Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar
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2024-12-01
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Malaria Journal
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BMC
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Melbourne School of Population and Global Health
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Journal Article
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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. ,... Smithuis, F. (2024). Molecular markers of artemisinin resistance during falciparum malaria elimination in Eastern Myanmar. Malaria Journal, 23 (1), https://doi.org/10.1186/s12936-024-04955-6.
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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.