Malaria with total resistance to the artemisinin antimalarial drug have spread from southeast Asia to the Indian border, which is a gateway to Africa, and scientists warn that substantial increases in international travel and migration could promote direct spread, threatening to repeat history.
The global spread of chloroquine resistance resulted in the loss of millions of lives in Africa and the new data emphasize the concern that artemisinin resistance could follow historical paths, according to a study published in The Lancet Infectious Diseases.
“Myanmar is considered the front line in the battle against artemisinin resistance as it forms a gateway for resistance to spread to the rest of the world,” said Charles Woodrow of the Mahidol-Oxford tropical medicine research unit.
The team at Oxford University collected 940 parasite samples at 55 malaria treatment centers across Myanmar and its border regions and found that almost 40 percent of the samples had mutations. resistant parasites were also confirmed in the Sagaing Region, only 25 km (15 miles) from the Indian border.
Deaths from malaria have nearly halved since 2000, to about 584,000 deaths each year, but Myanmar has substantially more malaria than any other country in southeast Asia and the new artemisinin resistance could reverse recent downward trends in morbidity and mortality.
From the late 1950s to the 1970s, chloroquine-resistant malaria spread across Asia to Africa and killed millions of people. Chloroquine was then replaced by sulphadoxine-pyrimethamine, but resistance appeared again in western Cambodia and again spread to Africa. The next drug was artemisinin, derived by Chinese scientists from a herb called sweet wormwood. Since then, The World Health Organization has recommended that artemisinin-only treatments should be withdrawn from the market in favor of combination therapies exactly to prevent losing its effect, but they remain available in many countries. There is no evidence of artemisinin resistance in Africa yet.
Even though there are far more cases of malaria in Africa, South East Asia has lower levels of natural malaria immunity than Africa.