‘Spread’ of Artemisinin Resistance in Myanmar Revisited
Eric P. M. Grist *
College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK.
*Author to whom correspondence should be addressed.
Abstract
Geostatistical models have been widely used to represent disease prevalence in spatial disease mapping. More recently, these models have been employed to estimate geographic ‘spread’ of artemisinin resistance (AR) in South East Asia from genetic mutations identified in the K13 gene of the malaria Plasmodiumfalciparum parasite. Here, I revisit the question of ‘spread’ of AR as represented by resistant plasmodiumfalciparum in Myanmar, when re-evaluated from K13 mutant alleles data published by Tun et al. [1]. The new analysis gives a broader perspective by incorporating information published by the World Health Organization (WHO) in 2015 and subsequently in 2018 of the K13 mutant alleles confirmed to confer or to be associated with artemisinin resistance. This provides insights which hitherto have not been described and reveals the disparity between the estimation of ‘spread’ of AR by Tun et al. [1] and that of AR prevalence based on metrics which are supported by published WHO data.
Keywords: K13, genetic markers, overestimation, prevalence, malaria, antimalarial drug resistance