Laos malaria outbreak in 2020–21 likely caused by multidrug-resistant strains of P. falciparum Epidemiology Laos Genetic Malaria TheLancetInfDis
By Dr. Sanchari Sinha Dutta, Ph.D.Dec 5 2022Reviewed by Benedette Cuffari, M.Sc. A recent study published in The Lancet Infectious Diseases journal describes the genetic epidemiology and dynamics of the parasite Plasmodium falciparum responsible for malaria outbreaks in Attapeu Province, Laos, during the 2020-2021 malaria season.
In recent years, some novel variants of Plasmodium falciparum have emerged and spread in the Greater Mekong Subregion, where pathogen transmission and related mortality is low. These variants have developed resistance to multiple drugs including artemisinin, mefloquine, and piperaquine and, as a result, can easily escape currently available therapeutic interventions.
As a part of routine genetic surveillance, southern Laos public health authorities collected 249 samples from Attapeu province during the outbreak. In an attempt to understand the epidemiological characteristics of the outbreak parasite, these samples were genotyped and their genetic signatures were compared with those of parasites circulating in previous seasons and other geographical regions.
In an attempt to identify populations of highly related individuals, pairwise genetic distances were estimated and used to cluster genetically similar parasites. A total of 30 clusters were identified. The most rapidly expanding variant was LAA1 , which was primarily responsible for the reduction in genetic diversity. The second largest variant was LAA2, which expanded more gradually to reach a frequency of 8% in 2021. The third largest variant was LAA7, whose expansion reduced over time with the induction in LAA1 expansion.
A strong correlation was observed between the emergence of the R539T mutation and the onset of the outbreak in Attapeu. This mutation was not found in other provinces of Laos; however, it was present in Attapeu at a low frequency before the outbreak.
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