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Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.

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tm-ar-mallika-2015-1.pdf (2.36 MB)

Issued Date

2015-04

Copyright Date

2015

Resource Type

Article

Language

eng

ISSN

1473-3099 (printed)
1474-4457 (electronic)

DOI

10.1016/S1473-3099(15)70032-0.

Rights Holder(s)

Elsevier Science

Bibliographic Citation

Tun KM, Imwong M, Lwin KM, Win AA, Hlaing TM, Hlaing T, et al. Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker. Lancet Infect Dis. 2015 Apr;15(4):415-21.

Suggested Citation

Tun, Kyaw M, Mallika Imwong, มัลลิกา อิ่มวงศ์, Lwin, Khin M, Win, Aye A, Hlaing, Tin M, Hlaing, Thaung, Lin, Khin, Kyaw, Myat P, Plewes, Katherine, Faiz, M Abul, Dhorda, Mehul, Cheah, Phaik Yeong, Sasithon Pukrittayakamee, ศศิธร ผู้กฤตยาคามี, Ashley, Elizabeth A, Anderson, Tim J C, Nair, Shalini, McDew-White, Marina, Flegg, Jennifer A, Grist, Eric P M, Guerin, Philippe, Maude, Richard J, Smithuis, Frank, Dondorp, Arjen M, Day, Nicholas P J, Nosten, François, White, Nicholas J, Woodrow, Charles J Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.. Tun KM, Imwong M, Lwin KM, Win AA, Hlaing TM, Hlaing T, et al. Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker. Lancet Infect Dis. 2015 Apr;15(4):415-21.. doi:10.1016/S1473-3099(15)70032-0. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/851

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Title

Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.

Author(s)

Tun, Kyaw M
 Mallika Imwong
 มัลลิกา อิ่มวงศ์
 Lwin, Khin M
 Win, Aye A
 Hlaing, Tin M
 Hlaing, Thaung
 Lin, Khin
 Kyaw, Myat P
 Plewes, Katherine
 Faiz, M Abul
 Dhorda, Mehul
 Cheah, Phaik Yeong
 Sasithon Pukrittayakamee
 ศศิธร ผู้กฤตยาคามี
 Ashley, Elizabeth A
 Anderson, Tim J C
 Nair, Shalini
 McDew-White, Marina
 Flegg, Jennifer A
 Grist, Eric P M
 Guerin, Philippe
 Maude, Richard J
 Smithuis, Frank
 Dondorp, Arjen M
 Day, Nicholas P J
 Nosten, François
 White, Nicholas J
 Woodrow, Charles J

Corresponding Author(s)

Mallika Imwong

Other Contributor(s)

Mahidol University. Faculty of Tropical Medicine. Department of Molecular Tropical Medicine and Genetics.
 Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit. Shoklo Malaria Research Unit.
 Mahidol University. Faculty of Tropical Medicine.
 Mahidol University. Faculty of Tropical Medicine. Mahidol-Oxford Tropical Medicine Research Unit.

Abstract

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.

Keyword(s)

Artemisinin-resistant
 K13 molecular marker
 Myanmar
 Plasmodium falciparum
 Open Access article

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URI

https://repository.li.mahidol.ac.th/handle/123456789/851

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TM-Article