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The Times of India
25 April 2009
By Kounteya Sinha
New Delhi,India

A new global threat has emerged–a malaria strain that has become resistant to Artemisinin, the best and the latest drug available to fight the disease.

Found first in 2007 in small pockets of the Mekong area (Thai–Cambodia border), the World Health Organisation now perceives it as a major threat to global efforts to combat the vector–borne disease.

Till last year, Who called this strain “Tolerant” to Artemisinin. This year, the global health watchdog has declared it “resistant” to Artemisinin in the Plasmodium falciparum parasite, which causes the most deadly form of malaria.

Artemisinin is normally used in a combination therapy (ACT). While Thailand has been using it for over five years, India started ACT last year and at present has 117 districts using this drug combo to fight malaria.

Earlier, experts said, ACT could kill the malaria parasite in a human bloodstream within 24 to 36 hours. With the drug resistant strain, ACT needs up to 120 hours to kill the parasite.

Who’s malaria advisor for southeast Asia, Dr Krong Pong, told TOI, “The malaria strain in a small part of the Mekong area has been found to be resistant to the wonder drug Artemisinin. The strain has caused prolongation of parasite clearance time. This is a global threat.”

Asked whether the drug resistant strain threatened India, Dr Pong said, “With people travelling far and wide all the time, it is possible that the drug resistant parasite will start to spread outside Thailand and Cambodia. In no time, an infected person can bring the parasite into India. At present however, the threat is contained in a few provinces of Thailand and Cambodia.”

Who has now formed a team of experts to combat the spread of the resistant strain to other parts of the world. The task force, that also includes an Indian vector–borne expert from the National Institute of Malaria Research, will meet in Cambodia next week to finalise a battle plan to combat and contain the strain.

An Indian expert told TOI, “The resistance in this region is because Artemisinin was being used here for long. In India, it was started just last year. We have started monitoring for Artemisinin resistance in India just like we did when chloroquine was our drug of choice.”

The development of ACT had actually given the world hope that malaria could be eradicated very soon.

To protect against artemisinin resistance, global health authorities are trying to ensure that it is sold only as a combination pill with other antimalaria medicines that linger longer in the blood, mopping up any Artemisinin–resistant parasites.

Artemisinin monotherapy, where the drug is taken alone, will allow parasites to more easily adapt to it. In Cambodia, a ban on Artemisinin monotherapy is being enforced.

“Time is of the essence here. We have to act now to contain this problem within the Mekong region. It must not be allowed to spread and become a regional and international threat,” said Shin Young–Soo, Who regional director for the Western Pacific.

A $22.5 million grant from the Bill and Melinda Gates Foundation to the Who will fund the global containment plan besides trying to eradicate malaria from the Mekong region.

Every year, there are 250 million cases of malaria infections around the world, causing nearly one million deaths.

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