Multi-drug resistant malaria spreading fast, could cause 'terrifying prospect,' scientists say

A strain of malaria resistant totwo key drugs has spread rapidly from Cambodia and has becomedominant in Vietnam, Laos and northern Thailand, with a"terrifying prospect" that it could reach Africa, scientistswarned on Monday,

Using genomic surveillance to track the spread ofdrug-resistant malaria, the scientists found that the strain,known as KEL1/PLA1, had also evolved and picked up new genetic mutations that may make it yet more resistant.

"We discovered [it]had spread aggressively, replacing localmalaria parasites, and had become the dominant strain in Vietnam, Laos and northeastern Thailand," said Roberto Amato,who worked with a team from Britain's Wellcome Sanger Instituteand Oxford University and Thailand's Mahidol University.

The risk is rising that the new strain could threatensub-Saharan Africa, where most malaria cases and deaths occur, largely among babies and children.

"This highly successful resistant parasite strain is capableof invading new territories and acquiring new genetic properties, raising the terrifying prospect that it could spreadto Africa ... as resistance to chloroquine did in the 1980s, contributing to millions of deaths," said Olivo Miotto of OxfordUniversity, who co-led the work.

Malaria is caused by Plasmodium parasites, which are carriedby mosquitoes and spread through their blood-sucking bites.

Almost 220 million people were infected with malaria in2017, according to World Health Organization estimates, and400,000 succumbed to it.

Malaria can be treated with medicines if caught earlyenough, but evolving drug-resistance such as the spread ofchloroquine-resistant malaria across Asia to Africa from thelate 1950s to the 1980 has hampered efforts to eliminate it.

The first-line treatment in many parts of Asia in the lastdecade has been a combination of dihydroartemisinin and piperaquine, also known as DHA-PPQ.

Researchers found in previous work that a strain of malariaresistant to this combination had evolved and spread across Cambodia between 2007 and 2013. This latest research, publishedin the Lancet Infectious Diseases journal, found it had crossedborders and tightened its grip.

Miotto said further work was now needed to establish how farthis resistance had spread and whether it had evolved further and eventually to understand which drugs would work againstresistant malaria parasites.

But there may be somealternative drugs that can be used instead, according to a different study published in the same journal.

"With the spread and intensification of resistance, our findings highlight the urgent need to adopt alternative first-line treatments," said Prof. Tran Tinh Hien, from the Oxford University Clinical Research Unit, in Vietnam, in a BBCNews story.

That could include using different drugs alongside artemisinin or using a combination of three drugs to overcome resistance.

"Other drugs may be effective at the moment but thesituation is extremely fragile," Miottosaid.