27 Feb 2009

Artemisinin-resistant malaria parasites emerge along the Thai-Cambodia border: Control Efforts Announced

Over the past several decades malaria parasite resistance to anti-malaria drugs = has emerged at the Thai-Cambodia border beginning with chloroquine, then sulfadoxine-pyrimethamine, and mefloquine. Unfortunately, artemisinin-resistant malaria parasites have recently been found as well here as well. Thus, the progress against malaria= made in part by implementation of the World Health Organization (WHO)’s po= licy of using Artemisinin-Combination Therapy (ACT) for all patients with uncomplicated falciparum malaria is now in jeopardy. Moreover, it reinforces the WHO’s position that all monotherapies of artemisinin and its deri= vatives should be removed from the market, and thus not available for use in place = of combination antimalarial drug therapy.

On 25 February the WHO announced how they will work with partners in Thailand and Cambodia, as well as Oxford<= /st1:City>, to use a grant ($22.5 million USD) from the Gates Foundation to contain the= se artemisinin-resistant malaria parasites before they spread to other parts of the world, as occurred in the past with chloroquine, sulfadoxine-pyrimetham= ine, and mefloquine.

"We know that malaria can be treated and prevented,” said Dr Regina Rabinovich, Director of Infectious Diseases Development at the Bill & Melinda Gates Foundation, “and if we lose the key treatment available= at this time, it's like living in a house with a half a roof.”

“The grant will be used to meet the following key objectives:<= /p>

eliminate artemisinin-tolerant parasites by detecting all malaria cases in target areas and ensuring effective treatment;
reduce exposure of = the parasites to artemisinin to limit emergence of resistance; =
prevent transmissio= n of artemisinin-tolerant malaria parasites through mosquito control and personal protection;
limit the spread of artemisinin-tolerant malaria parasites by mobile populations;
support the contain= ment and elimination of artemisinin-tolerant parasites through comprehensiv= e behavior change, communication, community mobilization and advocacy;
undertake basic and operational research to fill knowledge gaps and ensure that strategies applied are evidence-based; and
= = provide effective management, surveillance and coordination to enable a rapid = and high-quality implementation of the strategy.” =

Much is at stake in this collaborative international effort to control these emerging artemisinin-resistant malaria parasites. Particularly in the current = absence of a vaccine against falciparum malaria, widespread loss of Artemisinin Combination Therapy (ACT) could impair global efforts to control this disea= se, even with the expanding use of long-lasting insecticide bed nets and indoor residual spraying of specific insecticides.

Daniel R. Lucey, MD, MPH=

EROne Institutes, Washington Hospital Center

Adjunct Professor of Microbiology and Immunology

Georgetown University Medical Cente= r, Washington DC

Website for this newsletter: www.BePast.org<= span style=3D'mso-spacerun:yes'> (requires Internet Explorer)<= /o:p>