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Malar J. 2018 Dec 27;17(1):483. doi: 10.1186/s12936-018-2625-6.

Heterogeneous distribution of k13 mutations in Plasmodium falciparum in Laos.

Author information

1
Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
2
SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.
3
Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic.
4
National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic.
5
Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic.
6
SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic. p.brey@pasteur.la.
7
Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic. p.brey@pasteur.la.
8
Department of Tropical Medicine and Malaria, Research Institute, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan. kano@ri.ncgm.go.jp.
9
SATREPS Project (JICA/AMED) for Parasitic Diseases, Vientiane, Lao People's Democratic Republic. kano@ri.ncgm.go.jp.
10
Institut Pasteur du Laos, Ministry of Health, Sansenthai Road, Ban Kao-Gnot, Sisattanak District, P.O. Box 3560, Vientiane, Lao People's Democratic Republic. kano@ri.ncgm.go.jp.

Abstract

BACKGROUND:

The emergence and transnational spread of artemisinin resistance in Plasmodium falciparum in the Greater Mekong Sub-region (GMS) is a serious threat to malaria elimination in the region and could present a threat to malaria control in Africa. Recently, the Lao Government adopted the goal of malaria elimination by 2030, for which monitoring of artemisinin-resistant malaria within the country is indispensable. This study's objectives were to assess the distribution of k13 mutations in Laos.

METHODS:

Plasmodium falciparum isolates (n = 1151) were collected from five southern provinces in Laos between 2015 and 2016, and three isolates from the northernmost province bordering China in 2017. Polymorphisms of the k13 gene and two flanking regions were analysed to estimate relationship among the isolates.

RESULTS:

In the five southern provinces, overall 55.5% of the isolates possessed artemisinin-resistant mutations of the k13 gene (C580Y, P574L, R539T, Y493H). The C580Y was the predominant mutation (87.2%). The frequencies of the k13 mutations were heterogeneous in the five southern provinces, but with a clear tendency showing the highest frequency in the south (72.5%) and to a lower degree when moving northward (28.0%). The three isolates from the Lao-Chinese border also possessed the C580Y mutation. Analysis of the flanking loci demonstrated that these three isolates were genetically very close to resistant strains originating from western Cambodia.

CONCLUSIONS:

Artemisinin resistance was observed to be rapidly increasing and spreading northwards through Laos and has now reached the Chinese border. The Lao and Chinese governments, as well as the international community, should make dedicated efforts to contain the spread of k13 mutations within Laos and in the GMS.

KEYWORDS:

Artemisinin-resistance; Greater Mekong Sub-region; Laos; Malaria; Plasmodium falciparum; k13

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