Evidence map›Paper›PMID 25704894›Full record

ArticleThe Lancet. Infectious diseases2015

Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.

Kyaw M Tun, Mallika Imwong, Khin M Lwin, Aye A Win, Tin M Hlaing, Thaung Hlaing, Khin Lin, Myat P Kyaw, Katherine Plewes, M Abul Faiz and 17 more

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Article in The Lancet. Infectious diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 271 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
271citing papers in PubMed, 7 pooled it
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

271 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  15. Antimalarial Activity of KAF156 in Falciparum and Vivax Malaria.The New England journal of medicine · 2016
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211 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors.

Kyaw M TunMyanmar Oxford Clinical Research Unit, Yangon, Myanmar; Defence Services Medical Research Centre, Naypyitaw, Myanmar.
Mallika ImwongDepartment of Molecular Tropical Medicine and Genetics, Mahidol University, Bangkok, Thailand; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. Electronic address: noi@tropmedres.ac.
Khin M LwinShoklo Malaria Research Unit, Mae Sot, Thailand.
Aye A WinFaculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Institute of Medicine 1, Yangon, Myanmar.
Tin M HlaingDefence Services Medical Research Centre, Naypyitaw, Myanmar.
Thaung HlaingDefence Services Medical Research Centre, Naypyitaw, Myanmar; Department of Health, Ministry of Health, Naypyitaw, Myanmar.
Khin LinDepartment of Medical Research, Upper Myanmar, Myanmar.
Myat P KyawDepartment of Medical Research, Lower Myanmar, Myanmar.
Katherine PlewesMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
M Abul FaizMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Dev Care Foundation, Dhaka, Bangladesh.
Mehul DhordaWorldWide Antimalarial Resistance Network, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Phaik Yeong CheahMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Sasithon PukrittayakameeFaculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Elizabeth A AshleyMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Tim J C AndersonDepartment of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA.
Shalini NairDepartment of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA.
Marina McDew-WhiteDepartment of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA.
Jennifer A FleggWorldWide Antimalarial Resistance Network, Oxford, UK; School of Mathematical Sciences, Monash University, Melbourne, Australia.
Eric P M GristWorldWide Antimalarial Resistance Network, Oxford, UK.
Philippe GuerinWorldWide Antimalarial Resistance Network, Oxford, UK.
Richard J MaudeMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Frank SmithuisMyanmar Oxford Clinical Research Unit, Yangon, Myanmar; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Medical Action Myanmar, Yangon, Myanmar.
Arjen M DondorpMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Nicholas P J DayMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
François NostenShoklo Malaria Research Unit, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Nicholas J WhiteMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Charles J WoodrowMahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

Funding

Mapping Drug Resistance Genes in Plasmodium falciparumR37AI048071 · NIAID · TEXAS BIOMEDICAL RESEARCH INSTITUTE · PI ANDERSON, TIM J · 2012 to 2021
$7.9M
EXTRAMULAR RESEARCH FACILITIES CONSTRUCTIONC06RR017515 · NCRR · SOUTHWEST FOUNDATION FOR BIOMEDICAL RES · PI SHADE, ROBERT E · 2003 to 2003
$3.1M
MOLECULAR AND BIOCHEMICAL GENETICS LABORATORY RENOVATIONC06RR013556 · NCRR · SOUTHWEST FOUNDATION FOR BIOMEDICAL RES · PI SHADE, ROBERT E · 1998 to 1998
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NCRR NIH HHS C06 RR013556NCRR NIH HHS C06 RR017515NIAID NIH HHS R37 AI048071Wellcome Trust 093956
6 · The paper itself

Abstract

backgroundEmergence of artemisinin resistance in southeast Asia poses a serious threat to the global control of Plasmodium falciparum malaria. Discovery of the K13 marker has transformed approaches to the monitoring of artemisinin resistance, allowing introduction of molecular surveillance in remote areas through analysis of DNA. We aimed to assess the spread of artemisinin-resistant P falciparum in Myanmar by determining the relative prevalence of P falciparum parasites carrying K13-propeller mutations.

methodsWe did this cross-sectional survey at malaria treatment centres at 55 sites in ten administrative regions in Myanmar, and in relevant border regions in Thailand and Bangladesh, between January, 2013, and September, 2014. K13 sequences from P falciparum infections were obtained mainly by passive case detection. We entered data into two geostatistical models to produce predictive maps of the estimated prevalence of mutations of the K13 propeller region across Myanmar.

findingsOverall, 371 (39%) of 940 samples carried a K13-propeller mutation. We recorded 26 different mutations, including nine mutations not described previously in southeast Asia. In seven (70%) of the ten administrative regions of Myanmar, the combined K13-mutation prevalence was more than 20%. Geospatial mapping showed that the overall prevalence of K13 mutations exceeded 10% in much of the east and north of the country. In Homalin, Sagaing Region, 25 km from the Indian border, 21 (47%) of 45 parasite samples carried K13-propeller mutations.

interpretationArtemisinin resistance extends across much of Myanmar. We recorded P falciparum parasites carrying K13-propeller mutations at high prevalence next to the northwestern border with India. Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided.

fundingWellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme and the Bill & Melinda Gates Foundation.

Indexed as

Drug ResistanceAntimalarialsArtemisininsBangladeshCross-Sectional StudiesDNA, ProtozoanGenetic MarkersGenotypeMalaria, FalciparumMutationMyanmarPhylogeographyPlasmodium falciparumPrevalenceSequence Analysis, DNAThailandAntimalarialsartemisininArtemisininsDNA, ProtozoanGenetic Markers

Identifiers

PMID25704894
PMCPMC4374103

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.