Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar
Issued Date
2024-12-01
Resource Type
eISSN
14752875
Scopus ID
2-s2.0-85192385884
Journal Title
Malaria Journal
Volume
23
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Malaria Journal Vol.23 No.1 (2024)
Suggested Citation
Thu A.M., Phyo A.P., Pateekhum C., Rae J.D., Landier J., Parker D.M., Delmas G., Watthanaworawit W., McLean A.R.D., Arya A., Reyes A., Li X., Miotto O., Soe K., Ashley E.A., Dondorp A., White N.J., Day N.P., Anderson T.J.C., Imwong M., Nosten F., Smithuis F. Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar. Malaria Journal Vol.23 No.1 (2024). doi:10.1186/s12936-024-04955-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98347
Title
Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar
Author's Affiliation
Faculty of Tropical Medicine, Mahidol University
Mahidol Oxford Tropical Medicine Research Unit
Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale
Texas Biomedical Research Institute
Mahosot Hospital, Lao
Mahidol University
Nuffield Department of Medicine
University of California, Irvine
Myanmar Oxford Clinical Research Unit
Medical Action Myanmar
Mahidol Oxford Tropical Medicine Research Unit
Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale
Texas Biomedical Research Institute
Mahosot Hospital, Lao
Mahidol University
Nuffield Department of Medicine
University of California, Irvine
Myanmar Oxford Clinical Research Unit
Medical Action Myanmar
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Artemisinin resistance in Plasmodium falciparum threatens global malaria elimination efforts. To contain and then eliminate artemisinin resistance in Eastern Myanmar a network of community-based malaria posts was instituted and targeted mass drug administration (MDA) with dihydroartemisinin-piperaquine (three rounds at monthly intervals) was conducted. The prevalence of artemisinin resistance during the elimination campaign (2013–2019) was characterized. Methods: Throughout the six-year campaign Plasmodium falciparum positive blood samples from symptomatic patients and from cross-sectional surveys were genotyped for mutations in kelch-13—a molecular marker of artemisinin resistance. Result: The program resulted in near elimination of falciparum malaria. Of 5162 P. falciparum positive blood samples genotyped, 3281 (63.6%) had K13 mutations. The prevalence of K13 mutations was 73.9% in 2013 and 64.4% in 2019. Overall, there was a small but significant decline in the proportion of K13 mutants (p < 0.001). In the MDA villages there was no significant change in the K13 proportions before and after MDA. The distribution of different K13 mutations changed substantially; F446I and P441L mutations increased in both MDA and non-MDA villages, while most other K13 mutations decreased. The proportion of C580Y mutations fell from 9.2% (43/467) before MDA to 2.3% (19/813) after MDA (p < 0.001). Similar changes occurred in the 487 villages where MDA was not conducted. Conclusion: The malaria elimination program in Kayin state, eastern Myanmar, led to a substantial reduction in falciparum malaria. Despite the intense use of artemisinin-based combination therapies, both in treatment and MDA, this did not select for artemisinin resistance.