title: Malaria transmission intensity and the rate of spread of chloroquine resistant Plasmodium falciparum: Why have theoretical models generated conflicting results?
abstract: The rate at which falciparum resistant malaria spreads in different transmission settings is still a controversial subject. We have assessed the spread of mutant Plasmodium falciparum parasites in six Ugandan populations with varying prevalence of chloroquine resistance (CQR), malaria transmission intensity, multiplicity of parasite clones and prevalence of CQ use. For each population, we have determined the wild and mutant allele frequency at codons 76 and 86 of the pfcrt and pfmdr1 genes, respectively. The highest frequency (median = 16.3%, range: 0.0-70.4%) of infections with two pure mutants (no wild genotype in either gene), adjusted for clone multiplicity, was observed at the extremes of malaria transmission intensity. The wild/mutant (W/M) allele ratio (an index for tracking the progression of CQR) was less than one in all sites (median = 0.51, range: 0.09-0.98) for the pfcrt-76 gene, while it was greater than one in two of six sites (median = 0.75, range: 0.4-1.6) for the pfmdr1-86 gene, suggesting that the pfcrt-76 mutants were the predominant parasites at all sites. Furthermore, the pfmdr1-86 W/M allele ratio was consistently higher than that of the pfcrt-76. The spread of mutations linked to CQR in P. falciparum commences with the pfcrt-76 gene mutations, followed later by the pfmdr1-86 gene mutations that modulate higher CQR. Such spread occurs faster at the extremes of the transmission spectrum and could explain why mathematical models have previously generated conflicting results with respect to malaria transmission intensity and spread of CQR.
authors.affiliation: Ministry of Health, Epidemiological Surveillance Division, PO Box 7272, Kampala, Uganda. atalisuna@yahoo.com
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Talisuna
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.forename: Sagarika
authors.initials: S
authors.lastname: Samarasinghe
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Overmeir
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000483:Alleles; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology; D002738:Chloroquine / Q000494:pharmacology*; D003062:Codon; D004351:Drug Resistance; D019143:Evolution, Molecular; D005787:Gene Frequency; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D008962:Models, Theoretical; D009154:Mutation; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics; D015995:Prevalence; D015800:Protozoan Proteins / Q000235:genetics; D012189:Retrospective Studies; D012424:Rural Population; D013383:Suburban Population; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D003062:Codon; D015800:Protozoan Proteins; D002738:Chloroquine