Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
Genetic surveillance of Plasmodium falciparum (Pf) can track antimalarial-resistant strains, to inform decision-making by National Malaria Control Programmes (NMCPs). The GenRe-Mekong project prospectively collected 5982 samples in the Greater Mekong Subregion (GMS) between 2017 and 2022, genotyping drug resistance markers, and barcodes that recapitulate genetic variation. Genotypes were analyzed with the grcMalaria R package, first described in this paper, to translate genetic epidemiology data into actionable visual information. Since 2020, Pf incidences decreased rapidly, accompanied by a decline of dihydroartemisinin-piperaquine (DHA-PPQ) resistant lineages, previously dominant in the eastern GMS. The frequency of plasmepsin2/3 amplifications, conferring piperaquine resistance, dropped from 62% in 2017-2019 to 2% in 2022, coinciding with a switch in frontline therapy in Cambodia, Thailand, and Vietnam. While regional artemisinin resistance levels remained high, no evidence of emerging mefloquine resistance was found. Routine genetic surveillance proved valuable in monitoring rapid parasite population changes in response to public health interventions, providing actionable information for NMCPs.
Authors
- Siv Sovannaroth (ORCID: https://orcid.org/0000-0001-9173-3530)
- Richard J. Maude (ORCID: https://orcid.org/0000-0002-5355-0562)
- Varanya Wasakul (ORCID: https://orcid.org/0000-0002-2349-6120)
- Richard D. Pearson (ORCID: https://orcid.org/0000-0002-7386-3566)
- Nguyen Thi Kim Tuyen (ORCID: https://orcid.org/0009-0002-9417-1603)
- Thuy-Nhien Nguyen (ORCID: https://orcid.org/0000-0002-4101-5706)
- Paul N. Newton (ORCID: https://orcid.org/0000-0002-4608-6431)
- Ethan Booth
- S Chen
- Mayfong Mayxay (ORCID: https://orcid.org/0000-0002-6056-4516)
- Viengphone Sengsavath
- Nicholas Day (ORCID: https://orcid.org/0000-0003-2309-1171)
- Vo Ngoc Lam Phuong
- Saiamphone Xayvanghang
- Arjen M. Dondorp (ORCID: https://orcid.org/0000-0001-5190-2395)
- Sónia Gonçalves (ORCID: https://orcid.org/0000-0003-0321-3303)
- Olivo Miotto (ORCID: https://orcid.org/0000-0001-8060-6771)
- Sonexay Phalivong
- Keobouphaphone Chindavongsa
- Ngo Duc Thang
- Elizabeth A. Ashley (ORCID: https://orcid.org/0000-0002-7620-4822)
- Duc−Trung Pham
- Tess D. Verschuuren (ORCID: https://orcid.org/0000-0002-1448-7425)
- Victoria Simpson (ORCID: https://orcid.org/0000-0003-3402-6711)
- Supaporn Mahaphontrakoon
- Virasak Banouvong
- Huynh Hong Quang
- Cristina V. Ariani (ORCID: https://orcid.org/0009-0000-0887-5993)
Institutions
- National University of Singapore (SG)
- University of Health Science (KH)
- The Open University (GB)
- Mahidol University (TH)
- Mahosot Hospital (LA)
- Cambodia National Malaria Center (KH)
- Angkor Hospital for Children (KH)
- Wellcome Sanger Institute (GB)
- University of Oxford (GB)
- Ministry of Health of the Russian Federation (RU)
- Mahidol Oxford Tropical Medicine Research Unit (TH)
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LA)
- Oxford University Clinical Research Unit (VN)
- National University Health System (SG)
- National Institute of Malariology, Parasitology and Entomology (VN)
- University of Health Sciences (SO)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-05-20
- DOI
- https://doi.org/10.1038/s41467-025-59946-1
- Citations
- 10
- Primary Topic
- Malaria Research and Control
- Type
- article
- Field-Weighted Citation Impact
- 18.79
Funders
- Bill and Melinda Gates Foundation
- Global Fund to Fight AIDS, Tuberculosis and Malaria
- Wellcome Trust