The spread of drug-resistant malaria parasites to the Myanmar-India border has been identified as a major health threat.
The dangerous parasites are resistant to the drug artemisinin, which is the "frontline treatment" for malaria, the Wellcome Trust reported. If drug-resistant malaria spreads from Asia to the African sub-continent, it could put millions of lives at risk. Researchers found mutations in specific regions of the kelch gene (K13) indicating drug resistance in samples collected in the Sagaing Region, which is only about 15 miles 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 Dr. Charles Woodrow from the Mahidol-Oxford Tropical Medicine Research Unit and senior author of the study at Oxford University. "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."
To make their findings, the researchers collected DNA sequences of 940 samples of malaria infections from across Myanmar and regions in Thailand and Bangladesh. Out of those samples, the team identified the resistance-conferring K13 mutation in 39 percent of them.
"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 Dr. Mallika Imwong, research lead for the laboratory analysis at Mahidol University's Faculty of Tropical Medicine in Bangkok, Thailand.
The information allowed the researchers to create malaria maps that showed the extent of artemisinin resistance across the regions. They determined the prevalence of K13 mutations was greater than 10 percent in much of the east and north of Myanmar, which is extremely close to the border of India.
"Drug-resistant malaria parasites in the 1960s originated in South-east 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," said Professor Mike Turner, Head of Infection and Immunobiology at the Wellcome Trust.
The findings were published in a recent edition of The Lancet Infectious Diseases.
