Influx of diverse, drug resistant and transmissible Plasmodium falciparum into a malaria-free setting in Qatar

Al-Rumhi, A., Al-Hashami, Z., Al-Hamidhi, S., Gadalla, A., Naeem, R., Ranford-Cartwright, L. , Pain, A., Sultan, A. A. and Babiker, H. A. (2020) Influx of diverse, drug resistant and transmissible Plasmodium falciparum into a malaria-free setting in Qatar. BMC Infectious Diseases, 20, 413. (doi: 10.1186/s12879-020-05111-6) (PMID:32539801) (PMCID:PMC7296620)

Abstract

Background: Successful control programs have impeded local malaria transmission in almost all Gulf Cooperation Council (GCC) countries: Qatar, Bahrain, Kuwait, Oman, the United Arab Emirates (UAE) and Saudi Arabia. Nevertheless, a prodigious influx of imported malaria via migrant workers sustains the threat of local transmission. Here we examine the origin of imported malaria in Qatar, assess genetic diversity and the prevalence of drug resistance genes in imported Plasmodium falciparum, and finally, address the potential for the reintroduction of local transmission. Methods: This study examined imported malaria cases reported in Qatar, between 2013 and 2016. We focused on P. falciparum infections and estimated both total parasite and gametocyte density, using qPCR and qRT-PCR, respectively. We also examined ten neutral microsatellites and four genes associated with drug resistance, Pfmrp1, Pfcrt, Pfmdr1, and Pfkelch13, to assess the genetic diversity of imported P. falciparum strains, and the potential for propagating drug resistance genotypes respectively. Results: The majority of imported malaria cases were P. vivax, while P. falciparum and mixed species infections (P. falciparum / P. vivax) were less frequent. The primary origin of P. vivax infection was the Indian subcontinent, while P. falciparum was mostly presented by African expatriates. Imported P. falciparum strains were highly diverse, carrying multiple genotypes, and infections also presented with early- and late-stage gametocytes. We observed a high prevalence of mutations implicated in drug resistance among these strains, including novel SNPs in Pfkelch13. Conclusions: The influx of genetically diverse P. falciparum, with multiple drug resistance markers and a high capacity for gametocyte production, represents a threat for the reestablishment of drug-resistant malaria into GCC countries. This scenario highlights the impact of mass international migration on the reintroduction of malaria to areas with absent or limited local transmission.

• Item Type: Articles
• Additional Information: This publication was made possible by Sultan Qaboos University, Oman (Studentship for AR), and NPRP grant [NPRP 5–098 - 3 – 021] from the Qatar National Research Fund (a member of Qatar Foundation). The work was also funded through International Atomic Energy Agency (IAEA) grant OMA/6/006, and King Abdullah University of Science and Technology (KAUST) grant BAS/1/1020-01-01 (to AP).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ranford-Cartwright, Dr Lisa
• Authors: Al-Rumhi, A., Al-Hashami, Z., Al-Hamidhi, S., Gadalla, A., Naeem, R., Ranford-Cartwright, L., Pain, A., Sultan, A. A., and Babiker, H. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
• Journal Name: BMC Infectious Diseases
• Publisher: BioMed Central
• ISSN: 1471-2334
• ISSN (Online): 1471-2334
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMC Infectious Diseases 20: 43
• Publisher Policy: Reproduced under a Creative Commons License