Journal
EMERGING INFECTIOUS DISEASES
Volume 24, Issue 4, Pages 718-726Publisher
CENTERS DISEASE CONTROL
DOI: 10.3201/eid2404.170141
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Funding
- Ministry of Education, Culture, Sports, Science, and Technology of Japan
- Translational Research Network program (Japan Agency for Medical Research and Development)
- Global Health Innovative Technology Fund [G2013-105]
- Grants-in-Aid for Scientific Research [16K08765, 15K08453] Funding Source: KAKEN
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Because approximate to 90% of malaria cases occur in Africa, emergence of artemisinin-resistant Plasmodium falciparum in Africa poses a serious public health threat. To assess emergence of artemisinin-resistant parasites in Uganda during 2014-2016, we used the recently developed ex vivo ring-stage survival assay, which estimates ring-stage-specific P. falciparum susceptibility to artemisinin. We conducted 4 cross-sectional surveys to assess artemisinin sensitivity in Gulu, Uganda. Among 194 isolates, survival rates (ratio of viable drug-exposed parasites to drug-nonexposed controls) were high (>= 10%) for 4 isolates. Similar rates have been closely associated with delayed parasite clearance after drug treatment and are considered to be a proxy for the artemisinin-resistant phenotype. Of these, the PfKelch13 mutation was observed in only 1 isolate, A675V. Population genetics analysis suggested that these possibly artemisinin-resistant isolates originated in Africa. Large-scale surveillance of possibly artemisinin-resistant parasites in Africa would provide useful information about treatment outcomes and help regional malaria control.
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