Resistance to Malaria Drugs Widespread in Southeast Asia, Could Reach India and Africa

[Gert van der Hoek]

Resistance to Malaria Drugs Has Spread in SE Asia

WASHINGTON November 12, 2013 (AP)

By MATTHEW PENNINGTON Associated Press

International experts raised the alarm Tuesday over the spread of drug-resistant malaria in several Southeast Asian countries, saying it endangers major global gains in fighting the mosquito-borne disease that kills more than 600,000 people annually.

While the disease wreaks its heaviest toll in Africa, it's in nations along the Mekong River where the most serious threat to treating it has emerged.

The availability of therapies using the drug artemisinin has helped cut global malaria deaths by a quarter in the past decade. But over the same period, resistance to the drug emerged on Thailand's borders with Myanmar and Cambodia and has spread. It has been detected in southern Vietnam and likely exists in southern Laos, said Prof. Nick White of the Thailand-based Mahidol Oxford Tropical Medicine Research Unit.

Read more: ABC News

See also:

Drug-resistant malaria could spread fast, expert warns

New evidence for increasing resistance to malaria treatment

[Gert van der Hoek]

Re: Resistance to Malaria Drugs Has Spread in SE Asia

Drug-resistant malaria reaches Southeast Asia borders, could spread to Africa

Source: Reuters - Wed, 30 Jul 2014

* Study finds drug resistance in critical Asian regions

* Cambodia, Myanmar, Thailand among countries affected

* Fears malarial drug resistance could spread to Africa

* Mosquito-borne disease kills over 600,000 people a year

Read more: Trust.org

[Gert van der Hoek]

Re: Resistance to Malaria Drugs Widespread in Southeast Asia, Could Reach Africa

Tue, 16 Dec 2014

Drug-resistant malaria: The world's next big health crisis?

MALARIA'S NEW GROUND ZERO

Malaria death rates dropped by 47 percent between 2000 and 2014 worldwide but it still killed some 584,000 people in 2013, most of them in sub-Saharan Africa, according to the World Health Organization (WHO).

Much of the success in fighting the disease is due to the use of combination therapies (ACTs) based on artemisinin, a Chinese herb derivative, which is now under threat as malaria parasites have been building up resistance to the drugs.

Experts say Myanmar, which has the largest malaria burden in the region, is the next frontier in the spread of resistance to artemisinin.

Positioned between the Andaman Sea and the Himalayas and bordering India and China - home to 40 percent of the world's population - Myanmar is in a unique position to halt the spread of resistance to India and Africa.

"We need to act fast to avoid a big catastrophe," said Pascal Ringwald of the WHO's Global Malaria Programme. "The consequences could be disastrous."

If the problem spreads beyond the region, history would repeat itself for a third time, as resistance to other malaria drugs developed in the area before and spread to Africa to claim the lives of millions, especially children.

But the urgency is far greater this time as new drugs to replace ACTs are not yet available.

"Artemisinin resistance could wipe out a lot of the gains we've made in containing malaria and there is nothing yet to replace it," said Nyan Sint, an epidemiologist and regional malaria officer working with the government's national malaria control programmme.


ALL-OUT ASSAULT

Under a $100 million, three-year initiative in the Greater Mekong region, the Global Fund to Fight AIDS, Tuberculosis and Malaria has allocated $40 million to Myanmar to fight artemisinin resistance.

Part of the plan is an all-out assault to eliminate plasmodium falciparum, the deadliest malaria parasite, as containment through bed nets, insecticides and treating only those who test positive no longer works.

Villages with a high number of infected people will be flooded with drugs to be taken by everybody, well and sick, to eliminate falciparum before treatments fail completely. The plan has received ethical clearance from the Myanmar government.

Read more : Trust.org

[Gert van der Hoek]

Re: Resistance to Malaria Drugs Widespread in Southeast Asia, Could Reach Africa


Thomson Reuters Foundation

[Gert van der Hoek]

Alarm as 'super malaria' spreads in South East Asia


sept 22 2017

The rapid spread of "super malaria" in South East Asia is an alarming global threat, scientists are warning.

This dangerous form of the malaria parasite cannot be killed with the main anti-malaria drugs.

It emerged in Cambodia but has since spread through parts of Thailand, Laos and has arrived in southern Vietnam.
The team at the Oxford Tropical Medicine Research Unit in Bangkok said there was a real danger of malaria becoming untreatable.

Prof Arjen Dondorp, the head of the unit, told the BBC News website: "We think it is a serious threat. "It is alarming that this strain is spreading so quickly through the whole region and we fear it can spread further [and eventually] jump to Africa."

Failing treatments

In a letter, published in The Lancet Infectious Diseases, the researchers detail the "recent sinister development" that has seen resistance to the drug artemisinin emerge. About 212 million people are infected with malaria each year. It is caused by a parasite that is spread by blood-sucking mosquitoes and is a major killer of children.

[Gert van der Hoek]

Spread of a single multidrug resistant malaria parasite lineage (PfPailin) to Vietnam


Volume 17, No. 10 october 2017



The spread of artemisinin resistance in Plasmodium falciparum and the subsequent loss of partner antimalarial drugs in the Greater Mekong subregion1 presents one of the greatest threats to the control and elimination of malaria. Artemisinin resistance is associated with mutations in the PfKelchgene. Initially multiple independent Kelch mutations were observed,1 but in a recent sinister development, a single dominant artemisinin-resistant P falciparum C580Y mutant lineage has arisen in western Cambodia, outcompeted the other resistant malaria parasites, and subsequently acquired resistance to piperaquine.2

Cambodia had adopted dihydroartemisinin-piperaquine as first-line antimalarial treatment, but has now been forced to switch its first line artemisinin combination treatment back to artesunate-mefloquine as a consequence3. This dominant multidrug-resistant parasite lineage, identified first in Pailin in western Cambodia and tentatively denoted as PfPailin, then spread to northeastern Thailand and southern Laos2.

We now find that the PfPailin lineage, with associated piperaquine resistance (evidenced by amplification in the PfPlasmepsin2 gene), has spread to the south of Vietnam where it is responsible for alarming rates of failure of dihydroartemisinin-piperaquine?the National first-line treatment (figure).4 Microsatellite typing of 86 of 152 P falciparum isolates from the Binh Phuoc locality in 2016 shows the same flanking sequence surrounding the PfKelch C580Y gene as that observed in parasites from the affected areas of the other three Greater Mekong subregion countries.2

The evolution and subsequent transnational spread of this single fit multidrug-resistant malaria parasite lineage is of international concern.

[Gert van der Hoek]

25/08/20

Malaria: Artemisinin resistance emerges in Africa

Speed read

• Patients who received artemisinin-based treatments found to still carry the parasite that causes malaria
• Artemisinin the only molecule effective in severe cases of malaria
• Research ongoing to understand how to combat resistance

[KIGALI] Cases of resistance to the anti-malarial drug artemisinin have been identified in Rwanda, the first time this “major public health threat” has been discovered in Africa.

Artemisinin resistance is widespread across South-East Asia, but researchers say that until now it had not been reported in Africa, where 93 per cent of the world’s 228 million malaria cases and 94 per cent of the more than 400,000 deaths occur each year.

Chloroquine was the favoured first-line antimalarial treatment in the 1960s, before resistance developed in the Greater Mekong subregion and spread to Africa. This was followed by resistance to pyrimethamine, used in association with sulfadoxine, says the research team from institutes including the Rwanda Biomedical Centre (RBC), the Pasteur Institute, and the World Health Organization.

“This new resistance to artemisinin can be attributed to other biological and environmental factors, but the key for the moment is to seek out alternatives with new therapeutic tools.”

Patience Nkusi, University Teaching Hospital of Kigali

“The lost clinical efficacy of these compounds is suspected to have contributed to millions of additional malaria deaths in young African children in the 1980s,” the researchers say. “This study clearly shows early warning signs of [artemisinin resistance] in Rwanda.”

Increased access in malaria-endemic countries to the artemisinin-based combination therapies recommended by the WHO has “been integral to the remarkable success in reducing the global malaria burden over the last 15 years”, the WHO says.

But now, the spread or independent emergence of artemisinin resistance could pose a global public health threat as no alternative treatment is as efficient or tolerable, according to the WHO.


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