Study confirms artemisinin-resistant malaria close to border with India

Published today in Lancet Infectious Diseases reports, the study showed that if drug resistance spreads from Asia to the African sub-continent, or emerges in Africa independently as we’ve seen several times before, millions of lives will be at risk. It also noted that artemisinin resistance threatens to follow the same historical trajectory from Southeast Asia to the Indian subcontinent as seen in the past with other anti-malarial medicines.  

 “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 from the Mahidol-Oxford Tropical Medicine Research Unit (MORU) in Bangkok and senior author of the study at Oxford University. 

A number of 940 samples were collected at 55 malaria treatment centres across Myanmar and its border regions by a team led by Kyaw Myo Tun of the Nay Pyi Taw-based Defence Services Medical Research Centre, with coordination from MORU. The researchers examined whether parasite samples carried mutations in specific regions of the parasite’s kelch gene (K13) – a known genetic marker of artemisinin drug resistance.

After DNA testing, the team confirmed resistance in Homalin, Sagaing Region located only 25km from the Indian border. Of total samples, 371 (39 per cent) showed resistance.

Using this information, the researchers developed maps to display the predicted extent of artemisinin resistance determined by the prevalence of K13 mutations. The maps suggest that the overall prevalence of K13 mutations was greater than ten per cent 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,” says Professor Philippe Guerin, Director of the Worldwide Antimalarial Resistance Network (WWARN) and co-author of the study. “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.”

Professor Mike Turner, Head of Infection & Immunobiology at the Wellcome Trust, said: “Drug resistant malaria parasites in the 1960s originated in Southeast Asia and from there spread through Myanmar to India, and then to the rest of the world where it killed millions of people. The new research shows that history is repeating itself with parasites resistant to artemisinin drugs, the mainstay of modern malaria treatment, now widespread in Myanmar. We are facing the imminent threat of resistance spreading into India, with thousands of lives at risk.”

Gathering near ‘real-time’ information on malaria drug resistance is critical to help predict the geographic routes of drug resistance and inform national and regional patient treatment strategies, the researchers said. 

Mapping the spread together with a more systematic review and revision of medicine dosing strategies, especially for vulnerable groups such as children and pregnant women, will help to preserve and ultimately prolong the life-span of these life-saving medicines. It is only through researchers, policy makers, doctors and funding partners working collaboratively that the global health community can minimise the threat of resistance and safeguard the vital public health gains we have made in malaria control and elimination, they added.