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Title: Emergence of artemisinin-resistant malaria on the western border of Thailand: A longitudinal study
Authors: Aung Pyae Phyo
Standwell Nkhoma
Kasia Stepniewska
Elizabeth A. Ashley
Shalini Nair
Rose McGready
Carit Ler Moo
Salma Al-Saai
Arjen M. Dondorp
Khin Maung Lwin
Pratap Singhasivanon
Nicholas P.J. Day
Nicholas J. White
Tim J.C. Anderson
François Nosten
Mahidol University
Shoklo Malaria Research Unit
Texas Biomedical Research Institute
Churchill Hospital
WorldWide Antimalarial Resistance Network
Keywords: Medicine
Issue Date: 1-Jan-2012
Citation: The Lancet. Vol.379, No.9830 (2012), 1960-1966
Abstract: Artemisinin-resistant falciparum malaria has arisen in western Cambodia. A concerted international eff ort is underway to contain artemisinin-resistant Plasmodium falciparum, but containment strategies are dependent on whether resistance has emerged elsewhere. We aimed to establish whether artemisinin resistance has spread or emerged on the Thailand-Myanmar (Burma) border. Methods In malaria clinics located along the northwestern border of Thailand, we measured six hourly parasite counts in patients with uncomplicated hyperparasitaemic falciparum malaria (≤4% infected red blood cells) who had been given various oral artesunate-containing regimens since 2001. Parasite clearance half-lives were estimated and parasites were genotyped for 93 single nucleotide polymorphisms. Findings 3202 patients were studied between 2001 and 2010. Parasite clearance half-lives lengthened from a geometric mean of 2·6 h (95% CI 2·5-2·7) in 2001, to 3·7 h (3·6-3·8) in 2010, compared with a mean of 5·5 h (5·2-5·9) in 119 patients in western Cambodia measured between 2007 and 2010. The proportion of slow-clearing infections (half-life ≤6·2 h) increased from 0·6% in 2001, to 20% in 2010, compared with 42% in western Cambodia between 2007 and 2010. Of 1583 infections genotyped, 148 multilocus parasite genotypes were identifi ed, each of which infected between two and 13 patients. The proportion of variation in parasite clearance attributable to parasite genetics increased from 30% between 2001 and 2004, to 66% between 2007 and 2010. Interpret ation Genetically determined artemisinin resistance in P falciparum emerged along the Thailand-Myanmar border at least 8 years ago and has since increased substantially. At this rate of increase, resistance will reach rates reported in western Cambodia in 2-6 years.
ISSN: 1474547X
Appears in Collections:Scopus 2011-2015

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