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Antimalarial Drug Resistance in India

Posted on September 30, 2021 by admin1  20

In News

  • Recently, the New England Journal of Medicine published an article `Evidence of Artemisinin-Resistant Malaria in Africa’.
    • It confirmed the increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.

Malaria

  • Malaria is mosquito borne blood disease caused by plasmodium protozoa.
    • The parasites spread through the bites of infected female Anopheles mosquitoes.
    • It is preventable as well as curable but can be fatal in case of late or no treatment.
  • Mechanism of action
    • Plasmodium needs two hosts to complete its life cycle.
    • After entering the human body, parasites initially multiply within the liver cells 
    • Then it attacks the Red Blood Cells (RBCs) resulting in their rupture.

Courtesy: IndiaToday

  • Protozoa
    • There are 5 Plasmodium protozoa species that cause malaria in humans
    • Two of these species which pose  the greatest threat are.
      • Plasmodium falciparum and 
      • Plasmodium vivax
  • Disease Prevalence
    • It is predominantly found in the tropical and subtropical areas of Africa, South America as well as Asia.
    • Amongst India’s Neighbours, China was recently declared Malaria free by WHO.
  • Symptoms
    • Fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness.

Malaria Burden in India

  • The World Malaria Report (WMR) 2020 released by WHO gives the estimated cases for malaria across the world.
  • It indicates that India has made considerable progress in reducing its malaria burden.
  • India is the only highly endemic country which has reported a decline of 17.6% in 2019 as compared to 2018.

Malaria Vaccine

  • Mosquitrix or RTS,S
    • This vaccine has been branded as Mosquirix but is also known by its lab initials as RTS,S.
    • It was developed by GlaxoSmithKline (GSK) company and approved by the European Medicines Agency in 2015.
    • The vaccine has shown a maximum efficiency of nearly 40%.
  • R21/ Matrix M
    • Still under trial stage but may be 77% effective.

Recent Report of Antimalarial Drug Resistance

  • In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment.
    • They are especially effective against Plasmodium falciparum.
  • The study ‘Evidence of Artemisinin-Resistant Malaria in Africa’ described the presence of two mutations responsible for artemisinin resistance in Northern Uganda.
    • The report of artemisinin resistance in East Africa is a matter of great concern because 
      • This is the only drug that has saved several lives across the globe.

History of Drug Resistance

  • In the 1950s, chloroquine resistance came to light. 
  • Both chloroquine and pyrimethamine resistance originated from Southeast Asia 
  • From there they migrated to India and then on to Africa with disastrous consequences.
  • Similarly, artemisinin resistance developed from the six Southeast Asian countries and migrated to other continents, as is reported in India and Africa.
  • It would not be out of context that artemisinin is following the same path as has been seen with chloroquine.

Artemisinin-based combination therapy failure in India

  • In India, after the chloroquine resistance was seen in P. falciparum, artemisinin-based combination therapy was introduced in 2008.
  • In 2010, artesunate plus sulfadoxine-pyrimethamine (AS+SP) was introduced universally.
  • In 2013, in view of resistance to the partner drug SP in the 7 North Eastern States, 
    • The combination partner was replaced by artemether- lumefantrine (AL) for these states.
  • In 2019, Eastern India indicated the presence of 2 mutations in P. falciparum treated with artemisinin that linked to its presence of resistance.
  • Again in 2021, artemisinin-based combination therapy failure was reported from Central India.
    • Here too the partner drug SP showed triple mutations with artemisinin wild type.
  • This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. 
    • Here it is needed to change the partner drug as has been done in NE states in 2013 and subsequent cases.
  • Currently, several combinations of artemisinin derivatives are registered in India.

Conclusion and Way Forward

  • Monitor Chloroquine resistance in P. Vivax
    • Though there have been some reports of chloroquine resistance in P. vivax malaria, this drug is still the effective choice to treat this species.
    • Continued monitoring is needed.
  • Molecular Malaria Surveillance
    • The time has come to carry out Molecular Malaria Surveillance to find out the drug-resistant variants.
      • It will help in undertaking corrective measures in time to avert any consequences.

Few Initiatives related to Malaria

  • Initiatives of WHO
    • Celebration of World Malaria Day on 25th April every year. 
      • The 2021 theme is “Reaching the Zero Malaria target”.
    • ‘E-2025 Initiative’
      • The WHO has also identified 25 countries with the potential to eradicate malaria by 2025 under its ‘E-2025 Initiative’.
  • Indian Initiatives
    • 5 year National Strategic Plan for Malaria Elimination
      • Launched in 2017
      • It shifted focus from Malaria control to elimination.
      • It provided a roadmap to end malaria in 571 districts out of India’s 678 districts by 2022.
    • Malaria Elimination Research Alliance-India (MERA-India)
      • Established by Indian Council of Medical Research (ICMR)
      • It is a conglomeration of partners working on malaria control.

Source: IE

 
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