Abstract
BackgroundArtemisinin and partner drug resistant malaria parasites have emerged in Southeast Asia. If resistance were to emerge in Africa it could have a devastating impact on malaria-related morbidity and mortality. This study estimates the potential impact of artemisinin and partner drug resistance on disease burden in Africa if it were to emerge.MethodsUsing data from Asia and Africa, five possible artemisinin and partner drug resistance scenarios are characterized. An individual-based malaria transmission model is used to estimate the impact of each resistance scenario on clinical incidence and parasite prevalence across Africa. Artemisinin resistance is characterized by slow parasite clearance and partner drug resistance is associated with late clinical failure or late parasitological failure.ResultsScenarios with high levels of recrudescent infections resulted in far greater increases in clinical incidence compared to scenarios with high levels of slow parasite clearance. Across Africa, it is estimated that artemisinin and partner drug resistance at levels similar to those observed in Oddar Meanchey province in Cambodia could result in an additional 78 million cases over a 5 year period, a 7 % increase in cases compared to a scenario with no resistance. A scenario with high levels of slow clearance but no recrudescence resulted in an additional 10 million additional cases over the same period.ConclusionArtemisinin resistance is potentially a more pressing concern than partner drug resistance due to the lack of viable alternatives. However, it is predicted that a failing partner drug will result in greater increases in malaria cases and morbidity than would be observed from artemisinin resistance only.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-1075-7) contains supplementary material, which is available to authorized users.
Highlights
Artemisinin and partner drug resistant malaria parasites have emerged in Southeast Asia
The model is extended to incorporate the following four ways in which drug resistance could impact on an individual’s treatment outcome: 1) Slow parasite clearance (SPC)—The proportion of the population that are parasitaemic on day 3 after treatment is used as an indicator of slow clearance
By increasing the proportion of infections with resistant parasites that result in recrudescence a substantial increase in clinical incidence is predicted
Summary
Artemisinin and partner drug resistant malaria parasites have emerged in Southeast Asia. This study estimates the potential impact of artemisinin and partner drug resistance on disease burden in Africa if it were to emerge. Artemisinin-resistant Plasmodium falciparum strains have emerged and spread within South-East Asia in recent years [1, 2], resulting in reduced treatment efficacy [3]. Concern has been raised about the potential impact on malaria morbidity and mortality if malaria parasites with similar levels of artemisinin resistance were to spread to or emerge independently in Africa, where 90 % of the global mortality from malaria occurs [1]. Further analyses suggested that these artemisinin resistance associated mutations in the P. falciparum K-13 propeller gene have mainly resulted from independent emergences, rather than a geographical spread. Evidence of geographic spread between Cambodia and Vietnam exists, but there is no evidence
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