Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow
Abstract Background Plasmodium vivax malaria remains a major public health burden in Myanmar. Resistance to chloroquine (CQ), the first-line treatment for P. vivax, has been reported in the country and has potential to undermine local control efforts. Methods Patients over 6 years of age with uncomp...
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ftdoajarticles:oai:doaj.org/article:9fe8517997364122ab04cddc27e508be 2023-05-15T15:16:27+02:00 Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow Myo Win Htun Nan Cho Nwe Mon Khin Myo Aye Chan Myae Hlaing Myat Phone Kyaw Irene Handayuni Hidayat Trimarsanto Dorina Bustos Pascal Ringwald Ric N. Price Sarah Auburn Kamala Thriemer 2017-07-01T00:00:00Z https://doi.org/10.1186/s12936-017-1912-y https://doaj.org/article/9fe8517997364122ab04cddc27e508be EN eng BMC http://link.springer.com/article/10.1186/s12936-017-1912-y https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1912-y 1475-2875 https://doaj.org/article/9fe8517997364122ab04cddc27e508be Malaria Journal, Vol 16, Iss 1, Pp 1-13 (2017) Malaria Plasmodium Vivax Chloroquine Efficacy Resistance Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2017 ftdoajarticles https://doi.org/10.1186/s12936-017-1912-y 2022-12-31T16:02:17Z Abstract Background Plasmodium vivax malaria remains a major public health burden in Myanmar. Resistance to chloroquine (CQ), the first-line treatment for P. vivax, has been reported in the country and has potential to undermine local control efforts. Methods Patients over 6 years of age with uncomplicated P. vivax mono-infection were enrolled into clinical efficacy studies in Myawaddy in 2014 and Kawthoung in 2012. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. Pvmdr1 copy number (CN) and microsatellite diversity were assessed on samples from the patients enrolled in the clinical study and additional cross-sectional surveys undertaken in Myawaddy and Shwegyin in 2012. Results A total of 85 patients were enrolled in the CQ clinical studies, 25 in Myawaddy and 60 in Kawthoung. One patient in Myawaddy (1.2%) had an early treatment failure and two patients (2.3%) in Kawthoung presented with late treatment failures on day 28. The day 28 efficacy was 92.0% (95% CI 71.6–97.9) in Myawaddy and 98.3% (95% CI 88.7–99.8) in Kawthoung. By day 2, 92.2% (23/25) in Myawaddy and 85.0% (51/60) in Kawthoung were aparasitaemic. Genotyping and pvmdr1 CN assessment was undertaken on 43, 52 and 46 clinical isolates from Myawaddy, Kawthoung and Shwegyin respectively. Pvmdr1 amplification was observed in 3.2% (1/31) of isolates in Myawaddy, 0% (0/49) in Kawthoung and 2.5% (1/40) in Shwegyin. Diversity was high in all sites (H E 0.855–0.876), with low inter-population differentiation (F ST 0.016–0.026, P < 0.05). Conclusions Treatment failures after chloroquine were observed following chloroquine monotherapy, with pvmdr1 amplification present in both Myawaddy and Shwegyin. The results emphasize the importance of ongoing P. vivax drug resistance surveillance in Myanmar, particularly given the potential connectivity between parasite population at different sites. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 16 1 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Malaria Plasmodium Vivax Chloroquine Efficacy Resistance Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Malaria Plasmodium Vivax Chloroquine Efficacy Resistance Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Myo Win Htun Nan Cho Nwe Mon Khin Myo Aye Chan Myae Hlaing Myat Phone Kyaw Irene Handayuni Hidayat Trimarsanto Dorina Bustos Pascal Ringwald Ric N. Price Sarah Auburn Kamala Thriemer Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
topic_facet |
Malaria Plasmodium Vivax Chloroquine Efficacy Resistance Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background Plasmodium vivax malaria remains a major public health burden in Myanmar. Resistance to chloroquine (CQ), the first-line treatment for P. vivax, has been reported in the country and has potential to undermine local control efforts. Methods Patients over 6 years of age with uncomplicated P. vivax mono-infection were enrolled into clinical efficacy studies in Myawaddy in 2014 and Kawthoung in 2012. Study participants received a standard dose of CQ (25 mg/kg over 3 days) followed by weekly review until day 28. Pvmdr1 copy number (CN) and microsatellite diversity were assessed on samples from the patients enrolled in the clinical study and additional cross-sectional surveys undertaken in Myawaddy and Shwegyin in 2012. Results A total of 85 patients were enrolled in the CQ clinical studies, 25 in Myawaddy and 60 in Kawthoung. One patient in Myawaddy (1.2%) had an early treatment failure and two patients (2.3%) in Kawthoung presented with late treatment failures on day 28. The day 28 efficacy was 92.0% (95% CI 71.6–97.9) in Myawaddy and 98.3% (95% CI 88.7–99.8) in Kawthoung. By day 2, 92.2% (23/25) in Myawaddy and 85.0% (51/60) in Kawthoung were aparasitaemic. Genotyping and pvmdr1 CN assessment was undertaken on 43, 52 and 46 clinical isolates from Myawaddy, Kawthoung and Shwegyin respectively. Pvmdr1 amplification was observed in 3.2% (1/31) of isolates in Myawaddy, 0% (0/49) in Kawthoung and 2.5% (1/40) in Shwegyin. Diversity was high in all sites (H E 0.855–0.876), with low inter-population differentiation (F ST 0.016–0.026, P < 0.05). Conclusions Treatment failures after chloroquine were observed following chloroquine monotherapy, with pvmdr1 amplification present in both Myawaddy and Shwegyin. The results emphasize the importance of ongoing P. vivax drug resistance surveillance in Myanmar, particularly given the potential connectivity between parasite population at different sites. |
format |
Article in Journal/Newspaper |
author |
Myo Win Htun Nan Cho Nwe Mon Khin Myo Aye Chan Myae Hlaing Myat Phone Kyaw Irene Handayuni Hidayat Trimarsanto Dorina Bustos Pascal Ringwald Ric N. Price Sarah Auburn Kamala Thriemer |
author_facet |
Myo Win Htun Nan Cho Nwe Mon Khin Myo Aye Chan Myae Hlaing Myat Phone Kyaw Irene Handayuni Hidayat Trimarsanto Dorina Bustos Pascal Ringwald Ric N. Price Sarah Auburn Kamala Thriemer |
author_sort |
Myo Win Htun |
title |
Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
title_short |
Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
title_full |
Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
title_fullStr |
Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
title_full_unstemmed |
Chloroquine efficacy for Plasmodium vivax in Myanmar in populations with high genetic diversity and moderate parasite gene flow |
title_sort |
chloroquine efficacy for plasmodium vivax in myanmar in populations with high genetic diversity and moderate parasite gene flow |
publisher |
BMC |
publishDate |
2017 |
url |
https://doi.org/10.1186/s12936-017-1912-y https://doaj.org/article/9fe8517997364122ab04cddc27e508be |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 16, Iss 1, Pp 1-13 (2017) |
op_relation |
http://link.springer.com/article/10.1186/s12936-017-1912-y https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1912-y 1475-2875 https://doaj.org/article/9fe8517997364122ab04cddc27e508be |
op_doi |
https://doi.org/10.1186/s12936-017-1912-y |
container_title |
Malaria Journal |
container_volume |
16 |
container_issue |
1 |
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1766346751876268032 |