Drug-resistant malaria: the world's next big health crisis?

Reuters , Wednesday 17 Dec 2014

Over shadowed currently by Ebola, Malaria new drug-resistant strainskeeps health care experts awake at night.

Photo: Reuters

Ka Lar Nar caught malaria for the sixth time when he was working away from home on his small farm in the jungle of south-eastern Myanmar but this time it was a lot harder to get rid of it.

After testing positive for malaria he got a three-day course of drugs from a community health volunteer in his village but even though his fever subsided, he continued to be plagued by headaches and another test still showed positive results.

Experts say his case could be an indication of drug resistance to the mosquito-borne disease, which has been spreading in Myanmar and other countries in the Mekong River basin in what threatens to become the next big global health emergency if it marches on to India and Africa.

"This was a missed opportunity," said Eisa Hamid, an epidemiologist working with the United Nations in Myanmar, who specializes in monitoring and evaluating malaria programs. Normally, after three days of treatment the farmer's blood should have been clear of malaria-transmitting parasites.

"With any patient showing positive test results after three days of treatment, we have to suspect drug resistance, and more sophisticated blood testing should have been done as he could still carry the parasites that cause malaria in his blood."

MALARIA'S NEW GROUND ZERO

Malaria death rates dropped by 47 percent between 2000 and 2014 worldwide but it still killed some 584,000 people in 2013, most of them in sub-Saharan Africa, according to the World Health Organization (WHO).

Much of the success in fighting the disease is due to the use of combination therapies (ACTs) based on artemisinin, a Chinese herb derivative, which is now under threat as malaria parasites have been building up resistance to the drugs.

Experts say Myanmar, which has the largest malaria burden in the region, is the next frontier in the spread of resistance to artemisinin.

Positioned between the Andaman Sea and the Himalayas and bordering India and China - home to 40 percent of the world's population - Myanmar is in a unique position to halt the spread of resistance to India and Africa.

"We need to act fast to avoid a big catastrophe," said Pascal Ringwald of the WHO's Global Malaria Programme. "The consequences could be disastrous."

If the problem spreads beyond the region, history would repeat itself for a third time, as resistance to other malaria drugs developed in the area before and spread to Africa to claim the lives of millions, especially children.

But the urgency is far greater this time as new drugs to replace ACTs are not yet available.

"Artemisinin resistance could wipe out a lot of the gains we've made in containing malaria and there is nothing yet to replace it," said Nyan Sint, an epidemiologist and regional malaria officer working with the government's national malaria control program.

Before being identified in Myanmar in 2008, signs of resistance were found in Cambodia and since have also been confirmed in Thailand, Laos and Vietnam, according to the WHO.

Why parasites become resistant to drugs is not entirely clear but prolonged civil conflict, dense jungles, migration and poor quality drugs are all believed to play a part.

The human and economic cost of failing to stop the spread would be huge, according to a model published in the Malaria Journal last month. The study estimated an extra 116,000 deaths per year if artemisinin resistance is not stopped. Medical costs could exceed $32 million per year, while productivity losses from a rise in cases and deaths are estimated at $385 million.

 

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