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Resistance to the antimalarial drug artemisinin is present in Myanmar and has reached within 25 km of the Indian border, according to research published in The Lancet Infectious Diseases.
Researchers believe the spread of artemisinin-resistant malaria parasites into neighboring India would pose a serious threat to the global control and eradication of malaria.
And if drug resistance continues to spread, millions of lives could be at risk.
Kyaw Myo Tun, MD, of the Myanmar Oxford Clinical Research Unit in Yangon, Myanmar, and colleagues uncovered artemisinin resistance by analyzing parasite samples collected at 55 malaria treatment centers across Myanmar.
The group set out to determine if the samples carried mutations in specific regions of the parasite’s kelch gene (K13)—a known genetic marker of artemisinin resistance. And they confirmed the existance of resistant parasites in Homalin, in the Sagaing Region, which is located only 25 km from the Indian border.
“Myanmar is considered the frontline in the battle against artemisinin resistance, as it forms a gateway for resistance to spread to the rest of the world,” said Charles Woodrow, MD, of the University of Oxford in the UK.
“With artemisinins, we are in the unusual position of having molecular markers for resistance before resistance has spread globally. The more we understand about the current situation in the border regions, the better prepared we are to adapt and implement strategies to overcome the spread of further drug resistance.”
The researchers obtained the DNA sequences of 940 samples of Plasmodium falciparum malaria parasites from across Myanmar and neighboring border regions in Thailand and Bangladesh between 2013 and 2014. Of those 940 samples, 371 (39%) carried a resistance-conferring K13 mutation.
“We were able to gather patient samples rapidly across Myanmar, sometimes using discarded malaria blood diagnostic tests, and then test these immediately for the K13 marker, and so generate real-time information on the spread of resistance” said Mallika Imwong, PhD, of Mahidol University in Bangkok, Thailand.
Using this information, the researchers developed maps to display the predicted extent of artemisinin resistance determined by the prevalence of K13 mutations. The maps suggested the overall prevalence of K13 mutations was greater than 10% in large areas of the east and north of Myanmar, including areas close to the border with India.
“The identification of the K13 markers of resistance has transformed our ability to monitor the spread and emergence of artemisinin resistance,” said Philippe Guerin, MD, of the Worldwide Antimalarial Resistance Network in Oxford, UK.
“However, this study highlights that the pace at which artemisinin resistance is spreading or emerging is alarming. We need a more vigorous international effort to address this issue in border regions.” 
Photo by James Gathany
Resistance to the antimalarial drug artemisinin is present in Myanmar and has reached within 25 km of the Indian border, according to research published in The Lancet Infectious Diseases.
Researchers believe the spread of artemisinin-resistant malaria parasites into neighboring India would pose a serious threat to the global control and eradication of malaria.
And if drug resistance continues to spread, millions of lives could be at risk.
Kyaw Myo Tun, MD, of the Myanmar Oxford Clinical Research Unit in Yangon, Myanmar, and colleagues uncovered artemisinin resistance by analyzing parasite samples collected at 55 malaria treatment centers across Myanmar.
The group set out to determine if the samples carried mutations in specific regions of the parasite’s kelch gene (K13)—a known genetic marker of artemisinin resistance. And they confirmed the existance of resistant parasites in Homalin, in the Sagaing Region, which is located only 25 km from the Indian border.
“Myanmar is considered the frontline in the battle against artemisinin resistance, as it forms a gateway for resistance to spread to the rest of the world,” said Charles Woodrow, MD, of the University of Oxford in the UK.
“With artemisinins, we are in the unusual position of having molecular markers for resistance before resistance has spread globally. The more we understand about the current situation in the border regions, the better prepared we are to adapt and implement strategies to overcome the spread of further drug resistance.”
The researchers obtained the DNA sequences of 940 samples of Plasmodium falciparum malaria parasites from across Myanmar and neighboring border regions in Thailand and Bangladesh between 2013 and 2014. Of those 940 samples, 371 (39%) carried a resistance-conferring K13 mutation.
“We were able to gather patient samples rapidly across Myanmar, sometimes using discarded malaria blood diagnostic tests, and then test these immediately for the K13 marker, and so generate real-time information on the spread of resistance” said Mallika Imwong, PhD, of Mahidol University in Bangkok, Thailand.
Using this information, the researchers developed maps to display the predicted extent of artemisinin resistance determined by the prevalence of K13 mutations. The maps suggested the overall prevalence of K13 mutations was greater than 10% in large areas of the east and north of Myanmar, including areas close to the border with India.
“The identification of the K13 markers of resistance has transformed our ability to monitor the spread and emergence of artemisinin resistance,” said Philippe Guerin, MD, of the Worldwide Antimalarial Resistance Network in Oxford, UK.
“However, this study highlights that the pace at which artemisinin resistance is spreading or emerging is alarming. We need a more vigorous international effort to address this issue in border regions.”
Photo by James Gathany
Resistance to the antimalarial drug artemisinin is present in Myanmar and has reached within 25 km of the Indian border, according to research published in The Lancet Infectious Diseases.
Researchers believe the spread of artemisinin-resistant malaria parasites into neighboring India would pose a serious threat to the global control and eradication of malaria.
And if drug resistance continues to spread, millions of lives could be at risk.
Kyaw Myo Tun, MD, of the Myanmar Oxford Clinical Research Unit in Yangon, Myanmar, and colleagues uncovered artemisinin resistance by analyzing parasite samples collected at 55 malaria treatment centers across Myanmar.
The group set out to determine if the samples carried mutations in specific regions of the parasite’s kelch gene (K13)—a known genetic marker of artemisinin resistance. And they confirmed the existance of resistant parasites in Homalin, in the Sagaing Region, which is located only 25 km from the Indian border.
“Myanmar is considered the frontline in the battle against artemisinin resistance, as it forms a gateway for resistance to spread to the rest of the world,” said Charles Woodrow, MD, of the University of Oxford in the UK.
“With artemisinins, we are in the unusual position of having molecular markers for resistance before resistance has spread globally. The more we understand about the current situation in the border regions, the better prepared we are to adapt and implement strategies to overcome the spread of further drug resistance.”
The researchers obtained the DNA sequences of 940 samples of Plasmodium falciparum malaria parasites from across Myanmar and neighboring border regions in Thailand and Bangladesh between 2013 and 2014. Of those 940 samples, 371 (39%) carried a resistance-conferring K13 mutation.
“We were able to gather patient samples rapidly across Myanmar, sometimes using discarded malaria blood diagnostic tests, and then test these immediately for the K13 marker, and so generate real-time information on the spread of resistance” said Mallika Imwong, PhD, of Mahidol University in Bangkok, Thailand.
Using this information, the researchers developed maps to display the predicted extent of artemisinin resistance determined by the prevalence of K13 mutations. The maps suggested the overall prevalence of K13 mutations was greater than 10% in large areas of the east and north of Myanmar, including areas close to the border with India.
“The identification of the K13 markers of resistance has transformed our ability to monitor the spread and emergence of artemisinin resistance,” said Philippe Guerin, MD, of the Worldwide Antimalarial Resistance Network in Oxford, UK.
“However, this study highlights that the pace at which artemisinin resistance is spreading or emerging is alarming. We need a more vigorous international effort to address this issue in border regions.”