Increasing Prevalence of Artemisinin-Resistant HRP2-Negative Malaria in Eritrea

 This study investigated rising resistance to artemisinin in Plasmodium falciparum and increasing prevalence of HRP2-negative strains in Eritrea. From 2016 to 2019, drug-efficacy data revealed a growing proportion of patients with parasitemia persisting on day 3 after treatment. The Pfkelch13 R622I mutation, linked to partial artemisinin resistance was increasingly common and conferred low-level in vitro resistance. Additionally, HRP2/HRP3 gene deletions were present in a notable fraction of these resistant strains, potentially undermining rapid diagnostic tests. The findings highlight a concerning resistance hotspot in the Horn of Africa.

 This study investigated rising resistance to artemisinin in Plasmodium falciparum and increasing prevalence of HRP2-negative strains in Eritrea. From 2016 to 2019, drug-efficacy data revealed a growing proportion of patients with parasitemia persisting on day 3 after treatment. The Pfkelch13 R622I mutation, linked to partial artemisinin resistance was increasingly common and conferred low-level in vitro resistance. Additionally, HRP2/HRP3 gene deletions were present in a notable fraction of these resistant strains, potentially undermining rapid diagnostic tests. The findings highlight a concerning resistance hotspot in the Horn of Africa.