Now this is another deadly bite to worry about, more so because the antimalarial drugs available in India may soon lose their teeth against the vector-borne disease, like in Myanmar and Cambodia. In the first research report on drug-resistant malaria from India, scientists at the National Institute of Malaria Research (NIMR) have traced a mutation in the disease-causing parasite.
“Of the 384 samples we sequenced, non-synonymous mutations in the propeller region were found in four patients from the northeastern states. Though their presence did not correlate with ACT treatment failures, this mutation in the parasite comes as a major threat to India. The mutation has been witnessed in India for the first time. In near future, the resistance to drugs may occur in Indian patients too,” NIMR research scientist Dr Vas Dev said.
The Plasmodium falciparum parasite – which causes the most dangerous form of malaria with the highest rates of complications and mortality — is treated with Artemisinin-based Combination Therapy (ACT).
The treatment of malaria in southeast Asia is threatened with the emergence of artemisinin-resistant P. falciparum and India is under a constant threat.
“Genome association studies have strongly linked a locus on P. falciparum chromosome 13 to artemisinin resistance, and recent mutations in the kelch-13 propeller region (pfk-13) are strongly linked to resistance. To date, this information was not known in Indian samples,” Dr Dev added.
Concerned, the Union Health Ministry is keeping a strict watch on the situation.
“Though the mutation has not yet shown any drug resistance in India, it certainly is a major threat. Not only India but the entire world is under threat. Our scientists are carrying out various studies in this regard,” said Dr A.C. Dhariwal, National Vector-Borne Disease Control Programme, Directorate General of Health Services, Health Ministry.
The global implications of artemisinin losing its edge on malaria are alarming. In the 1970s, resistance to traditional anti-malarial drugs like chloroquine emerged in southeast Asia, and spread from Burma to India and Africa.
A new class of drugs, artemisinins, came to partial rescue of the patients but resistance to artemisinins first appeared in Cambodia in 2007 and then reached south Burma.
“Further phenotyping and genotyping studies are required to assess the status of artemisinin resistance in the region where we found the mutation,” Dr Dev said.
The government is actively engaged in carrying out efficacy studies.
India’s drug policy is changed for the area reporting 10 per cent or more total treatment failure to a tested drug; i.e. the currently used anti-malarials in a sample of minimum 30 P. falciparum test cases.
“Based on the efficacy studies, we keep changing the drug combinations. To combat the drug resistance in malaria, we recommend the use of combination therapy, i.e. Artesunate plus sulfadoxine pyrimethamine for treatment of P. falcipuram cases in chloroquine resistant areas, surrounding cluster of blocks and 117 high-endemic districts of the northeast, besides Andhra Pradesh, Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha,” Dr Dhariwal said.
Malaria is a public health problem in several parts of the country. Ninety-five per cent of India’s population resides in malaria-endemic areas, and 80 per cent of total malaria cases reported in the country are confined to areas comprising 20 per cent of the population in tribal, hilly, difficult and inaccessible areas.
The case load, though steady around 2 million cases annually in the late 90s, has shown a declining trend since 2002.
To date this year, 1,29,852 malaria cases have been reported with 30 deaths; 2014 witnessed 10,70,513 cases with 535 deaths; and in 2013 the number of cases was 8,81,730 with 440 deaths.
Government officials said the resistance in P. falciparum to chloroquine was observed to be very high and frequent in the studies conducted since 2001. Therefore, ACT is now being used as the first line of treatment for all Pf cases across the county.
"For strengthening surveillance, Rapid Diagnostic Test (RDT) for diagnosis of P. falciparum malaria was introduced in high endemic areas and its operation is being scaled up," the officials added.
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