Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion

Abstract 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, g...

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Main Authors: Varanya Wasakul, Tess D. Verschuuren, Nguyen Thuy-Nhien, Ethan Booth, Huynh Hong Quang, Ngo Duc Thang, Keobouphaphone Chindavongsa, Siv Sovannaroth, Virasak Banouvong, Viengphone Sengsavath, Mayfong Mayxay, Nguyen Thi Kim Tuyen, Vo Ngoc Lam Phuong, Pham Duc Trung, Sónia Gonçalves, Soun Chen, Sonexay Phalivong, Saiamphone Xayvanghang, Supaporn Mahaphontrakoon, Richard D. Pearson, Paul N. Newton, Richard J. Maude, Elizabeth A. Ashley, Cristina V. Ariani, Victoria J. Simpson, Nicholas P. Day, Arjen M. Dondorp, Olivo Miotto
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:Nature Communications
Online Access:https://doi.org/10.1038/s41467-025-59946-1
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author Varanya Wasakul
Tess D. Verschuuren
Nguyen Thuy-Nhien
Ethan Booth
Huynh Hong Quang
Ngo Duc Thang
Keobouphaphone Chindavongsa
Siv Sovannaroth
Virasak Banouvong
Viengphone Sengsavath
Mayfong Mayxay
Nguyen Thi Kim Tuyen
Vo Ngoc Lam Phuong
Pham Duc Trung
Sónia Gonçalves
Soun Chen
Sonexay Phalivong
Saiamphone Xayvanghang
Supaporn Mahaphontrakoon
Richard D. Pearson
Paul N. Newton
Richard J. Maude
Elizabeth A. Ashley
Cristina V. Ariani
Victoria J. Simpson
Nicholas P. Day
Arjen M. Dondorp
Olivo Miotto
author_facet Varanya Wasakul
Tess D. Verschuuren
Nguyen Thuy-Nhien
Ethan Booth
Huynh Hong Quang
Ngo Duc Thang
Keobouphaphone Chindavongsa
Siv Sovannaroth
Virasak Banouvong
Viengphone Sengsavath
Mayfong Mayxay
Nguyen Thi Kim Tuyen
Vo Ngoc Lam Phuong
Pham Duc Trung
Sónia Gonçalves
Soun Chen
Sonexay Phalivong
Saiamphone Xayvanghang
Supaporn Mahaphontrakoon
Richard D. Pearson
Paul N. Newton
Richard J. Maude
Elizabeth A. Ashley
Cristina V. Ariani
Victoria J. Simpson
Nicholas P. Day
Arjen M. Dondorp
Olivo Miotto
author_sort Varanya Wasakul
collection DOAJ
description Abstract 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.
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spelling doaj-art-dd39a3cea22f4776825087cf43fd600b2025-08-20T01:53:19ZengNature PortfolioNature Communications2041-17232025-05-0116111210.1038/s41467-025-59946-1Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong SubregionVaranya Wasakul0Tess D. Verschuuren1Nguyen Thuy-Nhien2Ethan Booth3Huynh Hong Quang4Ngo Duc Thang5Keobouphaphone Chindavongsa6Siv Sovannaroth7Virasak Banouvong8Viengphone Sengsavath9Mayfong Mayxay10Nguyen Thi Kim Tuyen11Vo Ngoc Lam Phuong12Pham Duc Trung13Sónia Gonçalves14Soun Chen15Sonexay Phalivong16Saiamphone Xayvanghang17Supaporn Mahaphontrakoon18Richard D. Pearson19Paul N. Newton20Richard J. Maude21Elizabeth A. Ashley22Cristina V. Ariani23Victoria J. Simpson24Nicholas P. Day25Arjen M. Dondorp26Olivo Miotto27Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityOxford University Clinical Research UnitMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityInstitute of Malariology, Parasitology and EntomologyNational Institute of Malariology, Parasitology and EntomologyCentre for Malariology, Parasitology and EntomologyNational Center for Parasitology, Entomology and Malaria ControlCentre for Malariology, Parasitology and EntomologyCentre for Malariology, Parasitology and EntomologyLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot HospitalOxford University Clinical Research UnitOxford University Clinical Research UnitOxford University Clinical Research UnitWellcome Sanger InstituteNational Center for Parasitology, Entomology and Malaria ControlLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot HospitalLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot HospitalMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityWellcome Sanger InstituteLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot HospitalMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityLao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot HospitalWellcome Sanger InstituteWellcome Sanger InstituteMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityMahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol UniversityAbstract 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.https://doi.org/10.1038/s41467-025-59946-1
spellingShingle Varanya Wasakul
Tess D. Verschuuren
Nguyen Thuy-Nhien
Ethan Booth
Huynh Hong Quang
Ngo Duc Thang
Keobouphaphone Chindavongsa
Siv Sovannaroth
Virasak Banouvong
Viengphone Sengsavath
Mayfong Mayxay
Nguyen Thi Kim Tuyen
Vo Ngoc Lam Phuong
Pham Duc Trung
Sónia Gonçalves
Soun Chen
Sonexay Phalivong
Saiamphone Xayvanghang
Supaporn Mahaphontrakoon
Richard D. Pearson
Paul N. Newton
Richard J. Maude
Elizabeth A. Ashley
Cristina V. Ariani
Victoria J. Simpson
Nicholas P. Day
Arjen M. Dondorp
Olivo Miotto
Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
Nature Communications
title Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
title_full Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
title_fullStr Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
title_full_unstemmed Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
title_short Genetic surveillance of Plasmodium falciparum populations following treatment policy revisions in the Greater Mekong Subregion
title_sort genetic surveillance of plasmodium falciparum populations following treatment policy revisions in the greater mekong subregion
url https://doi.org/10.1038/s41467-025-59946-1
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