FocaL Mass Drug Administration for Vivax Malaria Elimination

Inclusion Criteria: 1. Cluster eligibility * Within 8 hours transport of Iquitos * Incidence \<250/1000 and \>2 cases year prior to trial * Population size (\<650) 2. Chloroquine (CQ) eligibility * Resides in neighboring household but within 200 m of Pv index case in the past 2 years * Age ≥6 months old * Present for intervention * Adult ≥18 years old that provides informed consent * A child ≥8 years and \<18 years old that provides informed assent and has informed consent from their parents * A child ≥6 months old and \<8 years old that has informed consent from their parents 3. Tafenoquine (TQ) eligibility * Eligible to receive CQ * Age ≥16 years old * Adult ≥18 years old that provides informed consent * A child ≥16 years and \<18 years old that provides informed assent and has informed consent from their parents 4. Primaquine eligibility * Eligible to receive CQ and ineligible to receive TQ * Age ≥6 months old * Adult ≥18 years old that provides informed consent * A child ≥8 years and \<18 years old that provides informed assent and has informed consent from their parents * A child ≥6 months old and \<8 years old that has informed consent from their parents 5. Baseline evaluation and informed consent -Villagers will be eligible to participate in surveys if they slept in a household in cluster randomized to control or focal mass drug administration (fMDA) for at least one night in the past four weeks 6. Eligibility for fMDA * High-risk villagers are defined as individuals residing in households that are within 200 meters of a Plasmodium vivax index case households from the prior 2 years (including individuals in the index case household) will be eligible to receive fMDA that cycle * Villagers that were eligible but missed in the 1st round in a cycle, or become eligible in the next two months, will not be eligible to receive fMDA in the 2nd round in a cycle. Exclusion Criteria: 1. Chloroquine eligibility * History of retinal or visual field changes * Known hypersensitivity or adverse reaction to CQ * Currently taking CQ or have taken CQ in the past four weeks * Ineligible for TQ or PQ (see criteria below) * Hemoglobin \<9 g/dL 2. Tafenoquine eligibility * G6PD deficiency or intermediate status (defined as activity ≤6.0 UI/gHb per SD biosensor) * G6PD status unknown or refusal of G6PD status test * Acute or severe malaria * Pregnancy (known or identified by pregnancy test) * Refusal of pregnancy test if new amenorrhea in the past 4 weeks * Woman breastfeeding a child that is G6PD deficient or with unknown G6PD status * Known hypersensitivity or adverse reaction to TQ or PQ * Have taken mefloquine (i.e. artesunate- mefloquine), TQ or PQ, or other antimalarial in the past four weeks * Hemoglobin \< 9 g/dL 3. Primaquine eligibility * G6PD deficiency (defined as activity ≤4.0 UI/gHb per SD biosensor) * G6PD status unknown or refusal of G6PD status test * Acute or severe malaria * Pregnancy (known or identified by pregnancy test) * Refusal of pregnancy test if new amenorrhea in the past 4 weeks * Breastfeeding child with documented or unknown G6PD deficiency status * Woman breastfeeding a child with documented or unknown G6PD deficiency status * Known hypersensitivity or adverse reaction to TQ or PQ * Have taken mefloquine (i.e. artesunate- mefloquine), TQ or PQ, or other antimalarial in the past four weeks * Hemoglobin \< 9 g/dL