Malaria molecular epidemiology current situation in Africa

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Background

In response to the decline in artemisinin efficacy in Southeast Asia in 2008, >65 publications representing approximately 28 African countries, highlighted PfK13 gene mutations were primarily wildtype. However, mutations associated with artemisinin resistance in SE Asia (R561H, P574L and A675V) have been reported at low frequency in East Africa, underscoring the urgent need for drug resistance monitoring. The identification of Pfhrp2/3 deletions, that render rapid diagnostic tests (RDTs) invalid, has in 14 studies across 11 African countries demonstrated a wide variation in the methods used to estimate the prevalence of Pfhrp2/3 deletions, ranging from 62% in Eritrea to the 0.4% in Angola. Molecular tools are still being examined to: more robustly track imported and local malaria parasite populations; determine the extent of parasite relatedness; and define variations in malaria transmission. All these molecular platforms should be integrated into National Malaria Control Programme malaria surveillance strategies.

Malaria molecular surveillance has gained traction across Africa with various research institutions providing useful national data, highlighting molecular markers of antimalarial or diagnostic resistance. Following the great success of COVID-19 genomic surveillance across Africa to track variants and inform policy decision making to control transmission, the capacity to conduct such analyses has been demonstrated and this is now important to roll out for endemic diseases, such as malaria. Malaria remains a significant burden in Africa and the COVID-19 pandemic exacerbated the situation further. Systems need to be established to support malaria control and surveillance activities and they should be available in-country to generate data and monitor parasite populations to determine the impact of interventions on disease burden. This research topic focuses on one tool kit, malaria molecular epidemiology, that has the potential to rapidly improve malaria surveillance strategies. The research topic aims to highlight malaria molecular epidemiology as an important tool for surveillance through current data from Africa where the burden of malaria is the highest and disease transmission is heterogeneous across sub-Saharan Africa.

This topic is relatively broad, but will primarily consider topics that do not relate to genomics for malaria elimination and is keen to compile a resource of malaria publications from across Africa on drug resistance, hrp2/3 surveillance and a description of tools for measuring COI that can assist the majority of sub-Saharan Africa who need to improve their molecular surveillance strategies.

The themes of interesting include:

i) antimalarial resistance surveillance

ii) hrp2/3 surveillance,

iii) complexity of infection as a measure of malaria transmission intensity

iv) the use of genomics to track malaria infections, such as imported versus local infections.

Keywords: malaria, genomic, antimalarial, hrp2/3 resistance, surveillance

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