Resistance to malaria drug increasing

Resistance to the malaria drug artemisinin extends across much of Myanmar in Southeast Asia, according a new study, published online February 19 in The Lancet Infectious Diseases.

“We recorded P falciparum parasites carrying K13-propeller mutations at high prevalence next to the northwestern border with India,” lead author Kwan M. Tun, MD, with the Myanmar Oxford Clinical Research Unit, wrote. “Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided.”

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The group of researchers decided to study artemisinin resistance because it “poses a serious threat to the global control of Plasmodium falciparum malaria.” And Myanmar has substantially more malaria than any other country in Southeast Asia, so artemisinin resistance could “reverse recent downward trends in morbidity and mortality from malaria in the country”, Tun wrote.

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Also, 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, Tun wrote. As a result, researchers 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.

The researchers conducted a cross-sectional survey at malaria treatment centers at 55 sites in ten administrative regions in Myanmar, and in relevant border regions in Thailand and Bangladesh, between January, 2013, and September, 2014. They used geostatistical models to produce predictive maps of the estimated prevalence of mutations of the K13 propeller region across Myanmar.

They found that 39% of 940 samples carried a K13-propeller mutation. “We recorded 26 different mutations, including nine mutations not described previously in Southeast Asia,” Tun wrote. In 70% of the 10 administrative regions of Myanmar, the combined K13-mutation prevalence was more than 20%.

In addition, the researchers’ geospatial mapping showed that the overall prevalence of K13 mutations exceeded 10 percent 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.

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