India faces an imminent danger from drug-resistant malaria parasites detected near the Myanmar-India border, threatening to repeat history and rendering the frontline anti-malaria treatment useless while putting millions of lives at risk, scientists warned today.
The spread of malaria parasites resistant to the drug artemisinin into India would pose a serious threat to the global control and eradication of malaria, researchers 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," they said.
The researchers examined whether parasite samples collected at 55 malaria treatment centres across Myanmar carried mutations in specific regions of the parasite’s kelch gene (K13) – a known genetic marker of artemisinin drug resistance.
The team confirmed resistant parasites in Homalin, Sagaing Region located only 25km 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 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," said Woodrow.
The team obtained the DNA sequences of 940 samples of malaria infections (known as Plasmodium falciparum malaria parasites) from across Myanmar and neighbouring border regions in Thailand and Bangladesh between 2013 and 2014.
Of those 940 samples, 371 carried a resistance-conferring K13 mutation, researchers said.
"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.
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.
"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," Professor Mike Turner, Head of Infection and Immunobiology at the Wellcome Trust, 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," said Turner.
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, 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, they said.
"The identification of the K13 markers of resistance has transformed our ability to monitor the spread and emergence of artemisinin resistance," said 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," said Guerin.