Molecular epidemiology of P. vivax: Monitoring parasite transmission and drug resistance in the Asia-Pacific region

The overarching goal of the proposal is to use molecular information on Plasmodium to monitor antimalarial drug resistance, and how parasites adapt to public health interventions and spread within and across national borders. The focus will be on Plasmodium vivax but integrated within ongoing projects with other Plasmodia causing human infection.

P. vivax is a major public health burden in the Asia-Pacific region, causing up to 200 million cases of malaria per year. P. vivax is far more resilient to intervention than P. falciparum, and has greater capacity for resurgence in low and formerly endemic regions. Antimalarial resistance is spreading with the epicenter of chloroquine resistant P. vivax in our northern neighbors on the Island of Papua. New tools are needed to help track the adaptation and spread of parasites, in particular antimalarial drug resistance, so that control programs can be optimized to contain infection rapidly and effectively.

The proposed project will make use of a unique repository of genomic data on up to 1,200 P. vivax parasites with a global geographic spectrum including samples with antimalarial drug resistance phenotypes. Bioinformatic approaches will be used to explore the genomic data to identify small subsets of molecular surveillance markers that will allow high-throughput processing of patient samples to determine antimalarial drug resistance, imported infection, superinfection (where patients have evidence of being multiply infected), and persistence of strains both within individuals and communities.

Given that P. vivax is a global burden, often inflicting highly mobile human populations, the genetic data generated at the surveillance markers will have greatest strength through data sharing between countries. To promote this capacity, an open access, online data repository will be established to facilitate data sharing and exploration.