The Hindu : New Delhi News : Migrants may spread drug-resistant malaria: Study

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Migrants may spread drug-resistant malaria: Study

Aarti Dhar

NEW DELHI: Warning that refugees and migrating population could increase the possibility of introducing drug-resistant malaria strains into the non-immune population in India, a review study published in the latest edition of The Lancet Infectious Diseases has suggested that best practices for malaria control along the border areas and in migrant population needs to be established.

Overall, a robust and specific plan to combat drug-resistant parasites will be fundamental in fulfilling of commitment to malaria control in India. Malarial resistance for chloroquine and sulfa-pyrimethamine was first reported in India near the international border with Burma (now Myanmar). Reports of tolerance of malaria to artemisinin along the Thai-Cambodian border, and the historical westward spread of drug-resistant strains, generate concern about the long-term effectiveness of artemisinin-combination therapies in India, according to the study done by Naman K. Shah, Gajender P.S. Dhillon, Aditya P. Dash, Usha Arora, Neena Valecha and Steven R. Meshnick.

The study titled “Anti-malarial drug resistance of Plasmodium falciparum in India: changes over time and space'' says that further research and programmes are needed to combat anti-malarial drug resistance in India. Previously, chloroquine treatment, with primaquine as a gametocytocidal drug, was standard. Artemisinin combination treatments show useful gametocytocidal properties but do not eliminate mature gametocytes.“How the addition of single-dose primaquine to artesunate plus sulfadoxine-pyrimethamine will affect malaria transmission or the spread of drug-resistant strains in India is unclear. In-vitro susceptibility and molecular markers mirror intrinsic anti-malarial resistance to a drug and their changes precede clinical resistance. Molecular and in-vitro monitoring could supplement efficacy trials and provide early warning of drug resistance.''

After the launch of the National Malaria Control Programme in 1953, the number of malaria cases reported in India fell to a record low of 0·1 million in 1965. However, the initial success could not be maintained and a resurgence of malaria began in the late 1960s. Resistance of Plasmodium falciparum to chloroquine was first reported in 1973 and increases in anti-malarial resistance, along with rapid urbanisation and labour migration, complicated the challenge that India's large geographical area and population size already pose for malaria control. Although several institutions have done drug-resistance monitoring in India, a complete analysis of countrywide data across institutions does not exist. Continued use of chloroquine for treatment of P falciparum malaria in India will likely be ineffective. Resistance to sulfa-pyrimethamine should be closely monitored to protect the effectiveness of treatment with artesunate plus sulfadoxine-pyrimethamine, which is the new first-line treatment for P falciparum malaria. Strategies to reduce the emergence and spread of future drug resistance need to be proactive and supported by intensive monitoring, it says.

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