In recent years there is increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.

What is Malaria?

• Malaria is caused by the bite of the female Anopheles mosquito if the mosquito itself is infected with a malarial parasite.
• There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
• Therefore, to say that someone has contracted the Plasmodium ovale type of malaria means that the person has been infected by that particular parasite.

Burden of Malaria in India

• In 2018, the National Vector-borne Disease Control Programme (NVBDCP) estimated that approximately 5 lakh people suffered from malaria.
• 63% of the cases were of Plasmodium falciparum.
• The recent World Malaria Report 2020 said cases in India dropped from about 20 million in 2000 to about 5.6 million in 2019.

Treatment of Malaria

• Malaria is treated with prescription drugs to kill the parasite. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug.
• In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment.
• This is especially against Plasmodium falciparum parasite which is responsible for almost all malaria-related deaths in the world.

Why in news now?

• There are reports of artemisinin resistance in East Africa and is a matter of great concern as this is the only drug that has saved several lives across the globe.
• In India, after the failure of chloroquine to treat P. falciparum malaria successfully, artemisinin-based combination therapy was initially introduced in 2008.
• Currently, several combinations of artemisinin derivatives are registered in India.

Artemisinin-based combination therapy failure in India

• In 2019, a report from Eastern India indicated the presence of two mutations in P. falciparum cases treated with artemisinin that linked to its presence of resistance.
• Again in 2021, artemisinin-based combination therapy failure was reported from Central India where the partner drug SP showed triple mutations with artemisinin wild type.
• This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. Here it is needed to change the partner drug as has been done in NE states in 2013.

History of drug resistance

• In the 1950s chloroquine resistance came to light.
• Both chloroquine and pyrimethamine resistance originated from Southeast Asia following their migration to India and then on to Africa with disastrous consequences.
• Similarly, artemisinin resistance developed from the six Southeast Asian countries and migrated to other continents, as is reported in India and Africa.
• It would not be out of context that artemisinin is following the same path as has been seen with chloroquine.
• Now, the time has come to carry out Molecular Malaria Surveillance to find out the drug-resistant variants so that corrective measures can be undertaken in time to avert any consequences.
• Some experts even advocate using triple artemisinin-based combination therapies where the partner drug is less effective.

Try this PYQ:

Widespread resistance of malarial parasite to drugs like chloroquine has prompted attempts to develop a malarial vaccine to combat malaria.

Why is it difficult to develop an effective malaria vaccine?

(a) Malaria is caused by several species of Plasmodium

(b) Man does not develop immunity to malaria during natural infection

(c) Vaccines can be developed only against bacteria

(d) Man is only an intermediate host and not the definitive host

 

Post your answers here.

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