Abstract
BackgroundHenan Province has been in the malaria elimination stage, with all reports of the disease being imported since 2012 and over 90% coming from Africa. Surveillance and population studies are essential for the early detection and subsequent prevention of the spread of drug resistance. The K13-propeller gene was recently identified as a proposed molecular marker of artemisinin (ART) resistance. In this study, we detected mutations of the K13-propeller gene in samples taken from imported malaria cases in Henan Province from 2012 to 2015.MethodsThere were 483 samples that were obtained from Plasmodium falciparum–infected malaria migrant workers who returned to Henan Province from Africa between 2012 and 2015. The single nucleotide polymorphisms in the K13-propeller gene were assessed by nested PCR with DNA sequencing. Frequency and geographic difference of K13-propeller gene mutant types were analyzed.ResultsOf 483 patients, 476 were cured and 7 died. There were no K13-propeller mutations in the blood samples from the 7 patients who died, but there were 23 different genotypes of the K13-propeller that were observed in 24 (4.97%) of the samples. C580Y, which was the predominant one in the resistance of ART, was not detected in the samples, but R539T and P574L which have also been associated with ART resistance, were observed in two samples from Angola and Equatorial Guinea. No mutations were detected in 11 samples from North Africa. The frequency of the K13-propeller was 6.50% (8/123) in Central Africa, followed by East Africa (1/19, 5.26%), West Africa (9/198, 4.55%) and South Africa (6/132, 4.55%). There was no significant difference among these four areas (P = 0.795).ConclusionR539T and P574L were found in migrant workers who traveled from Africa to Henan Province, although the frequency of the K13-propeller mutants was low. These data may enrich the molecular surveillance of antimalarial resistance and will be helpful for developing and updating the antimalarial policy in Henan Province.
Highlights
Henan Province has been in the malaria elimination stage, with all reports of the disease being imported since 2012 and over 90% coming from Africa
C580Y, which was the predominant one in the resistance of ART, was not detected in the samples, but R539T and P574L which have been associated with ART resistance, were observed in two samples from Angola and Equatorial Guinea
R539T and P574L were found in migrant workers who traveled from Africa to Henan Province, the frequency of the K13-propeller mutants was low
Summary
Henan Province has been in the malaria elimination stage, with all reports of the disease being imported since 2012 and over 90% coming from Africa. We detected mutations of the K13-propeller gene in samples taken from imported malaria cases in Henan Province from 2012 to 2015. Malaria is the most critical human parasitic disease caused by Plasmodium, it is a serious threat to human health, and there were about 214 million cases of malaria and 438,000 deaths from it in 2015, of which 90% occurred in Africa [1]. P. falciparum was successfully eliminated in 1988 and no indigenous malaria cases have been reported in Henan. Imported malaria cases have increased year after year. P. falciparum which was imported from Africa, has been mainly responsible for the increasing impacts [3, 4].
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