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.Mahidol University2024-05-152024-05-152024-12-01Malaria Journal Vol.23 No.1 (2024)https://repository.li.mahidol.ac.th/handle/20.500.14594/98347Background: 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.MedicineImmunology and MicrobiologyArticleSCOPUS10.1186/s12936-024-04955-62-s2.0-8519238588414752875