Article on South East Asia's malaria problem, with maps showing the areas of drug-resistant strains in Cambodia and neighboring countries.

Malaria’s ticking time bomb
Scientists are racing to stamp out the disease in southeast Asia before unstoppable strains spread.
By Amy Maxmen

Throngs of men and women ventured into the forests of northeastern Cambodia in April, lured by a bumper crop of a rare tropical treat called samrong. After days of hiking through the wilderness, some of the travellers returned to their homes with a bounty of the wrinkled seeds, which fetch a high price as a special dessert or an ingredient in traditional Chinese medicine. But many soon fell ill. Khong Chhoem, a 56-year-old rice farmer, says the fevers hit him a few days after the expedition. His muscles hurt. His eyes hurt. He had unbearable nightmares. A health worker told Chhoem that he had tested positive for Plasmodium falciparum, the deadliest kind of malaria-causing parasite. But because a wave of malaria was sweeping through the region, medicine was in short supply. Chhoem eventually found a shop that carried the drugs he needed, and he recovered. But in the intervening days, mosquitoes probably sucked up the parasites in his blood and spread them to other people.

After years in decline, malaria infection rates seem to be on the rise in northeastern Cambodia, where people are moving deeper into lush, mosquito-ridden territories in search of timber and seasonal goods such as samrong (Scaphium affine). Their movements provide opportunities for P. falciparum — which requires both human and insect hosts — to thrive. There are other contributors as well, such as treatment delays that allow the parasites to linger and spread, and an alarming decline in the potency of gold-standard malaria drugs called artemisinin-based combination therapies (ACTs).

What happens next here matters for the entire world; malaria remains one of the biggest killers in low-income countries. Estimates of the number of deaths each year range from 450,000 to 720,000 — and ACT pills keep that toll from being much higher. And although southeast Asia accounts for just 7% of malaria cases worldwide, it has a notorious history as the breeding ground for strains of malaria parasites that resist every drug thrown at them and then spread to other regions.

To eliminate malaria, public-health officials are trying to cover the region with volunteers and health workers who can dispense malaria drugs promptly, and report any signs of an upsurge. They are also looking to researchers for tools that can forestall drug resistance, technologies that improve detection of the parasite, and evidence on strategies for rooting it out. The pressure is on.
https://www.nature.com/immersive/d41586 ... e290d5b72e

'Millions at risk' if antimalarial drug resistance spreads from Asia, doctors warn
One by one, previous treatments are failing against a disease that kills hundreds of thousands of people every year.
30 December 2018
Millions of lives will be in danger if antimalarial drug resistance spreads from Asia to Africa, doctors have warned.

About half of the world's population is at risk of malaria, but some of the drugs used to treat it have started to fail.

Currently, artemisinin-based combination therapies (ACTs) are the gold standard of antimalarial treatment - but in 2008, a parasite resistant to artemisinin emerged in Pailin, western Cambodia.

Initially, the partner drugs in ACTs could still beat the infection. However, researchers found a strain also resistant to piperaquine (a partner drug) had started to spread in 2014.

Since then, this double-resistant parasite has moved across southeast Asia and now a triple-resistant strain has been found in northern Cambodia.

Dr James Callery from The Mahidol Oxford Tropical Medicine Research Unit (MORU) told Sky News: "Previously, when we had the resistance to chloroquine in Africa, we saw a massive upsurge in deaths and morbidity from malaria, and it was only because of the ACTs that came along that we were able to bring that down and start getting it more under control.

"We found artemisinin resistance and partner drug resistance emerged in western Cambodia and then we saw it spread across Cambodia to northeastern Thailand, southern Laos and then more recently down to south Vietnam as well.

"If we get failure from [ACTs], then we will go back to the dark days of seeing all these deaths among children, and getting to the point where we might get malaria that isn't treatable."

Until recently, the standard antimalarial drug used in Cambodia was failing in up to 60% of cases, prompting the national malaria control program to change their medication.

This same drug is now also failing in Vietnam.

Dr Callery is one of a team of experts trialling a possible alternative: a new combination of three antimalarial treatments being tested in northern Cambodia as part of a project backed by Oxford University.

The area is a malaria hotspot, with many people infected after being bitten by malaria mosquitoes which in the forests where they work.

As part of a clinical trial at the MORU clinic in Siem Pang, patients are given a three-day course of three drugs. They are monitored over six weeks to ensure the medicine has worked and they remain disease free. Researchers say that, so far, it appears to be effective and safe.

While southeast Asia only accounts for about 5% of the world's malaria cases, it has a history as a breeding ground for drug-resistant strains of the parasites.
https://news.sky.com/story/millions-at- ... n-11594653

Fighting malaria in the remote reaches of Cambodia
Jan 11, 2019 6:35 PM EST
Fred de Sam Lazaro

Malaria causes nearly half a million deaths worldwide every year. Ninety percent of them are in sub-Saharan Africa, where poor infrastructure limits delivery of drugs. But now there is worry that those drugs are losing effectiveness as disease strains become resistant. Special correspondent Fred de Sam Lazaro reports from Cambodia, where scientists are researching and tracking new outbreaks.

Rat was caught up in a surge in malaria that began in mid-2017, a year when infections nearly doubled to some 45,000. She contracted the mosquito-borne illness while working on a logging team deep in the forest.

Like Rat, the vast majority of cases respond to treatment. But scientists fear that it's in this remote area along the Thai border that they could lose the battle to contain the malaria parasite.

About a decade ago here in Cambodia, scientists began to see cases in which the deadliest form of the malaria parasite had mutated and become resistant to the last available drugs that could fight it. That resistant strain has since spread, with cases in Thailand and Southern Vietnam.

It raises the possibility of a resurgence of resistant malaria that scientists fear could spread far beyond Southeast Asia.

https://www.pbs.org/newshour/show/fight ... f-cambodia

April 21, 2019
Ministry targets eliminating malaria by 2025

During the upcoming celebration of National Malaria Day this year, the Health Ministry is targeting to eliminate the disease in the Kingdom by 2025.

One of the oldest threats to human health, malaria kills more than 400,000 people globally every year, and Cambodia joins hands with its neighbors in the Greater Mekong Sub-region to end malaria, said a joint statement by the Health Ministry and World Health Organization (WHO) issued on Friday.

It said that as one of the six countries that make up the Greater Mekong Sub-region, Cambodia continues to commit to eliminating malaria before 2030 through a call for action at the ministerial level throughout the Sub-region.

“In the last five years, the Sub-region has more than halved the number of malaria cases and reduced deaths by more than 80 percent. Cambodia has the ambitious target to eliminate all human malaria in its territory by 2025.” read the statement.

Dr Huy Rekol, Director of the National Centre for Parasitology, Entomology and Malaria Control, said that Cambodia had zero malaria-related deaths last year and the number of infections caused by Plasmodium falciparum, the deadliest type of malaria, decreased by almost 30 percent compared to 2017.

Dr Rekol noted that there were 65,114 cases of malaria last year, including about 10,000 cases of the falciparum variety.
https://www.khmertimeskh.com/50596489/m ... a-by-2025/

April 26, 2019
Goal to eliminate malaria faces hurdles: Report

Malaria Futures for Asia (MalaFA) on Tuesday said that “the last mile in malaria elimination in the region” is being threatened by a growing resistance to anti-malarial drugs and insecticides.

However, MalaFA also noted that the Kingdom’s current target to be malaria-free by 2025 is “believed to be within reach”.

The findings were released in a report in Bangkok during a panel discussion of international experts on progress made so far to eliminate the disease.

The report was made following feedback from anti-malaria programme directors, researchers and NGOs from Cambodia, India, Myanmar, Thailand and Vietnam.

The research was commissioned by Novartis Social Business to obtain the views of malaria experts in the South and Greater Mekong Sub-region, such as health officials, members of parliament, senior civil servants, heads of national malaria control programmes and representatives of academia and non-governmental organisations.
https://www.khmertimeskh.com/50598313/g ... -report-2/