Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar
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 dihydroartemisi...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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BioMed Central
2024
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| _version_ | 1826314842509672448 |
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| author | Thu, AM Phyo, AP Pateekhum, C Rae, JD Landier, J Parker, DM Delmas, G Watthanaworawit, W McLean, ARD Arya, A Reyes, A Li, X Miotto, O Soe, K Ashley, EA Dondorp, A White, NJ Day, NP Anderson, TJC Imwong, M Nosten, F Smithuis, F |
| author_facet | Thu, AM Phyo, AP Pateekhum, C Rae, JD Landier, J Parker, DM Delmas, G Watthanaworawit, W McLean, ARD Arya, A Reyes, A Li, X Miotto, O Soe, K Ashley, EA Dondorp, A White, NJ Day, NP Anderson, TJC Imwong, M Nosten, F Smithuis, F |
| author_sort | Thu, AM |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-09-25T04:16:43Z |
| format | Journal article |
| id | oxford-uuid:32be5457-fff8-4000-9383-c38ff1f56c7f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-12-09T03:14:32Z |
| publishDate | 2024 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:32be5457-fff8-4000-9383-c38ff1f56c7f2024-10-16T09:39:42ZMolecular markers of artemisinin resistance during falciparum malaria elimination in Eastern MyanmarJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:32be5457-fff8-4000-9383-c38ff1f56c7fEnglishJisc Publications RouterBioMed Central2024Thu, AMPhyo, APPateekhum, CRae, JDLandier, JParker, DMDelmas, GWatthanaworawit, WMcLean, ARDArya, AReyes, ALi, XMiotto, OSoe, KAshley, EADondorp, AWhite, NJDay, NPAnderson, TJCImwong, MNosten, FSmithuis, FBackground: 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. |
| spellingShingle | Thu, AM Phyo, AP Pateekhum, C Rae, JD Landier, J Parker, DM Delmas, G Watthanaworawit, W McLean, ARD Arya, A Reyes, A Li, X Miotto, O Soe, K Ashley, EA Dondorp, A White, NJ Day, NP Anderson, TJC Imwong, M Nosten, F Smithuis, F Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title | Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title_full | Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title_fullStr | Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title_full_unstemmed | Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title_short | Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar |
| title_sort | molecular markers of artemisinin resistance during falciparum malaria elimination in eastern myanmar |
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