS. It converts uric acid to allantoin, producing hydrogen peroxide, which oxidizes hemoglobin to methemoglobin. G6PD deficiency decreases cellular ability to reduce glutathione and thus detoxify hydrogen peroxide. This causes life-threatening methemoglobinemia and hemolysis. Methylene blue is contraindicated due to the risk of worsening hemolysis in G6PD deficiency. Methemoglobinemia is typically treated in such cases with exchange transfusion or hyperbaric oxygen therapy.

No description available.

Orientador: Claudia Regina Bonini Domingos / Banca: Antonio Fabron Junior / Banca: Luiz Carlos de Mattos / Banca: Sonia Maria Oliani / Banca: Wilson Araújo Silva Junior / Resumo: Na talassemia beta, o acúmulo das cadeias alfa livres, bem como a liberação do grupo heme e do ferro durante o processo hemolítico, ocasionam aumento de danos oxidativos que podem resultar em lipoperoxidação de membranas celulares, desnaturação de proteínas e oxidação da hemoglobina. Na deficiência de glicose- 6-fosfato desidrogenase (G6PD), esse aumento é decorrente da diminuição da produção de nicotinamida adenina dinucleotídeo fosfato reduzido (NADPH) que pode resultar em hemólise intravascular. Diante da possibilidade de estresse oxidativo nos portadores de beta talassemia heterozigota e nos indivíduos com deficiência de G6PD, neste trabalho avaliou-se a expressão fenotípica das afecções genéticas por meio da identificação das mutações e análise de marcadores para estresse oxidativo. Para o estabelecimento dos grupos controle e com deficiência de G6PD foram avaliadas 544 amostras de sangue periférico de indivíduos da região Noroeste do Estado de São Paulo, sendo 426 doadores de sangue e 118 indivíduos de uma instituição de ensino superior. Para a composição do grupo com talassemia beta heterozigota foram avaliadas 46 amostras de sangue de indivíduos com diagnóstico clínico de talassemia beta da cidade de São Carlos/SP. Foram realizados métodos de triagem e confirmatórios para a identificação da talassemia beta heterozigota e da deficiência de G6PD, e dosagens bioquímicas para quantificação das espécies reativas ao ácido tiobarbitúrico (TBARS), utilizado como marcador de estresse oxidativo, e para a determinação da capacidade antioxidante em equivalência ao Trolox (TEAC). Os polimorfismos da glutationa S-transferase (GST) GSTM1 e GSTT1 foram avaliados por PCR multiplex o de GSTP1 por PCR/RFLP. No grupo com talassemia beta heterozigota foram encontradas 18 (39%) amostras com a mutação CD39; 22 (48%) com a mutação... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: In beta thalassemia, the excess of unpaired alpha chains, as well as the heme group and iron released during the hemolytic process increase the oxidative damage. In G6PD deficiency, this increase is caused by a reduced production of NADPH that results in an intravascular hemolysis. Thus, facing the oxidative stress possibility in beta thalassemia carriers and G6PD deficiency individuals, it was aimed to evaluate the fenotypic expression of this genetic disorders through the mutation identification, as well as the oxidative stress marker analysis. We used 544 peripheral blood samples of individuals from São Paulo's northwestern to control group and to G6PD deficiency group establishment. For beta thalassemia heterozygote group were evaluated 48 blood samples of São Carlos/SP city. Tests were carried out aiming the screening and confirmation of beta thalassemia and G6PD deficiency, as well as the analysis of lipid peroxidation products measured as thiobarbituric acid reactive species (TBARS) and Trolox equivalent antioxidant capacity (TEAC). Were determined the frequencies of GSTM1, GSTT1 and GSTP1 polymorphisms. The analysis with beta thalassemia carriers allowed to establish in the study group a frequency of 39% for CD39 mutation, 48% for IVS-I-110 mutation and 2% for IVS-I-6 mutation. For G6PD deficiency was founded a frequency of 3.86%. The beta thalassemic group evaluation showed an increase of TBARS and TEAC values, when compared to the control group. There was a tendency to increase lipid peroxidation in beta0 CD39 mutants compared to beta+ IVS-I-110 mutants, because there is more free chains amount in beta0 thalassemia than beta+ thalassemia. In the G6PD deficiency analysis was found a lower G6PD activity in men than in women, but there was no interference of gender in the TBARS and TEAC assays results. The comparison between the control group and the G6PD deficiency group... (Complete abstract click electronic access below) / Doutor

Deficiency of glucose-6-phosphate dehydrogenase (G6PD) is a hereditary recessive disease associated with X-chromosome, in which carriers of this deficiency can develop hemolytic anemia during oxidative stress induced by food, medicines and infections. The prevalence of this deficiency is not fully established in the country. In the state of Sergipe, this study aimed to establish this prevalence, through analyzes of blood samples collected on filter paper, of newborns (NB) attended by the State Neonatal Screening Program. The results obtained are presented in the form of two scientific articles (chapter 1 and chapter 2). The first article aimed to identify interferences in the quantitative technique for the diagnosis of G6PD deficiency in samples collected on filter paper of newborns collected from May to October of 2016 at health posts in the state of Sergipe. Divided into five groups, the samples were analyzed under preanalytical and analytical conditions, evaluating the frequency of positive results before and after standardization of the technique. The main interferences observed in the preanalytical phase were the quality of the sample, the time between collection and examination and the temperature during transportation. In the analytical phase the interference in the elution of the samples was observed. The second scientific article refers to the detection of the prevalence of G6PD deficiency in samples of newborns from the state of Sergipe (Chapter 2). Blood samples of newborns collected on filter paper from health posts throughout the state were analyzed between August 2016 and January 2017. In part of the positive samples, the G6PD dosage repetition and complementary tests were performed to evaluate anemia: blood count, reticulocyte count and bilirubin dosage. Confirmed cases were called for clinical evaluation and genetic counseling. Of the 9,040 initial samples, 3,274 were excluded due to poor quality, leaving 5,766 valid samples remaining. The prevalence of G6PD deficiency found in the state of Sergipe was 9.35%, 3.33% female and 4.87% male, with the highest prevalence in the Sergipe State (6.40%). Only 39.99% of the samples followed the Ministry of Health's recommendation for collection between 3 and 7 days after birth. The use of antibiotics that can trigger hemolytic reactions were reported in only 0.35% of the female NBs and 0.64% of the male sex. Of the 473 positive results, 100 newborns were summoned, of whom 50 attended with the parents. Of these, 20 NB presented confirmation of the positive tests, as well as 4 mothers and one father. Four NB presented reduced results for red blood cells, hemoglobin and hematocrit, and two patients presented bilirubin dosage above the reference value. Patients who had the deficiency of the confirmed enzyme participated in a clinical evaluation and genetic counseling, to elucidate the disease, prophylaxis and care with food and use of medicines that can trigger a hemolytic crisis. With this study, it can be concluded that the prevalence of G6PD deficiency in the state of Sergipe is 9.35%, considered high, but consistent with the world literature, mainly due to the influence of African peoples. Likewise, the highest prevalence was in the male sex, and the boys were homozygous that manifested the deficiency associated with the mutation in the G6PD gene. / A deficiência de glicose-6-fosfato desidrogenase (G6PD) é uma doença hereditária recessiva associada ao cromossomo X, na qual portadores dessa deficiência podem desenvolver anemia hemolítica durante estresse oxidativo induzido por alimentos, medicamentos e infecções. A prevalência dessa deficiência não está totalmente estabelecida no país. No estado de Sergipe este estudo teve como objetivo estabelecer essa prevalência, por meio de análises de amostras de sangue colhidas em papel de filtro, de recém-nascidos (RN) atendidos pelo Programa de Triagem Neonatal do estado. Os resultados obtidos estão apresentados na forma de dois artigos científicos (capítulo 1 e capítulo 2). O primeiro artigo teve como objetivo identificar interferências na técnica quantitativa para o diagnóstico da deficiência da G6PD em amostras colhidas em papel de filtro de recém-nascidos, coletadas de maio a outubro de 2016 em postos de saúde do estado de Sergipe. Divididas em cinco grupos, as amostras foram analisadas em condições pré-analíticas e analíticas, avaliando-se a frequência de resultados positivos antes e depois da padronização da técnica. Os principais interferentes observados na fase pré-analítica foram a qualidade da amostra, o tempo entre coleta e exame e a temperatura durante o transporte. Na fase analítica foi observada a interferência na eluição das amostras. O segundo artigo científico refere-se à detecção da prevalência da deficiência da G6PD em amostras de recém-nascidos do estado de Sergipe (Capítulo 2). Foram analisadas amostras de sangue de recém-nascidos colhidos em papel filtro, provenientes dos postos de saúde de todo o estado, entre agosto de 2016 a janeiro de 2017. Em parte das amostras positivas, foram realizadas a repetição da dosagem de G6PD e exames complementares para avaliação da anemia: hemograma, contagem de reticulócitos e dosagem de bilirrubinas. Os casos confirmados foram convocados para avaliação clínica e aconselhamento genético. Das 9.040 amostras iniciais, 3.274 foram excluídas por má qualidade, restando 5.766 amostras válidas. A prevalência da deficiência da G6PD encontrada no estado de Sergipe foi de 9,35%, 3,33% do sexo feminino e 4,87% do sexo masculino, sendo a maior prevalência no Leste Sergipano (6,40%). Apenas 39,99% das amostras seguiram a recomendação do Ministério da Saúde para realização da coleta entre 3 a 7 dias após o nascimento. O uso de antibióticos que podem desencadear reações hemolíticas foram relatados em apenas 0,35% dos RN do sexo feminino e 0,64% do sexo masculino. Dos 473 resultados positivos, foram convocados 100 recém-nascidos, dos quais compareceram 50 juntamente com os pais. Destes, 20 RN apresentaram confirmação dos testes positivos, bem como 4 mães e um pai. Quatro RN apresentaram resultados reduzidos para hemácias, hemoglobina e hematócrito, e dois pacientes apresentaram dosagem de bilirrubinas acima do valor de referência. Os pacientes que tiveram a deficiência da enzima confirmada participaram de uma avaliação clínica e aconselhamento genético, para elucidação da doença, profilaxia e cuidados com alimentação e uso de medicamentos que possam desencadear uma crise hemolítica. Com este estudo pode-se concluir que a prevalência da deficiência da G6PD no estado de Sergipe é de 9,35%, considerada alta, porém condizente com a literatura mundial, principalmente pela influência dos povos africanos. Da mesma forma, a maior prevalência foi no sexo masculino, sendo os meninos homozigotos que manifestam a deficiência associada à mutação no gene da G6PD. / São Cristóvão, SE

Die Infektion mit dem Erreger der Malaria tropica, Plasmodium falciparum, verläuft individuell unterschiedlich. Während manche der Infizierten rasch an einer komplizierten Malaria versterben, zeigen andere keinerlei Symptomatik, obwohl jahrelang eine Parasitämie besteht. Was diese Individuen voneinanderen unterscheidet, ist weitgehend unbekannt. Morbidität und Mortalität der Erkrankung sind von der Auseinandersetzung zwischen Wirt und Parasit abhängig, die von exogenen und endogenen Faktoren beeinflußt wird. Unter den endogenen Faktoren spielen die genetischen Determinanten, die sowohl an angeborenen als auch an erworbenen Resistenz- und Immunmechanismen beteiligt sind, eine besondere Rolle. In den hier zusammengefaßten Arbeiten wurden als Determinanten der angeborenen Resistenz gegenüber Malaria die Sichelzellanämie, Alpha-Thalassämie, G6PD-Mangel und der HLA-Klasse-II-Polymorphismus und als genetische Einflußfaktoren von erworbenen Immunmechanismen Varianten des TNF-Promotors, von ICAM-1 und iNOS untersucht. Die Arbeiten unterstützen die Hypothese, daß die Interaktion von Mensch und Plasmodien zu einer ständigen gegenseitigen Beeinflussung und Anpassung geführt hat. Die koevolutonäre Veränderung der Genome der beiden Organismen ist wahrscheinlich mitverantwortlich für die unterschiedliche geographische Verteilung von Genvarianten sowohl des Menschen als auch der Plasmodien und scheint auch heute noch Teil einer komplexen und dynamischen Anpassung von Wirt und Parasit zu sein. / The manifestation of an infection with Plasmodium falciparum, the pathogen of malaria, is individually different. Some indiviuals have a high risk of developing severe malaria, whereas others remain asymptomatic despite a long-lasting parasitemia. The basis of these differences is unknown. Morbidity and mortality of malaria are dependent on the interaction between the host and the parasite which is influenced by exogenic and endogenic factors. The latter are determined by genetic elements involved in innate and acquired mechanisms of resistance and immunity. The studies summerized here address genetic determinants of innate resistance against malaria (sickle cell trait, alpha-thalassemia, G6PD deficiency, blood groups and HLA class II alleles) and those of acquired immunity (variants of the TNF promoter, ICAM-1, and iNOS). The results support the view that the interaction between humans and plasmodia has led to continuous mutual influences and adaptations. Probably, the co-evolution of the genomes of both organisms is jointly responsible for the different geographical distribution of parasitic and human gene variants. This process seems to be part of an ongoing complex and dynamic adaptation of the host and the parasite.

No description available.

Over a third of the world’s population lives at risk of potentially severe Plasmodium vivax malaria. Unique aspects of this parasite’s biology and interactions with its human host make it harder to control and eliminate than the better studied Plasmodium falciparum parasite. Spatial mapping of two human genetic polymorphisms were developed to support evidence-based targeting of control interventions and therapies. First, to enumerate and map the population at risk of P. vivax infection (PvPAR), the prevalence of this parasite’s human blood cell receptor – the Duffy antigen – was mapped globally. Duffy negative individuals are resistant to infection, and this map provided the means to objectively model the low endemicity of P. vivax across Africa. The Duffy maps helped resolve that only 3% of the global PvPAR was from Africa. The second major research focus was to map the spatial distribution of glucose-6-phosphate dehydrogenase enzyme deficiency (G6PDd), the genetic condition which predisposes individuals to potentially life-threatening haemolysis from primaquine therapy. Despite this drug’s vital role in being the only treatment of relapsing P. vivax parasites, risks of G6PDd-associated haemolysis result in significant under-use of primaquine. G6PDd was found to be widespread, with an estimated frequency of 8.0% (50% CI: 7.4-8.8%) across malarious regions. Third, it was important to represent more detailed descriptions of the genetic diversity underpinning this enzyme disorder, which ranges in phenotype from expressing mild to life-threatening primaquine-induced haemolysis. These variants’ spatial distributions were mapped globally and showed strikingly conspicuous distributions, with widespread A- dominance across Africa, predominance of the Mediterranean variant from the Middle East across to India, and east of India diversifying into a different and diverse array of variants, showing heterogeneity both at regional and community levels. Fourth, the G6PDd prevalence and severity maps were synthesised into a framework assessing the spatial variability of overall risk from G6PDd to primaquine therapy. This found that risks from G6PDd were too widespread and potentially severe to sanction primaquine treatment without prior G6PDd screening, particularly across Asia where the majority of the population are Duffy positive and G6PDd was common and severe. Finally, the conclusions from these studies were discussed and recommendations made for essential further research needed to support current efforts into P. vivax control.