Plasmodium falciparum kelch 13 Mutations, 9 Countries in Africa, 2014-2018

Abstract

The spread of drug resistance to antimalarial treatments poses a serious public health risk globally. To combat this risk, molecular surveillance of drug resistance is imperative. We report the prevalence of mutations in the Plasmodium falciparum kelch 13 propeller domain associated with partial artemisinin resistance, which we determined by using Sanger sequencing samples from patients enrolled in therapeutic efficacy studies from 9 sub-Saharan countries during 2014-2018. Of the 2,865 samples successfully sequenced before treatment (day of enrollment) and on the day of treatment failure, 29 (1.0%) samples contained 11 unique nonsynonymous mutations and 83 (2.9%) samples contained 27 unique synonymous mutations. Two samples from Kenya contained the S522C mutation, which has been associated with delayed parasite clearance; however, no samples contained validated or candidate artemisinin-resistance mutations.

Keywords: Africa; Pfk13 mutations; Plasmodium falciparum; antimicrobial resistance; artemisinin resistance; kelch 13; malaria; molecular surveillance; parasites.

Figure

Prevalence of Plasmodium falciparum kelch 13 mutations in pretreatment therapeutic efficacy study samples, 9 countries in Africa, 2014–2018. A total of 11 unique nonsynonymous and 27 unique synonymous mutations were detected in 2,865 successfully sequenced pretreatment and day of failure samples from Angola, Benin, Democratic Republic of the Congo, Guinea, Kenya, Malawi, Mali, Tanzania, and Zambia collected during 2014–2018. A total of 2,753 samples were wild-type. Data from Angola includes results from 2 therapeutic efficacy studies.