Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out

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dc.contributor.authorRaman, Jaishreeen_ZA
dc.contributor.authorMauff, Katyaen_ZA
dc.contributor.authorMuianga, Pedroen_ZA
dc.contributor.authorMussa, Abdulen_ZA
dc.contributor.authorMaharaj, Rajendraen_ZA
dc.contributor.authorBarnes, Karen Ien_ZA
dc.date.accessioned2015-11-23T12:36:28Z
dc.date.available2015-11-23T12:36:28Z
dc.date.issued2011en_ZA
dc.description.abstractAntimalarial drug resistance is a major obstacle to malaria control and eventual elimination. The routine surveillance for molecular marker of resistance is an efficient way to assess drug efficacy, which remains feasible in areas where malaria control interventions have succeeded in substantially reducing malaria transmission. Community based asexual parasite prevalence surveys were conducted annually in sentinel sites in Gaza Province, Mozambique from 2006 until 2010, before, during and after antimalarial policy changes to artesunate plus sulfadoxine-pyrimethamine in 2006 and to artemether-lumefantrine in 2008. Genetic analysis of dhfr , dhps , crt , and mdr1 resistant genes was conducted on 3 331 (14.4%) Plasmodium falciparum PCR positive samples collected over the study period from 23 229 children aged 2 to 15 years. The quintuple dhfr/dhps mutation associated with sulfadoxine-pyrimethamine resistance increased from 56.2% at baseline to 75.8% by 2010. At baseline the crt 76T and mdr1 86Y mutants were approaching fixation, 96.1% and 74.7%, respectively. Following the deployment of artemisinin-based combination therapy, prevalence of both these chloroquine-resistance markers began declining, reaching 32.4% and 30.9%, respectively, by 2010. All samples analysed over the 5-year period possessed a single copy of the mdr1 gene. The high and increasing prevalence of the quintuple mutation supports the change in drug policy from artesunate plus sulfadoxine-pyrimethamine to artemether-lumefantrine in Mozambique. As chloroquine related drug pressure decreased in the region, so did the molecular markers associated with chloroquine resistance ( crt 76T and mdr1 86Y). However, this reversion to the wild-type mdr186N predisposes parasites towards developing lumefantrine resistance. Close monitoring of artemether-lumefantrine efficacy is therefore essential, particularly given the high drug pressure within the region where most countries now use artemether-lumefantrine as first line treatment.en_ZA
dc.identifier.apacitationRaman, J., Mauff, K., Muianga, P., Mussa, A., Maharaj, R., & Barnes, K. I. (2011). Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out. <i>PLoS One</i>, http://hdl.handle.net/11427/15340en_ZA
dc.identifier.chicagocitationRaman, Jaishree, Katya Mauff, Pedro Muianga, Abdul Mussa, Rajendra Maharaj, and Karen I Barnes "Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/15340en_ZA
dc.identifier.citationRaman, J., Mauff, K., Muianga, P., Mussa, A., Maharaj, R., & Barnes, K. I. (2011). Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out. PLoS One, 6(10), e25992. doi:10.1371/journal.pone.0025992en_ZA
dc.identifier.ris TY - Journal Article AU - Raman, Jaishree AU - Mauff, Katya AU - Muianga, Pedro AU - Mussa, Abdul AU - Maharaj, Rajendra AU - Barnes, Karen I AB - Antimalarial drug resistance is a major obstacle to malaria control and eventual elimination. The routine surveillance for molecular marker of resistance is an efficient way to assess drug efficacy, which remains feasible in areas where malaria control interventions have succeeded in substantially reducing malaria transmission. Community based asexual parasite prevalence surveys were conducted annually in sentinel sites in Gaza Province, Mozambique from 2006 until 2010, before, during and after antimalarial policy changes to artesunate plus sulfadoxine-pyrimethamine in 2006 and to artemether-lumefantrine in 2008. Genetic analysis of dhfr , dhps , crt , and mdr1 resistant genes was conducted on 3 331 (14.4%) Plasmodium falciparum PCR positive samples collected over the study period from 23 229 children aged 2 to 15 years. The quintuple dhfr/dhps mutation associated with sulfadoxine-pyrimethamine resistance increased from 56.2% at baseline to 75.8% by 2010. At baseline the crt 76T and mdr1 86Y mutants were approaching fixation, 96.1% and 74.7%, respectively. Following the deployment of artemisinin-based combination therapy, prevalence of both these chloroquine-resistance markers began declining, reaching 32.4% and 30.9%, respectively, by 2010. All samples analysed over the 5-year period possessed a single copy of the mdr1 gene. The high and increasing prevalence of the quintuple mutation supports the change in drug policy from artesunate plus sulfadoxine-pyrimethamine to artemether-lumefantrine in Mozambique. As chloroquine related drug pressure decreased in the region, so did the molecular markers associated with chloroquine resistance ( crt 76T and mdr1 86Y). However, this reversion to the wild-type mdr186N predisposes parasites towards developing lumefantrine resistance. Close monitoring of artemether-lumefantrine efficacy is therefore essential, particularly given the high drug pressure within the region where most countries now use artemether-lumefantrine as first line treatment. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0025992 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out TI - Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out UR - http://hdl.handle.net/11427/15340 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15340
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0025992
dc.identifier.vancouvercitationRaman J, Mauff K, Muianga P, Mussa A, Maharaj R, Barnes KI. Five years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll out. PLoS One. 2011; http://hdl.handle.net/11427/15340.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Clinical Pharmacologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2011 Raman et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMalariaen_ZA
dc.subject.otherAntimalarialsen_ZA
dc.subject.otherChloroquineen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherMalarial parasitesen_ZA
dc.subject.otherMozambiqueen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherMutationen_ZA
dc.titleFive years of antimalarial resistance marker surveillance in Gaza Province, Mozambique, following artemisinin-based combination therapy roll outen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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