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Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion

Author

Listed:
  • Varanya Wasakul

    (Mahidol University)

  • Tess D. Verschuuren

    (Mahidol University)

  • Nguyen Thuy-Nhien

    (Oxford University Clinical Research Unit)

  • Ethan Booth

    (Mahidol University)

  • Huynh Hong Quang

    (Institute of Malariology, Parasitology and Entomology)

  • Ngo Duc Thang

    (National Institute of Malariology, Parasitology and Entomology)

  • Keobouphaphone Chindavongsa

    (Centre for Malariology, Parasitology and Entomology)

  • Siv Sovannaroth

    (National Center for Parasitology, Entomology and Malaria Control)

  • Virasak Banouvong

    (Centre for Malariology, Parasitology and Entomology)

  • Viengphone Sengsavath

    (Centre for Malariology, Parasitology and Entomology)

  • Mayfong Mayxay

    (Mahosot Hospital
    Ministry of Health
    University of Oxford
    National University of Singapore)

  • Nguyen Thi Kim Tuyen

    (Oxford University Clinical Research Unit)

  • Vo Ngoc Lam Phuong

    (Oxford University Clinical Research Unit)

  • Pham Duc Trung

    (Oxford University Clinical Research Unit)

  • Sónia Gonçalves

    (Wellcome Sanger Institute)

  • Soun Chen

    (National Center for Parasitology, Entomology and Malaria Control)

  • Sonexay Phalivong

    (Mahosot Hospital)

  • Saiamphone Xayvanghang

    (Mahosot Hospital)

  • Supaporn Mahaphontrakoon

    (Mahidol University)

  • Richard D. Pearson

    (Wellcome Sanger Institute)

  • Paul N. Newton

    (Mahosot Hospital
    University of Oxford)

  • Richard J. Maude

    (Mahidol University
    University of Oxford
    The Open University)

  • Elizabeth A. Ashley

    (Mahosot Hospital
    University of Oxford)

  • Cristina V. Ariani

    (Wellcome Sanger Institute)

  • Victoria J. Simpson

    (Wellcome Sanger Institute)

  • Nicholas P. Day

    (Mahidol University
    University of Oxford)

  • Arjen M. Dondorp

    (Mahidol University
    University of Oxford)

  • Olivo Miotto

    (Mahidol University
    University of Oxford)

Abstract

Genetic surveillance of Plasmodium falciparum (Pf) can track antimalarial-resistant strains, to inform decision-making by National Malaria Control Programmes (NMCPs). The GenRe-Mekong project prospectively collected 5982 samples in the Greater Mekong Subregion (GMS) between 2017 and 2022, genotyping drug resistance markers, and barcodes that recapitulate genetic variation. Genotypes were analyzed with the grcMalaria R package, first described in this paper, to translate genetic epidemiology data into actionable visual information. Since 2020, Pf incidences decreased rapidly, accompanied by a decline of dihydroartemisinin-piperaquine (DHA-PPQ) resistant lineages, previously dominant in the eastern GMS. The frequency of plasmepsin2/3 amplifications, conferring piperaquine resistance, dropped from 62% in 2017-2019 to 2% in 2022, coinciding with a switch in frontline therapy in Cambodia, Thailand, and Vietnam. While regional artemisinin resistance levels remained high, no evidence of emerging mefloquine resistance was found. Routine genetic surveillance proved valuable in monitoring rapid parasite population changes in response to public health interventions, providing actionable information for NMCPs.

Suggested Citation

  • Varanya Wasakul & Tess D. Verschuuren & Nguyen Thuy-Nhien & Ethan Booth & Huynh Hong Quang & Ngo Duc Thang & Keobouphaphone Chindavongsa & Siv Sovannaroth & Virasak Banouvong & Viengphone Sengsavath &, 2025. "Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion," Nature Communications, Nature, vol. 16(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-59946-1
    DOI: 10.1038/s41467-025-59946-1
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    References listed on IDEAS

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    1. Patrick K. Tumwebaze & Melissa D. Conrad & Martin Okitwi & Stephen Orena & Oswald Byaruhanga & Thomas Katairo & Jennifer Legac & Shreeya Garg & David Giesbrecht & Sawyer R. Smith & Frida G. Ceja & Sam, 2022. "Decreased susceptibility of Plasmodium falciparum to both dihydroartemisinin and lumefantrine in northern Uganda," Nature Communications, Nature, vol. 13(1), pages 1-12, December.
    2. M. Isabel Veiga & Satish K. Dhingra & Philipp P. Henrich & Judith Straimer & Nina Gnädig & Anne-Catrin Uhlemann & Rowena E. Martin & Adele M. Lehane & David A. Fidock, 2016. "Globally prevalent PfMDR1 mutations modulate Plasmodium falciparum susceptibility to artemisinin-based combination therapies," Nature Communications, Nature, vol. 7(1), pages 1-12, September.
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