Health researchers have warned that Plasmodium parasites resistant to the frontline malaria drug artemisinin have spread westward from southeast Asia to just short of the Indian border, a gateway to Africa. A spread into India would pose a serious threat to the global control and eradication of malaria. Myanmar, which carries the region's highest burden of malaria infections, is considered the parasite's main route from southeast Asia to India and beyond. However, the research team stressed that there was no evidence to support artemisinin resistance has indeed reached India. The World Health Organization has recommended artemisinin-only treatments be withdrawn from the market in favor of combination therapies to protect against the spread of resistance.
Since the Plasmodium parasite developed resistance to other malaria drug types, artemisinin is the best and safest medicine to treat the estimated 198 million malaria infections that occurred worldwide in 2013. Artemisinin resistance has not yet been detected in Africa. It is a growing problem in southeast Asian nations like Cambodia, Thailand and Vietnam, and is suspected to have taken hold in South America. The study said, "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."
Researchers collected samples from patients at 55 treatment centers across Myanmar and border regions of Thailand and Bangladesh in 2013 and 2014. They examined them for telltale mutations in the K13 or 'kelch' gene. They found that 39 percent of 940 malaria samples carried a mutation. Study co-author Philippe Guerin said, "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."
There have been examples in history of malaria drugs chloroquine and sulphadoxine-pyrimethamine (SP) becoming less effective due to the emergence of resistance, costing millions of lives. SP was then followed by artemisinin to treat malaria, a drug derived by Chinese scientists from a herb called sweet wormwood.
Mike Turner of the Wellcome Trust which co-funded the study said, "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."
The study is published in The Lancet Infectious Diseases.