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Drug-Resistant Malaria Spreads in SE Asia

On Thailand’s border with Myanmar, also known as Burma, a malaria research and treatment clinic is stepping up efforts to eliminate a drug-resistant form of the parasite before it spreads abroad.

Artemisinin medicines have been highly effective against malaria when used in combination with other drugs. But in five countries in Southeast Asia –Cambodia, Vietnam, Thailand, Myanmar and Laos – the malaria parasite has adapted a resistance to the treatment.

The Wang Pha Clinic, near a busy border crossing in Thailand, has had great success over the last two decades in reducing the impact of malaria. Case loads have dropped dramatically, but doctors like Cindy Chu, the clinic supervisor, remain concerned.

“We used to see a lot of malaria at the Wang Pha clinic but now with efforts of elimination and active surveillance and even the setting up of malaria posts on the other side of the border, the malaria rates have really gone down," she said. "So we don’t see as much malaria as we used to. But on the other hand the malaria that we do see is more complicated and because of artemisinin resistance, the cases we see here require additional therapy.”

Doctors can treat infected patients with stronger drug cocktails, but worry it’s just a matter of time before those medicines also become ineffective.

Dr. Francois Nosten, has been conducting research on the Thai-Myanmar border for the past 30 years and he sees the clock ticking.

“This is a global public health emergency because we could see in our studies that the progression of resistance is quite fast," Nosten said. "For example in 2007 none of the patients were infected with a resistant parasite. In 2012, 80 percent of the patients are infected with the resistant parasite so in just a few years the majority of the infections are caused by the resistant parasite.”

Nosten favors a more radical approach against resistant malaria to control its spread: administering medicine to entire villages where the parasite can lie dormant and undetectable in many people.

“What we predict is in order to stop the progression of artemisinin resistance, we need to eliminate malaria," Nosten said. "It's not good to just reduce the number of cases, reduce the transmission of the disease, we need to eliminate the parasite.

As medical teams make plans to distribute anti-malarial drugs in remote villages that have become malaria hotspots, many are hoping that the effort will stop the spread of an increasingly dangerous parasite.