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Drug-resistant malaria spreading

Gabriel DomínguezFebruary 20, 2015

A drug-resistant strain of malaria from Southeast Asia can be found within 25 kilometers of the Indian border, potentially posing a serious threat to the global control and eradication of the disease, a new study found.

Symbolbild Malaria
Image: picture-alliance/dpa

The report, published by Oxford scientists in The Lancet Infectious Diseases journal on February 20, states that the spread of drug-resistant malaria parasites has already taken hold in Myanmar.

The country is considered to be the front line in the battle against the world's most effective antimalarial drug - Artemisinin - as it forms "a gateway for resistance to spread to the rest of the world," according to Charles Woodrow of the Mahidol-Oxford tropical medicine research unit, who led the study at Oxford University.

The scientist told DW he believes it will likely take no longer than five years for resistance to reach and become established in India.

'History is repeating itself'

Professor Mike Turner, Head of Infection & Immunobiology at the Wellcome Trust, warned of the potential consequences, pointing out that drug-resistant malaria parasites had once originated in Southeast Asia in the 1960s 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 Turner.

Symbolbild Arzneimittel Medikamente Pillen Tabletten Kapseln Ampullen
Malaria is treated with two drugs - an artemisinin and a 'partner' drugImage: Fotolia/motorlka

The authors of the report also warned that given the history, millions of lives will be at risk "if drug resistance spreads from Asia to the African sub-continent, or emerges in Africa independently."

Woodrow explains that in the short-term there could well be no visible effects of the drug resistance reaching India, given that malaria is treated with two drugs - an artemisinin and a "partner" drug. "If the partner drug is still effective then most patients will still be cured," said the scientist.

However, he added that in the mid- to long-term the partner drug is very likely to fail, because the two drugs support each other, and the reduced effect of the artemisinin will greatly increase the ability of the parasite to become resistant to other drugs.

'Alarming rate'

"There are currently only two widely available types of partner drugs for the region, and once resistance develops to both of these, treatment options for malaria become very small and the risk of recurrent malaria and problems associated with that becomes much higher," said Woodrow, adding that this whole process might take around 3 to 5 years to develop once artemisinin resistance is established.

For the latest study the team obtained 940 parasite samples of malaria infections from across Myanmar and neighboring border regions in Thailand and Bangladesh between 2013 and 2014.

The researchers found that almost 40 percent had mutations in their so-called kelch gene, K13 - a known genetic marker of artemisinin drug resistance. The team confirmed resistant parasites in Homalin, Sagaing Region, located only 25 kilometers from the Indian border.

Professor Philippe Guerin, Director of the Worldwide Antimalarial Resistance Network and co-author of the study, said the findings highlight 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," he stressed.

Southeast Asia affected

A study by the Mahidol-Oxford Tropical Medicine Research Unit released in July last year had previously found that the drug-resistant strain was common in parts of Thailand, Cambodia, Myanmar and Laos as well as eastern Myanmar.

Although there has been a substantial reduction in the number of people falling ill and dying from malaria - with approximately 3.3 million deaths prevented since 2000 - it is estimated that more than 627,000 people still die from the disease each year, most of them children under five years of age living in Africa.

The disease also remains a major cause of illness and death in the Asia-Pacific region, with an estimated 32 million new cases and around 47,000 deaths annually.

"We believe that only a small proportion of these deaths are from drug-resistant malaria. The usual reason falciparum malaria kills people is because they are diagnosed late in the course of the infection," Elizabeth Ashley, a clinical researcher at Mahidol-Oxford told DW, adding that if artemisinin resistance reached India and Bangladesh, then the spread to Africa would become impossible to contain.

Symbolbild Tropenkrankheiten Malaria Duengefieber & Co
Africa has the highest number of malaria cases in the worldImage: Getty Images/Fred Dufour

Woodrow said the most effective approach to fighting the disease is to ensure that all patients with possible malaria are tested with good, solid diagnostic methods and take complete antimalarial treatment courses, following existing recommendations.

A commitment to eradicate

Last November, the leaders of 18 Asia-Pacific nations at the 9th East Asia Summit (EAS) committed to freeing the region of the mosquito-borne disease within the next 15 years. In order to speed up efforts to eradicate the disease, the leaders welcomed a proposal by the Australian and Vietnamese Prime Ministers, as co-chairs of the Asia Pacific Leaders Malaria Alliance (APLMA), to develop regional responses and address the issue of resistance to anti-malaria medicines.

Australia and Vietnam were given the task to submit a plan for achieving this goal to the 10th EAS, set to be held in Malaysia.