title: Molecular surveillance of artemisinin resistance falciparum malaria among migrant goldmine workers in Myanmar.
abstract: Artemisinin resistance has been reported in Greater Mekong Sub-region countries, including Myanmar. After discovery of artemisinin resistance marker (K13), molecular surveillance on artemisinin resistance in endemic regions have been conducted. As the migrant population represents a high percentage of malaria cases, molecular surveillance of artemisinin resistance among migrant workers is of great concern.
  
  
  
  A cross-sectional survey was conducted in Shwegyin Township, where migrants work in the goldmines. Blood samples were collected from uncomplicated Plasmodium falciparum-infected migrant workers by active and passive cases screening with rapid diagnostic testing (RDT) and microscopy. Amplification and sequence analysis of artemisinin resistance molecular markers, such as k13, pfarps10, pffd, pfmdr2, pfmrp1, pfrad5, and pfcnbp, were carried out and pfmdr1 copy number analysis was conducted by real-time PCR.
  
  
  
  Among the 100 falciparum-infected patients, most were male (90%), of working age (20-40 years) with median parasite density of 11,166 parasites/µL (range 270-110,472 parasites/µL). Artemisinin resistance molecular marker, k13 mutations were detected in (21/100, 21.0%) in which composed of a validated marker, C580Y (9/21, 42.9%) and candidate markers such as P574L (5/21, 23.8%), P667T (5/21, 23.8%) and M476I (2/21, 9.5%). Underlying genetic markers predisposing to become k13 mutants were found as V127M of pfarps10 (41/100, 41.0%), D153Y of pffd (64/100, 64.0%), T484I of pfmdr2 (58/100, 58.0%) and F1390I of pfmrp1 (24/100, 24.0%). The pfmdr1 copy number analysis revealed six copy numbers (1/100, 1.0%), three (2/100, 2.0%), two (8/100, 8.0%) and only one copy number (89/100, 89.0%). Only one sample showed both k13 mutation (P667T) and multiple copy number of pfmdr1.
  
  
  
  High mutant rate of artemisinin resistance markers and relatively high pfmdr1 copy number among isolates collected from migrant goldmine workers alert the importance of containment measures among this target population. Clinical and molecular surveillance of artemisinin resistance among migrants should be scaled up.
authors.affiliation: Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.|Department of Medical Research, Yangon, Myanmar.
authors.forename: Myat Htut
authors.initials: MH
authors.lastname: Nyunt
authors.affiliation: Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.|Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Anhui, People's Republic of China.
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Medical Research, Yangon, Myanmar.
authors.forename: Khin Myo
authors.initials: KM
authors.lastname: Aye
authors.affiliation: Department of Medical Research, Yangon, Myanmar.
authors.forename: Kyin Hla
authors.initials: KH
authors.lastname: Aye
authors.affiliation: Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.
authors.forename: Jin-Hee
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.
authors.forename: Seong-Kyun
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Medical Research, Yangon, Myanmar.
authors.forename: Kay Thwe
authors.initials: KT
authors.lastname: Han
authors.affiliation: Department of Medical Research, Yangon, Myanmar.
authors.forename: Ye
authors.initials: Y
authors.lastname: Htut
authors.affiliation: Department of Medical Environmental Biology and Tropical Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea. etaekhan@gmail.com.
authors.forename: Eun-Taek
authors.initials: ET
authors.lastname: Han
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use; D037621:Artemisinins / Q000494:pharmacology* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004351:Drug Resistance / Q000235:genetics*; D005260:Female; D005819:Genetic Markers / Q000235:genetics; D006046:Gold; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000469:parasitology*; D008297:Male; D000067572:Miners / Q000706:statistics & numerical data*; D008906:Mining; D002052:Myanmar; D010963:Plasmodium falciparum / Q000187:drug effects*; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D005819:Genetic Markers; D006046:Gold; C031327:artemisinin
keywords: Artemisinin resistance; Malaria; Migrant; Molecular surveillance; Myanmar