Evidence of <i>P</i>. <i>vivax</i> in Africa.

Panel A maps all available reports of P. vivax occurrence (n = 657 unique sites) by evidence type (1980–2016). Data from Howes et al. [14] are combined with the results of this update (new points are shown in S4 Fig). Panel B summarises exported malaria infections among travellers returning to non-endemic countries, grouped by suspected country of origin and Plasmodium species. Pie charts represent the proportional contribution by malaria species, sized based on a log-transformation of the total number of infections. The numbers shown beside each pie chart refer to the number of P. vivax infection reports attributed to each country. The traveller infections database represents an opportunistic assembly of reports, and does not aim to be comprehensive; reports are aggregates of data from 1991 to 2016, see S3 Fig for timespan of input data. Panel C documents the framework used to weight the data from Panels A and B to characterise the strength of evidence of local P. vivax transmission. Evidence weights (top row) were assigned for each evidence type in each Admin1 unit (state/province), and summed to indicate the total evidence of P. vivax in a given unit. The resulting composite evidence map is shown in Panel D. Darker shading indicates increased evidence of the presence of P. vivax. White indicates units for which no evidence was found (evidence strength = 0), and grey shading indicates regions where environmental conditions are unsuitable for P. vivax transmission [22]. *National reported infections among returning travellers were scaled by the total number of Admin1 units in a given country. For countries with fewer traveller P. vivax cases than Admin1 units, a weighting of 0.5 was given to each admin unit.