Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.

Despite the clear public health benefit of insecticide-treated bednets (ITNs), the impact of malaria transmission-reduction by vector control on the spread of drug resistance is not well understood. In the present study, the effect of sustained transmission reduction by ITNs on the prevalence of Pla...

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Autores principales:	Monica Shah, Simon Kariuki, Jodi Vanden Eng, Anna J Blackstock, Kimberly Garner, Wangeci Gatei, John E Gimnig, Kim Lindblade, Dianne Terlouw, Feiko ter Kuile, William A Hawley, Penelope Phillips-Howard, Bernard Nahlen, Edward Walker, Mary J Hamel, Laurence Slutsker, Ya Ping Shi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/04317cb2012848a396d6180229bcac00
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spelling	oai:doaj.org-article:04317cb2012848a396d6180229bcac002021-11-18T07:34:32ZEffect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.1932-620310.1371/journal.pone.0026746https://doaj.org/article/04317cb2012848a396d6180229bcac002011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22096496/?tool=EBIhttps://doaj.org/toc/1932-6203Despite the clear public health benefit of insecticide-treated bednets (ITNs), the impact of malaria transmission-reduction by vector control on the spread of drug resistance is not well understood. In the present study, the effect of sustained transmission reduction by ITNs on the prevalence of Plasmodium falciparum gene mutations associated with resistance to the antimalarial drugs sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) in children under the age of five years was investigated during an ITN trial in Asembo area, western Kenya. During the ITN trial, the national first line antimalarial treatment changed from CQ to SP. Smear-positive samples collected from cross sectional surveys prior to ITN introduction (baseline, n = 250) and five years post-ITN intervention (year 5 survey, n = 242) were genotyped for single nucleotide polymorphisms (SNPs) at dhfr-51, 59, 108, 164 and dhps-437, 540 (SP resistance), and pfcrt-76 and pfmdr1-86 (CQ resistance). The association between the drug resistance mutations and epidemiological variables was evaluated. There were significant increases in the prevalence of SP dhps mutations and the dhfr/dhps quintuple mutant, and a significant reduction in the proportion of mixed infections detected at dhfr-51, 59 and dhps-437, 540 SNPs from baseline to the year 5 survey. There was no change in the high prevalence of pfcrt-76 and pfmdr1-86 mutations. Multivariable regression analysis further showed that current antifolate use and year of survey were significantly associated with more SP drug resistance mutations. These results suggest that increased antifolate drug use due to drug policy change likely led to the high prevalence of SP mutations 5 years post-ITN intervention and reduced transmission had no apparent effect on the existing high prevalence of CQ mutations. There is no evidence from the current study that sustained transmission reduction by ITNs reduces the prevalence of genes associated with malaria drug resistance.Monica ShahSimon KariukiJodi Vanden EngAnna J BlackstockKimberly GarnerWangeci GateiJohn E GimnigKim LindbladeDianne TerlouwFeiko ter KuileWilliam A HawleyPenelope Phillips-HowardBernard NahlenEdward WalkerMary J HamelLaurence SlutskerYa Ping ShiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 11, p e26746 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Monica Shah Simon Kariuki Jodi Vanden Eng Anna J Blackstock Kimberly Garner Wangeci Gatei John E Gimnig Kim Lindblade Dianne Terlouw Feiko ter Kuile William A Hawley Penelope Phillips-Howard Bernard Nahlen Edward Walker Mary J Hamel Laurence Slutsker Ya Ping Shi Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
description	Despite the clear public health benefit of insecticide-treated bednets (ITNs), the impact of malaria transmission-reduction by vector control on the spread of drug resistance is not well understood. In the present study, the effect of sustained transmission reduction by ITNs on the prevalence of Plasmodium falciparum gene mutations associated with resistance to the antimalarial drugs sulfadoxine-pyrimethamine (SP) and chloroquine (CQ) in children under the age of five years was investigated during an ITN trial in Asembo area, western Kenya. During the ITN trial, the national first line antimalarial treatment changed from CQ to SP. Smear-positive samples collected from cross sectional surveys prior to ITN introduction (baseline, n = 250) and five years post-ITN intervention (year 5 survey, n = 242) were genotyped for single nucleotide polymorphisms (SNPs) at dhfr-51, 59, 108, 164 and dhps-437, 540 (SP resistance), and pfcrt-76 and pfmdr1-86 (CQ resistance). The association between the drug resistance mutations and epidemiological variables was evaluated. There were significant increases in the prevalence of SP dhps mutations and the dhfr/dhps quintuple mutant, and a significant reduction in the proportion of mixed infections detected at dhfr-51, 59 and dhps-437, 540 SNPs from baseline to the year 5 survey. There was no change in the high prevalence of pfcrt-76 and pfmdr1-86 mutations. Multivariable regression analysis further showed that current antifolate use and year of survey were significantly associated with more SP drug resistance mutations. These results suggest that increased antifolate drug use due to drug policy change likely led to the high prevalence of SP mutations 5 years post-ITN intervention and reduced transmission had no apparent effect on the existing high prevalence of CQ mutations. There is no evidence from the current study that sustained transmission reduction by ITNs reduces the prevalence of genes associated with malaria drug resistance.
format	article
author	Monica Shah Simon Kariuki Jodi Vanden Eng Anna J Blackstock Kimberly Garner Wangeci Gatei John E Gimnig Kim Lindblade Dianne Terlouw Feiko ter Kuile William A Hawley Penelope Phillips-Howard Bernard Nahlen Edward Walker Mary J Hamel Laurence Slutsker Ya Ping Shi
author_facet	Monica Shah Simon Kariuki Jodi Vanden Eng Anna J Blackstock Kimberly Garner Wangeci Gatei John E Gimnig Kim Lindblade Dianne Terlouw Feiko ter Kuile William A Hawley Penelope Phillips-Howard Bernard Nahlen Edward Walker Mary J Hamel Laurence Slutsker Ya Ping Shi
author_sort	Monica Shah
title	Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
title_short	Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
title_full	Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
title_fullStr	Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
title_full_unstemmed	Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.
title_sort	effect of transmission reduction by insecticide-treated bednets (itns) on antimalarial drug resistance in western kenya.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/04317cb2012848a396d6180229bcac00
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Effect of transmission reduction by insecticide-treated bednets (ITNs) on antimalarial drug resistance in western Kenya.

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