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Title: Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: A cross-sectional survey of the K13 molecular marker
Authors: Kyaw M. Tun
Mallika Imwong
Khin M. Lwin
Aye A. Win
Tin M. Hlaing
Thaung Hlaing
Khin Lin
Myat P. Kyaw
Katherine Plewes
M. Abul Faiz
Mehul Dhorda
Phaik Yeong Cheah
Sasithon Pukrittayakamee
Elizabeth A. Ashley
Tim J.C. Anderson
Shalini Nair
Marina McDew-White
Jennifer A. Flegg
Eric P.M. Grist
Philippe Guerin
Richard J. Maude
Frank Smithuis
Arjen M. Dondorp
Nicholas P.J. Day
François Nosten
Nicholas J. White
Charles J. Woodrow
Myanmar Oxford Clinical Research Unit
Defence Services Medical Research Centre
Mahidol University
Shoklo Malaria Research Unit
Institute of Medicine (1)
Ministry of Health
Department of Medical Research
WorldWide Antimalarial Resistance Network
Nuffield Department of Clinical Medicine
Dev Care Foundation
Texas Biomedical Research Institute
Monash University
Medical Action Myanmar
Keywords: Medicine
Issue Date: 1-Apr-2015
Citation: The Lancet Infectious Diseases. Vol.15, No.4 (2015), 415-421
Abstract: © 2015 Tun et al. Background: Emergence of artemisinin resistance in southeast Asia poses a serious threat to the global control of Plasmodium falciparum malaria. Discovery of the K13 marker has transformed approaches to the monitoring of artemisinin resistance, allowing introduction of molecular surveillance in remote areas through analysis of DNA. We aimed to assess the spread of artemisinin-resistant P falciparum in Myanmar by determining the relative prevalence of P falciparum parasites carrying K13-propeller mutations. Methods: We did this cross-sectional survey at malaria treatment centres at 55 sites in ten administrative regions in Myanmar, and in relevant border regions in Thailand and Bangladesh, between January, 2013, and September, 2014. K13 sequences from P falciparum infections were obtained mainly by passive case detection. We entered data into two geostatistical models to produce predictive maps of the estimated prevalence of mutations of the K13 propeller region across Myanmar. Findings: Overall, 371 (39%) of 940 samples carried a K13-propeller mutation. We recorded 26 different mutations, including nine mutations not described previously in southeast Asia. In seven (70%) of the ten administrative regions of Myanmar, the combined K13-mutation prevalence was more than 20%. Geospatial mapping showed that the overall prevalence of K13 mutations exceeded 10% in much of the east and north of the country. In Homalin, Sagaing Region, 25 km from the Indian border, 21 (47%) of 45 parasite samples carried K13-propeller mutations. Interpretation: Artemisinin resistance extends across much of Myanmar. We recorded P falciparum parasites carrying K13-propeller mutations at high prevalence next to the northwestern border with India. Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided. Funding: Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme and the Bill & Melinda Gates Foundation.
ISSN: 14744457
Appears in Collections:Scopus 2011-2015

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