Thu A. M. auteur aut IRD Phyo A. P. auteur aut IRD Pateekhum C. auteur aut IRD Rae J. D. auteur aut IRD Landier Jordi auteur aut IRD Parker D. M. auteur aut IRD Delmas G. auteur aut IRD Watthanaworawit W. auteur aut IRD McLean A. R. D. auteur aut IRD Arya A. auteur aut IRD Reyes A. auteur aut IRD Li X. auteur aut IRD Miotto O. auteur aut IRD Soe K. auteur aut IRD Ashley E. A. auteur aut IRD Dondorp A. auteur aut IRD White N. J. auteur aut IRD Day N. P. auteur aut IRD Anderson T. J. C. auteur aut IRD Imwong M. auteur aut IRD Nosten F. auteur aut IRD Smithuis F. auteur aut IRD text journalArticle eng text/pdf reformatted digital access Background Artemisinin resistance in Plasmodium falciparum threatens global malaria elimination efforts. To contain and then eliminate artemisinin resistance in Eastern Myanmar a network of community-based malaria posts was instituted and targeted mass drug administration (MDA) with dihydroartemisinin-piperaquine (three rounds at monthly intervals) was conducted. The prevalence of artemisinin resistance during the elimination campaign (2013-2019) was characterized. Methods Throughout the six-year campaign Plasmodium falciparum positive blood samples from symptomatic patients and from cross-sectional surveys were genotyped for mutations in kelch-13-a molecular marker of artemisinin resistance. Result The program resulted in near elimination of falciparum malaria. Of 5162 P. falciparum positive blood samples genotyped, 3281 (63.6%) had K13 mutations. The prevalence of K13 mutations was 73.9% in 2013 and 64.4% in 2019. Overall, there was a small but significant decline in the proportion of K13 mutants (p < 0.001). In the MDA villages there was no significant change in the K13 proportions before and after MDA. The distribution of different K13 mutations changed substantially; F446I and P441L mutations increased in both MDA and non-MDA villages, while most other K13 mutations decreased. The proportion of C580Y mutations fell from 9.2% (43/467) before MDA to 2.3% (19/813) after MDA (p < 0.001). Similar changes occurred in the 487 villages where MDA was not conducted. Conclusion The malaria elimination program in Kayin state, eastern Myanmar, led to a substantial reduction in falciparum malaria. Despite the intense use of artemisinin-based combination therapies, both in treatment and MDA, this did not select for artemisinin resistance. specialized P. falciparum Mass drug administration Kelch13 Artemisinin resistance Malaria elimination MYANMAR 052 050 23 1 138 [11 p.] 2024 https://www.documentation.ird.fr/hor/fdi:010090641 10.1186/s12936-024-04955-6 [F B010090641] https://www.documentation.ird.fr/hor/fdi:010090641 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2024-06/010090641.pdf IRD - Base Horizon / Pleins textes 2024-06-12 2025-11-06 fdi:010090641 fre