The challenge of artemisinin resistance can only be met by eliminating Plasmodium falciparum malaria across the Greater Mekong subregion
The challenge of artemisinin resistance can only be met by eliminating Plasmodium falciparum malaria across the Greater Mekong subregion
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DOI：
10.1186/1475-2875-13-286
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发表时间：
2014-07-27
期刊：
影响因子：
3
通讯作者：
Feachem, Richard G. A.
中科院分区：
文献类型：
--
作者：
Gueye, Cara Smith;Newby, Gretchen;Feachem, Richard G. A.
基于青蒿素的组合是目前最有效的抗疟疾药物，除了病媒控制外，还导致疟疾发病率和死亡率显着下降。然而，亚太地区大湄公河次区域（GMS）已发现青蒿素耐药病灶，威胁到在疟疾控制方面取得的重大成果，并可能造成更难以治疗和消除的寄生虫库。目前正在努力阻止青蒿素耐药性的蔓延，包括协调活动和资金，以及识别疑似青蒿素耐药性的区域，目前正在使用新发现的分子标记。然而，将资源用于遏制耐药寄生虫可能效率低下，而且监测影响也具有挑战性。更可持续的解决方案是从大湄公河次区域快速消除所有恶性疟原虫寄生虫。由于多种原因，该策略更加有效。首先，次区域战略符合当前的消除承诺，并将建立在现有国家对消除政治支持以及加强国家间合作的基础上。其次，大湄公河次区域的人员流动挑战是次区域范围的，需要统一的消除战略。第三，各国需要改善和加强疟疾行动以实现消除，这将是整个次区域的共同目标。围绕消除恶性疟的目标不仅将利用现有的区域机构来推动政治和资金支持，而且还将利用现有的资金来实现这一次区域目标。
Artemisinin-based combinations are currently the most effective anti-malarials and, in addition to vector control, have led to significant declines in malaria morbidity and mortality. However, foci of artemisinin drug resistance have been identified in the Greater Mekong subregion (GMS) of the Asia Pacific, threatening the major gains made in malaria control and potentially creating a parasite pool that is more difficult to treat and eliminate. Efforts are underway to halt the spread of artemisinin resistance, including coordination of activities and funding, and identification of areas of suspected artemisinin resistance, now using a newly identified molecular marker. However, targeting resources to the containment of resistant parasites is likely inefficient and monitoring impact is challenging. A more sustainable solution is the rapid elimination of all Plasmodium falciparum parasites from the GMS. This strategy is more efficient for several reasons. First, a subregional strategy is in line with current commitment to elimination and will build upon the existing national political support for elimination as well as enhancing collaboration among countries. Second, the challenge of human mobility in the GMS is subregional in scope and requires a harmonized elimination strategy. Third, countries will need to improve and intensify malaria operations to reach elimination, and this will be a singular goal across the subregion. Rallying around the goal of P. falciparum elimination will not only utilize existing regional bodies to catalyze political and funding support, but will also leverage the funding already in place to achieve this subregional goal.