Last Updated: 14/06/2024
Enhanced Active Surveillance: Establish genetic epidemiological surveillance for tracking antimalarial drug resistance
Objectives
Primary Objective:
To establish a genetic epidemiological surveillance system to guide malaria elimination in Vietnam, in particular targeting multidrug resistant P. falciparum malaria.
Secondary Objectives:
- To obtain near real-time information on the prevalence of artemisinin and partner drug (DHA-PQP) antimalarial resistance in Vietnam using genetic markers.
- To monitor the spread of multidrug resistant falciparum malaria.
- To reconstruct routes and pattern of spread of P. falciparum parasites and drug resistance.
- To provide genetic tools for investigating and characterizing malaria outbreaks.
- To integrate genetic data into clinical and parasitological surveillance systems, in order to support decision-making on antimalarial drug policy and malaria control and elimination interventions.
- To evaluate the feasibility and sustainability of integrating genetic surveillance at the VHW level.
National Institute of Malaria, Parasitology and Entomology (NIMPE) Vietnam, Vietnam
Background:
The emergence and spread of resistance to artemisinin and ACT partner drugs in the GMS is threatening to reverse the recent gains in malaria control.
The recent increase in multidrug resistant falciparum malaria has rendered the infection very difficult to treat in Western Cambodia and Northern Cambodia, with high failure rates to AM-LUM, AAS-MQ, DHA-PQP and Proguanil-Amodiaquine. Successful elimination will require a particular focus on identifying hotspots of drug resistant parasites and focusing tailored responses against these parasites. The following strategies will be required:
- rapidly identify, characterise and act upon outbreak of drug resistant parasites.
- monitor resistance patterns in real-time to inform drug policy.
reconstruct geographical patterns of spread, so that these can be interrupted by targeted interventions.
Overall goal:
To integrate genetic epidemiology as a routine part of epidemiological surveillance, and incorporate the acquisition of near-real-time data from conventional and genetic epidemiology into decision-making on drug policies and intervention priorities for malaria elimination.
Project Overview
The proposed genetic surveillance system utilises the existing network of community-based health workers to establish a system for DBS collection and transport from Tier 1 areas in Vietnam. This genetic surveillance system will accelerate the assessment of artemisinin resistance at a village level.
Project Methodology
The GIS mapping conducted in the dry season (November-December 2015) will provide the geo-spatial foundation for the genetic epidemiology surveillance. Routine data collection of malaria cases from MOTs and VHWs will be collected in real-time using mobile phone uploads integrated into the Spatial Decision Support System to generate real-time reporting to NIMPE to inform strategic targeted actions for the control of transmission foci and for malaria elimination. MOTs and VMWs will also collect dried blood spots (DBS), thick/thin films and a microtainer of blood from finger-prick samples according to the specific SOPs. This will be performed for all patients that test positive for P. falciparum or mixed malaria infection by microscopy or RDT.
These samples will be used to establish the presence of various drug resistance markers, such as K13 mutations, as well as markers for MDR genetic background and others. These results will be provided to NIMPE as a regular monthly report in a format mutually agreed upon by the Recon Project and NIMPE. These data will then be integrated into the SDSS.
Oct 2015 — Dec 2016
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