Surveillance of Antimalarial Resistance Molecular Markers in Imported Plasmodium falciparum Malaria Cases in Anhui, China, 2012–2016

Tao Zhang Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Xian Xu Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Jingjing Jiang Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Chen Yu Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Cuicui Tian Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Weidong Li Anhui Provincial Center for Disease Control and Prevention, Anhui, China

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Between 2012 and 2016, over 80% of registered malaria cases in Anhui province were Plasmodium falciparum returned from Africa. However, drug-resistance marker polymorphisms in imported P. falciparum cases have not been assessed. This study looked at the distribution of antimalarial–drug resistance by evaluating K13-propeller, pfmdr1, and pfcrt gene mutations. Fourteen synonymous and 15 nonsynonymous mutations in the K13-propeller gene were detected in samples from nine African countries, yet no candidate and validated K13 resistance mutations were found. The prevalence of pfcrt K76T and pfmdr1 N86Y mutants was 27.7% and 19.9%, respectively. Six different pfcrt genotypes were found, with C72V73M74N75T76 being the most common (89.2%). The pfcrt 76-pfmdr1 86 haplotype combination was evaluated in 173 isolates, and the N86T76 genotype was the most prevalent (50.3%). Notably, the prevalence of the N86Y mutation in Africa marked a decline from 31.0% in 2012 to 8.2% in 2016. Our findings suggest that there is no immediate threat to artemisinin efficacy in imported P. falciparum infections returned from Africa to Anhui province. Nevertheless, pfcrt K76T and pfmdr1 N86Y mutations were modestly prevalent, suggesting the presence of chloroquine resistance in these cases. Accordingly, dihydroartemisinin + piperaquine may be a better choice than artesunate + amodiaquine for the treatment of uncomplicated P. falciparum infections in Anhui province. In addition to, artemether–lumefantrine can be introduced as an alternative measure.

Author Notes

Address correspondence to Weidong Li, Department of Prevention of Endemic Diseases and Parasitic Diseases, Anhui Provincial Center for Disease Control and Prevention, Anhui, China. E-mail: ahcdclwd@163.com

Financial support: This study has been supported by the Anhui Province Family Planning Commission Research Project (2017)61.

Authors’ address: Tao Zhang, Xian Xu, Jingjing Jiang, Chen Yu, Cuicui Tian, and Weidong Li, Department of Prevention of Endemic Diseases and Parasitic Diseases, Anhui Provincial Center for Disease Control and Prevention, Anhui, China, E-mails: lumanman123@126.com, xx@ahcdc.com.cn, jjj@ahcdc.com.cn, yc-perfect@163.com, 1113485604@qq.com, and ahcdclwd@163.com.

These authors contributed equally to this work.

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