Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
WorldWide Antimalarial Resistance Network, Oxford, UK.
Lancet Microbe. 2022 Mar;3(3):e184-e192. doi: 10.1016/S2666-5247(21)00249-4.
The increase in artemisinin resistance threatens malaria elimination in Asia by the target date of 2030 and could derail control efforts in other endemic regions. This study aimed to develop up-to-date spatial distribution visualisations of the () gene markers of artemisinin resistance in for policy makers.
In this systematic review and spatiotemporal analysis we used the WorldWide Antimalarial Resistance Network (WWARN) surveyor molecular markers of artemisinin resistance database. We updated the database by searching PubMed and SCOPUS for studies published between Jan 1, 1990, and March 31, 2021. Articles were included if they contained data on markers of artemisinin resistance from patients' samples in Asia and articles already included in the WWARN database were excluded. Data were extracted from the published articles and authors were contacted when information was missing. We used the lowest administrative unit levels for the sampling locations of all the data to describe the spatiotemporal distribution. The numbers of samples tested and those with each molecular marker in each administrative unit level were aggregated by year to calculate the marker prevalence over time.
Data were collated from 72 studies comprising markers from 16 613 blood samples collected from 1991 to 2020 from 18 countries. Most samples were from Myanmar (3842 [23·1%]), Cambodia (3804 [22·9%]), and Vietnam (2663 [16·0%]). The median time between data collection and publication was 3·6 years (range 0·9-25·0, IQR 2·7 [2·5-5·2]). There was a steady increase in the prevalence of WHO-validated markers, with the lowest of 4·3% in 2005 (n=47) and the highest of 62·9% in 2018 (n=264). Overall, the prevalence of Cys580Tyr mutation increased from 48·9% in 2002 to 84·9% in 2018.
From 2002 to 2018, there has been a steady increase in geographical locations and the proportion of infected people with validated artemisinin resistance markers. More consistent data collection, over more extended periods in the same areas with the rapid sharing of data are needed to map the spread and evolution of resistance to better inform policy decisions. Data in the literature are reported in a heterogeneous way leading to difficulties in pooling and interpretation. We propose here a tool with a set of minimum criteria for reporting future studies.
This research was funded in part by the Wellcome Trust.
青蒿素耐药性的增加威胁到 2030 年亚洲消除疟疾的目标，也可能破坏其他流行地区的控制工作。本研究旨在为决策者开发最新的青蒿素耐药性 () 基因标记物的空间分布可视化。
在这项系统评价和时空分析中，我们使用了世界疟疾抗药性网络 (WWARN) 调查员分子标记物抗药性数据库。我们通过在 PubMed 和 SCOPUS 中搜索 1990 年 1 月 1 日至 2021 年 3 月 31 日期间发表的研究，对数据库进行了更新。如果文章包含亚洲患者样本中青蒿素耐药性标记物的数据，并且文章已经包含在 WWARN 数据库中，则将其包含在内。从已发表的文章中提取数据，如果信息缺失，我们会联系作者。我们使用采样地点的最低行政单位级别来描述时空分布。将每年汇总各行政单位级别中检测到的样本数量和具有每种分子标记物的样本数量，以计算随时间推移的标记物流行率。
从 1991 年至 2020 年，从 18 个国家的 16613 份血液样本中收集了 72 项研究的数据，其中包含来自 的标记物。大多数样本来自缅甸（3842 [23.1%]）、柬埔寨（3804 [22.9%]）和越南（2663 [16.0%]）。数据收集和发表之间的中位数时间为 3.6 年（范围 0.9-25.0，IQR 2.7 [2.5-5.2]）。世界卫生组织（WHO）验证的标记物的流行率呈稳步上升趋势，最低值为 2005 年的 4.3%（n=47），最高值为 2018 年的 62.9%（n=264）。总体而言，Cys580Tyr 突变的流行率从 2002 年的 48.9%上升到 2018 年的 84.9%。
从 2002 年到 2018 年，具有验证的青蒿素耐药性标记物的地理位置和受感染人群的比例都在稳步增加。需要在同一地区更长期、更一致地收集数据，并快速共享数据，以绘制耐药性的传播和演变情况，以便更好地为决策提供信息。文献中的数据以异构方式报告，导致难以汇总和解释。我们在这里提出了一个工具，其中包含一组报告未来研究的最低标准。
这项研究部分由惠康信托基金资助。
