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The severe Mediterranean variant (G6PD Med) found across Europe and Asia is thought to confer protection against malaria, but its effect is unclear. We fitted a Bayesian statistical model to observed G6PD Med allele frequencies in 999 Pashtun patients presenting with acute\n                    <jats:italic>Plasmodium vivax<\/jats:italic>\n                    malaria and 1408 population controls. G6PD Med was associated with reductions in symptomatic\n                    <jats:italic>P. vivax<\/jats:italic>\n                    malaria incidence of 76% (95% credible interval [CI], 58\u201388) in hemizygous males and homozygous females combined and 55% (95% CI, 38\u201368) in heterozygous females. Unless there is very large population stratification within the Pashtun (confounding these results), the G6PD Med genotype confers a very large and gene-dose proportional protective effect against acute vivax malaria. The proportion of patients with vivax malaria at risk of haemolysis following 8-aminoquinoline radical cure is substantially overestimated by studies measuring G6PD deficiency prevalence in healthy subjects.\n                  <\/jats:p>","DOI":"10.7554\/elife.62448","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T09:11:19Z","timestamp":1612516279000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.62448","source":"Crossref","is-referenced-by-count":40,"title":["Protective effect of Mediterranean-type glucose-6-phosphate dehydrogenase deficiency against Plasmodium vivax malaria"],"prefix":"10.7554","volume":"10","author":[{"given":"Ghulam R","family":"Awab","sequence":"first","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"},{"name":"Nangarhar Medical Faculty, Jalalabad, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahima","family":"Aaram","sequence":"additional","affiliation":[{"name":"Kabul Medical University, Kabul, Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuda","family":"Jamornthanyawat","sequence":"additional","affiliation":[{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanokon","family":"Suwannasin","sequence":"additional","affiliation":[{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Watcharee","family":"Pagornrat","sequence":"additional","affiliation":[{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, 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