Substantial increase in mutations in the genes pfdhfr and pfdhps puts sulphadoxine–pyrimethamine‐based intermittent preventive treatment for malaria at risk in Burkina Faso. Issue 6 (27th March 2014)

• Record Type: Journal Article
• Authors: Geiger, Carolin; Compaore, Guillaume; Coulibaly, Boubacar; Sie, Ali; Dittmer, Martin; Sanchez, Cecilia; Lanzer, Michael; Jänisch, Thomas
• Is Part Of: Tropical medicine & international health. Volume 19:Issue 6(2014:Jun.)
• Page Start: 690
• Page End: 697
• Publication Date: 2014-03-27
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12305
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12305-abs-0001"> <title>Abstract</title> <sec id="tmi12305-sec-0001" sec-type="section"> <title>Objective</title> <p>Sulphadoxine–pyrimethamine (SP) is widely used as intermittent preventive treatment (IPT) for malaria in pregnant women in Sub‐Saharan Africa. There are reports of wide‐spread SP resistance in countries where SP had once been used as a first‐line treatment. It is unclear whether the development of SP resistance also affects countries where SP is mainly used in the context of IPT, as is the case in Burkina Faso. To assess the efficacy of SP‐based IPT, we monitored the prevalence of SP conferring genetic mutations in the genes <italic>dhfr</italic> and <italic>dhps</italic> in <italic>Plasmodium falciparum</italic> populations in a rural area of Burkina Faso over a period of 13 years.</p> </sec> <sec id="tmi12305-sec-0002" sec-type="section"> <title>Methods</title> <p>Molecular epidemiological study consisted of six consecutive cross‐sectional surveys of rainy and dry seasons (2009–2012). Data from the rainy season in 2000 served as a baseline. Mutations in <italic>dhfr</italic> and <italic>dhps</italic> associated with SP resistance were analysed by pyrosequencing in 861 parasite‐positive samples.</p> </sec> <sec id="tmi12305-sec-0003" sec-type="section"> <title>Results</title> <p>The prevalence of the SP resistance conferring triple <italic>dhfr</italic> mutation 51I, 59R, 108N increased from 1.3% in the rainy season of 2000 to 35.3% in 2009, and 54.3% in 2011 (<italic>P </italic>≤ 0.001). Comparing rainy and dry seasons, we observed an increasing step‐like pattern with higher prevalence of the <italic>dhfr</italic> triple mutant in the respective dry season compared with the preceding rainy season. The proportion of the <italic>dhps</italic> 437Gly mutation in the rainy season of 2000 was 53.2% and subsequently increased to 77.6% in 2009 (<italic>P </italic>≤ 0.001).</p> </sec> <sec id="tmi12305-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The increase in molecular markers linked with SP resistance jeopardises the efficacy of IPTp and the planned IPTi interventions in Burkina Faso, calling for careful monitoring of genotypic resistance markers and <italic>in vivo</italic> validation of IPT efficacy.</p> </sec> </abstract>