Browsing by Author "Defence Services Medical Research Centre"

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    Bayesian spatiotemporal analysis of malaria infection along an international border: Hlaingbwe Township in Myanmar and Tha-Song-Yang District in Thailand
    (2018-11-16) Aung Minn Thway; Chawarat Rotejanaprasert; Jetsumon Sattabongkot; Siam Lawawirojwong; Aung Thi; Tin Maung Hlaing; Thiha Myint Soe; Jaranit Kaewkungwal; Mahidol University; Defence Services Medical Research Centre; National Malaria Control Program; Geo-Informatics and Space Technology Development Agency
    © 2018 The Author(s). Background: One challenge in moving towards malaria elimination is cross-border malaria infection. The implemented measures to prevent and control malaria re-introduction across the demarcation line between two countries require intensive analyses and interpretation of data from both sides, particularly in border areas, to make correct and timely decisions. Reliable maps of projected malaria distribution can help to direct intervention strategies. In this study, a Bayesian spatiotemporal analytic model was proposed for analysing and generating aggregated malaria risk maps based on the exceedance probability of malaria infection in the township-district adjacent to the border between Myanmar and Thailand. Data of individual malaria cases in Hlaingbwe Township and Tha-Song-Yang District during 2016 were extracted from routine malaria surveillance databases. Bayesian zero-inflated Poisson model was developed to identify spatial and temporal distributions and associations between malaria infections and risk factors. Maps of the descriptive statistics and posterior distribution of predicted malaria infections were also developed. Results: A similar seasonal pattern of malaria was observed in both Hlaingbwe Township and Tha-Song-Yang District during the rainy season. The analytic model indicated more cases of malaria among males and individuals aged ≥ 15 years. Mapping of aggregated risk revealed consistently high or low probabilities of malaria infection in certain village tracts or villages in interior parts of each country, with higher probability in village tracts/villages adjacent to the border in places where it could easily be crossed; some border locations with high mountains or dense forests appeared to have fewer malaria cases. The probability of becoming a hotspot cluster varied among village tracts/villages over the year, and some had close to no cases all year. Conclusions: The analytic model developed in this study could be used for assessing the probability of hotspot cluster, which would be beneficial for setting priorities and timely preventive actions in such hotspot cluster areas. This approach might help to accelerate reaching the common goal of malaria elimination in the two countries.
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    Delay in diagnosis and treatment among adult multidrug resistant tuberculosis patients in Yangon Regional Tuberculosis Center, Myanmar: A cross-sectional study
    (2018-11-20) Ye Minn Htun; Tin Mi Mi Khaing; Yin Yin; Zaw Myint; Si Thu Aung; Tin Maung Hlaing; Ngamphol Soonthornworasiri; Udomsak Silachamroon; Yuthichai Kasetjaroen; Jaranit Kaewkungwal; Mahidol University; Regional Tuberculosis Center; Ministry of Health and Sports; Defence Services Medical Research Centre; Bureau of Tuberculosis
    © 2018 The Author(s). Background: Delays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar. This study aimed to explore delays in diagnosis and treatment initiation, and associated factors among patients with multidrug-resistant tuberculosis. Methods: A cross-sectional study was conducted at Yangon Regional Tuberculosis Centre, Myanmar. Data were collected by face-to-face interviews and treatment-card reviews of all adult patients who had registered and started treatment with the standard regimen from May to November, 2017. Delay time was categorized by using median cut-off and analyzed using SPSS version 23.0. Logistic regression analysis was performed to assess the relative impact of predictor variables on diagnosis and treatment delays. Results: A total of 210 patients participated in this study. The median diagnosis delay was 9 days, IQR 3 (8-11) and 58.6% of the patients experienced a long diagnosis delay. Below middle school education (adjusted odds ratio [AOR] = 2.75, 95% CI = 1.22-6.21), non-permanent salaried employment (AOR = 3.03, 95% CI = 1.32-6.95), co-existing diabetes mellitus (AOR = 5.06, 95% CI = 1.97-13.01) and poor awareness (AOR = 2.99, 95% CI = 1.29-6.92) were independent predictors of long diagnosis delay. The median treatment delay was 13 days, IQR 9 (8-17) and 51% of the patients experienced long treatment delay. Age 31-50 years (AOR = 4.50, 95% CI = 1.47-13.97) and age > 50 years (AOR = 9.40, 95% CI = 2.55-34.83), history with MDR-TB patient (AOR = 3.16, 95% CI = 1.29-7.69), > 20 km away from a Regional TB Centre (AOR = 14.33, 95% CI = 1.91-107.64) and poor awareness (AOR = 4.62, 95% CI = 1.56-13.67) were independent predictors of long treatment delay. Conclusions: Strengthening comprehensive health education, enhancing treatment adherence counseling, providing more Xpert MTB/RIF machines, expanding decentralized MDR-TB treatment centers, ensuring timely sputum transportation, provision of a patient support package immediately after confirmation, and strengthening contact-tracing for all household contacts with MDR-TB patients and active tuberculosis screening were the most effective ways to shorten delays in MDR-TB diagnosis and treatment initiation.
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    Genomic structure and diversity of Plasmodium falciparum in Southeast Asia reveal recent parasite migration patterns
    (2019-12-01) Amol C. Shetty; Christopher G. Jacob; Fang Huang; Yao Li; Sonia Agrawal; David L. Saunders; Chanthap Lon; Mark M. Fukuda; Pascal Ringwald; Elizabeth A. Ashley; Kay Thwe Han; Tin Maung Hlaing; Myaing M. Nyunt; Joana C. Silva; Kathleen E. Stewart; Christopher V. Plowe; Timothy D. O’Connor; Shannon Takala-Harrison; Harald Noedl; Wasif A. Khan; Paul Newton; Myat P. Kyaw; Nicholas J. White; Arjen M. Dondorp; Nicholas P. Day; Charles J. Woodrow; Mehul Dhorda; M. Abul Faiz; Rick M. Fairhurst; Pharath Lim; Rupam Tripura; Mayfong Mayxay; Ye Htut; Francois Nosten; Aung Pyae Phyo; Sasithon Pukrittayakamee; Tran Tinh Hien; Nguyen Thanh Thuy Nhien; Olugbenga A. Mokuolu; Caterina I. Fanello; Marie A. Onyamboko; Medizinische Universitat Wien, Zentrum für Pathophysiologie, Infektiologie und Immunologie; Chinese Center for Disease Control and Prevention; Organisation Mondiale de la Santé; University of Maryland; National Institute of Allergy and Infectious Diseases; Armed Forces Research Institute of Medical Sciences, Thailand; University of Maryland School of Medicine; Mahidol University; University of Ilorin; International Centre for Diarrhoeal Disease Research Bangladesh; Nuffield Department of Clinical Medicine; Duke University; Wellcome Sanger Institute; University of Health Sciences; Malaria Research Group and Dev Care Foundation; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU); Defence Services Medical Research Centre; Armed Forces Research Institute of Medical Sciences; WorldWide Antimalarial Resistance Network; Oxford University Clinical Research Unit (OUCRU); Ministry of Health
    © 2019, The Author(s). Estimates of Plasmodium falciparum migration may inform strategies for malaria elimination. Here we elucidate fine-scale parasite population structure and infer recent migration across Southeast Asia using identity-by-descent (IBD) approaches based on genome-wide single nucleotide polymorphisms called in 1722 samples from 54 districts. IBD estimates are consistent with isolation-by-distance. We observe greater sharing of larger IBD segments between artemisinin-resistant parasites versus sensitive parasites, which is consistent with the recent spread of drug resistance. Our IBD analyses reveal actionable patterns, including isolated parasite populations, which may be prioritized for malaria elimination, as well as asymmetrical migration identifying potential sources and sinks of migrating parasites.
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    Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion: an observational study
    (2020-01-01) Mallika Imwong; Mehul Dhorda; Kyaw Myo Tun; Aung Myint Thu; Aung Pyae Phyo; Stephane Proux; Kanokon Suwannasin; Chanon Kunasol; Suttipat Srisutham; Jureeporn Duanguppama; Ranitha Vongpromek; Cholrawee Promnarate; Aungkana Saejeng; Nardlada Khantikul; Rungniran Sugaram; Supinya Thanapongpichat; Nongyao Sawangjaroen; Kreepol Sutawong; Kay Thwe Han; Ye Htut; Khin Linn; Aye Aye Win; Tin M. Hlaing; Rob W. van der Pluijm; Mayfong Mayxay; Tiengkham Pongvongsa; Koukeo Phommasone; Rupam Tripura; Thomas J. Peto; Lorenz von Seidlein; Chea Nguon; Dysoley Lek; Xin Hui S. Chan; Huy Rekol; Rithea Leang; Cheah Huch; Dominic P. Kwiatkowski; Olivo Miotto; Elizabeth A. Ashley; Myat Phone Kyaw; Sasithon Pukrittayakamee; Nicholas P.J. Day; Arjen M. Dondorp; Frank M. Smithuis; Francois H. Nosten; Nicholas J. White; Shoklo Malaria Research Unit; Thailand Ministry of Public Health; Mahosot Hospital, Lao; Mahidol University; Nuffield Department of Medicine; Prince of Songkla University; Wellcome Sanger Institute; University of Oxford Medical Sciences Division; Myanmar Health Network Organization; University of Health Sciences; Myanmar Oxford Clinical Research Unit; University of Medicine 1; Ministry of Health and Sports; Medical Action Myanmar; Defence Services Medical Academy; Buntharik Hospital; Defence Services Medical Research Centre; Savannakhet Provincial Health Department; Royal Society of Thailand; Worldwide Antimalarial Resistance Network; National Center for Parasitology, Entomology and Malaria Control; Office of Disease Prevention and Control
    © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: The Greater Mekong subregion is a recurrent source of antimalarial drug resistance in Plasmodium falciparum malaria. This study aimed to characterise the extent and spread of resistance across this entire region between 2007 and 2018. Methods: P falciparum isolates from Myanmar, Thailand, Laos, and Cambodia were obtained from clinical trials and epidemiological studies done between Jan 1, 2007, and Dec 31, 2018, and were genotyped for molecular markers (pfkelch, pfcrt, pfplasmepsin2, and pfmdr1) of antimalarial drug resistance. Genetic relatedness was assessed using microsatellite and single nucleotide polymorphism typing of flanking sequences around target genes. Findings: 10 632 isolates were genotyped. A single long pfkelch Cys580Tyr haplotype (from −50 kb to +31·5 kb) conferring artemisinin resistance (PfPailin) now dominates across the eastern Greater Mekong subregion. Piperaquine resistance associated with pfplasmepsin2 gene amplification and mutations in pfcrt downstream of the Lys76Thr chloroquine resistance locus has also developed. On the Thailand–Myanmar border a different pfkelch Cys580Tyr lineage rose to high frequencies before it was eliminated. Elsewhere in Myanmar the Cys580Tyr allele remains widespread at low allele frequencies. Meanwhile a single artemisinin-resistant pfkelch Phe446Ile haplotype has spread across Myanmar. Despite intense use of dihydroartemisinin–piperaquine in Kayin state, eastern Myanmar, both in treatment and mass drug administrations, no selection of piperaquine resistance markers was observed. pfmdr1 amplification, a marker of resistance to mefloquine, remains at low prevalence across the entire region. Interpretation: Artemisinin resistance in P falciparum is now prevalent across the Greater Mekong subregion. In the eastern Greater Mekong subregion a multidrug resistant P falciparum lineage (PfPailin) dominates. In Myanmar a long pfkelch Phe446Ile haplotype has spread widely but, by contrast with the eastern Greater Mekong subregion, there is no indication of artemisinin combination therapy (ACT) partner drug resistance from genotyping known markers, and no evidence of spread of ACT resistant P falciparum from the east to the west. There is still a window of opportunity to prevent global spread of ACT resistance. Funding: Thailand Science Research and Innovation, Initiative 5%, Expertise France, Wellcome Trust.
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    Optimal health and disease management using spatial uncertainty: A geographic characterization of emergent artemisinin-resistant Plasmodium falciparum distributions in Southeast Asia
    (2016-10-24) Eric P.M. Grist; Jennifer A. Flegg; Georgina Humphreys; Ignacio Suay Mas; Tim J.C. Anderson; Elizabeth A. Ashley; Nicholas P.J. Day; Mehul Dhorda; Arjen M. Dondorp; M. Abul Faiz; Peter W. Gething; Tran T. Hien; Tin M. Hlaing; Mallika Imwong; Jean Marie Kindermans; Richard J. Maude; Mayfong Mayxay; Marina McDew-White; Didier Menard; Shalini Nair; Francois Nosten; Paul N. Newton; Ric N. Price; Sasithon Pukrittayakamee; Shannon Takala-Harrison; Frank Smithuis; Nhien T. Nguyen; Kyaw M. Tun; Nicholas J. White; Benoit Witkowski; Charles J. Woodrow; Rick M. Fairhurst; Carol Hopkins Sibley; Philippe J. Guerin; WorldWide Antimalarial Resistance Network (WWARN); Nuffield Department of Clinical Medicine; Monash University; Texas Biomedical Research Institute; Mahidol University; National Institute of Allergy and Infectious Diseases; Dev Care Foundation; University of Oxford; Oxford University Clinical Research Unit; Defence Services Medical Research Centre; Medecins Sans Frontieres, Brussels; Pasteur Institute in Cambodia; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU); University of Maryland School of Medicine; Menzies School of Health Research; Myanmar Oxford Clinical Research Unit; University of Washington, Seattle; Harvard School of Public Health
    © 2016 The Author(s). Background: Artemisinin-resistant Plasmodium falciparum malaria parasites are now present across much of mainland Southeast Asia, where ongoing surveys are measuring and mapping their spatial distribution. These efforts require substantial resources. Here we propose a generic 'smart surveillance' methodology to identify optimal candidate sites for future sampling and thus map the distribution of artemisinin resistance most efficiently. Methods: The approach uses the 'uncertainty' map generated iteratively by a geostatistical model to determine optimal locations for subsequent sampling. Results: The methodology is illustrated using recent data on the prevalence of the K13-propeller polymorphism (a genetic marker of artemisinin resistance) in the Greater Mekong Subregion. Conclusion: This methodology, which has broader application to geostatistical mapping in general, could improve the quality and efficiency of drug resistance mapping and thereby guide practical operations to eliminate malaria in affected areas.
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    The origins of malaria artemisinin resistance defined by a genetic and transcriptomic background
    (2018-12-01) Lei Zhu; Jaishree Tripathi; Frances Maureen Rocamora; Olivo Miotto; Rob van der Pluijm; Till S. Voss; Sachel Mok; Dominic P. Kwiatkowski; François Nosten; Nicholas P.J. Day; Nicholas J. White; Arjen M. Dondorp; Zbynek Bozdech; Aung Pyae Phyo; Elizabeth A. Ashley; Frank Smithuis; Khin Lin; Kyaw Myo Tun; M. Abul Faiz; Mayfong Mayxay; Mehul Dhorda; Nguyen Thanh Thuy-Nhien; Paul N. Newton; Sasithon Pukrittayakamee; Tin M. Hlaing; Tran Tinh Hien; Ye Htut; Columbia University Medical Center; University of Oxford; Universitat Basel; Swiss Tropical and Public Health Institute (Swiss TPH); UCL; Mahidol University; Nuffield Department of Clinical Medicine; Wellcome Sanger Institute; Nanyang Technological University; Malaria Research Group and Dev Care Foundation; Mahosot Hospital; Defence Services Medical Research Centre
    © 2018, The Author(s). The predisposition of parasites acquiring artemisinin resistance still remains unclear beyond the mutations in Pfk13 gene and modulation of the unfolded protein response pathway. To explore the chain of casualty underlying artemisinin resistance, we reanalyze 773 P. falciparum isolates from TRACI-study integrating TWAS, GWAS, and eQTL analyses. We find the majority of P. falciparum parasites are transcriptomically converged within each geographic site with two broader physiological profiles across the Greater Mekong Subregion (GMS). We report 8720 SNP-expression linkages in the eastern GMS parasites and 4537 in the western. The minimal overlap between them suggests differential gene regulatory networks facilitating parasite adaptations to their unique host environments. Finally, we identify two genetic and physiological backgrounds associating with artemisinin resistance in the GMS, together with a farnesyltransferase protein and a thioredoxin-like protein which may act as vital intermediators linking the Pfk13 C580Y mutation to the prolonged parasite clearance time.
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    Parasite clearance rates in Upper Myanmar indicate a distinctive artemisinin resistance phenotype: A therapeutic efficacy study
    (2016-01-01) Kyaw Myo Tun; Atthanee Jeeyapant; Mallika Imwong; Min Thein; Sai Soe Moe Aung; Tin Maung Hlaing; Prayoon Yuentrakul; Cholrawee Promnarate; Mehul Dhorda; Charles J. Woodrow; Arjen M. Dondorp; Elizabeth A. Ashley; Frank M. Smithuis; Nicholas J. White; Nicholas P.J. Day; Defence Services Medical Research Centre; Myanmar Oxford Clinical Research Unit; Mahidol University; Nuffield Department of Clinical Medicine; Medical Action Myanmar; Worldwide Antimalarial Resistance Network
    Background: Artemisinin resistance in Plasmodium falciparum extends across Southeast Asia where it is associated with worsening partner drug resistance and a decline in the efficacy of frontline artemisinin-based combination therapy. Dihydroartemisinin-piperaquine (DP) is an essential component of preventive and curative treatment in the region, but its therapeutic efficacy has fallen in Cambodia. Methods: A prospective clinical and parasitological evaluation of DP was conducted at two sites in Upper Myanmar between August 2013 and December 2014, enrolling 116 patients with acute uncomplicated falciparum malaria. Patients received DP orally for 3 days together with primaquine 0.25 mg/kg on admission. Parasite clearance half-lives based on 6 hourly blood smears, and day 42 therapeutic responses were assessed as well as parasite K13 genotypes. Results: Median parasite clearance half-life was prolonged, and clearance half-life was greater than 5 h in 21 % of patients. Delayed parasite clearance was significantly associated with mutations in the propeller region of the parasite k13 gene. The k13 F446I mutation was found in 25.4 % of infections and was associated with a median clearance halflife of 4.7 h compared with 2.7 h for infections without k13 mutations (p < 0.001). There were no failures after 42 days of follow-up, although 18 % of patients had persistent parasitaemia on day 3. Conclusion: The dominant k13 mutation observed in Upper Myanmar, F446I, appears to be associated with an intermediate rate of parasite clearance compared to other common mutations described elsewhere in the Greater Mekong Subregion. Discerning this phenotype requires relatively detailed clearance measurements, highlighting the importance of methodology in assessing artemisinin resistance.
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    Prevalence of pharmacogenomic variants in 100 pharmacogenes among Southeast Asian populations under the collaboration of the Southeast Asian Pharmacogenomics Research Network (SEAPharm)
    (2021-12-01) Chakkaphan Runcharoen; Koya Fukunaga; Insee Sensorn; Nareenart Iemwimangsa; Sommon Klumsathian; Hang Tong; Nam Sy Vo; Ly Le; Tin Maung Hlaing; Myo Thant; Shamsul Mohd Zain; Zahurin Mohamed; Yuh Fen Pung; Francis Capule; Jose Nevado; Catherine Lynn Silao; Zeina N. Al-Mahayri; Bassam R. Ali; Rika Yuliwulandari; Kinasih Prayuni; Hilyatuz Zahroh; Dzul Azri Mohamed Noor; Phonepadith Xangsayarath; Dalouny Xayavong; Sengchanh Kounnavong; Somphou Sayasone; Zoe Kordou; Ioannis Liopetas; Athina Tsikrika; Evangelia Eirini Tsermpini; Maria Koromina; Christina Mitropoulou; George P. Patrinos; Aumpika Kesornsit; Angkana Charoenyingwattana; Sukanya Wattanapokayakit; Surakameth Mahasirimongkol; Taisei Mushiroda; Wasun Chantratita; Faculty of Medicine, YARSI University; YARSI University; School of Pharmaceutical Sciences, Universiti Sains Malaysia; International University,Vietnam National University Ho Chi Minh City; The University of Nottingham Malaysia Campus; University of the Philippines Manila; University of the Philippines College of Medicine; College of Medicine and Health Sciences United Arab Emirates University; School of Health Sciences; Universiti Malaya; Riken; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Thailand Ministry of Public Health; Mahidol University; Defence Services Medical Research Centre; Defence Services Medical Academy; Vingroup Big Data Institute; Lao Tropical and Public Health Institute; The Golden Helix Foundation; National Center for Laboratory and Epidemiology
    Pharmacogenomics can enhance the outcome of treatment by adopting pharmacogenomic testing to maximize drug efficacy and lower the risk of serious adverse events. Next-generation sequencing (NGS) is a cost-effective technology for genotyping several pharmacogenomic loci at once, thereby increasing publicly available data. A panel of 100 pharmacogenes among Southeast Asian (SEA) populations was resequenced using the NGS platform under the collaboration of the Southeast Asian Pharmacogenomics Research Network (SEAPharm). Here, we present the frequencies of pharmacogenomic variants and the comparison of these pharmacogenomic variants among different SEA populations and other populations used as controls. We investigated the different types of pharmacogenomic variants, especially those that may have a functional impact. Our results provide substantial genetic variations at 100 pharmacogenomic loci among SEA populations that may contribute to interpopulation variability in drug response phenotypes. Correspondingly, this study provides basic information for further pharmacogenomic investigations in SEA populations.
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    Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: A cross-sectional survey of the K13 molecular marker
    (2015-04-01) 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
    © 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.
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    Use of rapid enzyme-linked immunosorbent assays for serological screening of melioidosis in myanmar
    (2018-01-01) Zin Zayar Win; Phornpun Phokrai; Zarni Aung; Thein Zaw; Mary N. Burtnick; Narisara Chantratita; Paul J. Brett; Tin Maung Hlaing; Mahidol University; University of Nevada School of Medicine; Biomedical Research Division; Defence Services Medical Research Centre
    Copyright © 2018 by The American Society of Tropical Medicine and Hygiene. Burkholderia pseudomallei, the etiologic agent of melioidosis, is an important but under-recognized cause of disease in the tropics. Although first described over a century ago as a septicemic illness associated with morphine addicts in Rangoon, Burma, there is little information regarding the incidence of melioidosis in present-day Myanmar. To address this issue, we used two recently developed and validated serological assays to detect B. pseudomallei–specific antibodies in 124 serum samples obtained from febrile patients in the delta region of Myanmar. Using cutoff values derived from culture-confirmed melioidosis cases in neighboring Thailand, 3.2% of the samples exhibited reactivity profiles consistent with active B. pseudomallei infections. Collectively, these findings indicate that melioidosis likely represents a significant cause of morbidity and mortality in Myanmar and support the need for further studies to assess the true burden of disease in this country.