The Story
“Concerns over stable artemisinin resistance in Uganda”
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00642-4/abstract
by Marcia Triunfol
The Lancet Infectious Diseases, November 2023
The Pitch
A pressing concern in the field of malaria research – the emergence and sustained prevalence of artemisinin resistance – has just unfolded a new facet. Since 2005, artemisinin-based combinations have been the standard treatment for uncomplicated cases of malaria in Africa.
The fear of artemisinin resistance emerging in the region has been a constant concern, particularly following the identification of resistance pockets in Southeast Asia and even in African regions of low incidence of malaria. The resistance is due to mutations in the parasite’s PfK13 gene and is associated with a delayed clearance after treatment with artemisinin-based combinations.
In 2016 in Uganda, PfK13 mutations were detected and associated with partial resistance, both clinically and in vitro experiments. This finding challenges the former notion that resistance would likely emerge in regions with low malaria incidence, in which immunity against the disease is low but it would be less likely to appear in high-incidence areas.
Since the finding of PfK13 mutations in 2016, an international collaboration of researchers from the University of California, San Francisco, United States of America, Makerere University in Kampala, Uganda, and others, have collected samples from 10 sites in Uganda from symptomatic individuals to determine the genetic profile of the isolates hoping to better understand how these mutations emerged in a region of high-transmission.
In a study recently published in the New England Journal of Medicine, the group alerts for a sustained prevalence in Uganda of parasites carrying artemisinin-resistance–mediating PfK13 mutations and raises some hypotheses to explain the unexpected surge of resistance in the region. Among their hypotheses are the persistent artemisinin monotherapy use, a practice known to undermine resistance mitigation efforts, and the discontinuation of indoor residual spraying in 2014, which correlates with a significant malaria upsurge in the same areas now witnessing escalated resistance prevalence – a rise from 8% in 2016 to 32% in 2022 is reported in the study.
I’m very interested in writing this story. My plan is to interview malaria researchers working in the region but also in other areas where Malaria is endemic, particularly in Brazil. I will ask them how they interpret this new finding, and what public policies need to be implemented to avoid the spread of malaria resistance in Uganda or the surge of a similar situation in other countries, mainly Brazil.
Let me know if interested in this story,
Thank you!!
Marcia Triunfol