TY - JOUR AU - Leslie, Toby AU - Kaur, Harpakash AU - Mohammed, Nasir AU - Kolaczinski, Kate AU - Ord, Rosalynn L. AU - Rowland, Mark T1 - Epidemic of Plasmodium falciparum Malaria Involving Substandard Antimalarial Drugs, Pakistan, 2003 T2 - Emerging Infectious Disease journal PY - 2009 VL - 15 IS - 11 SP - 1753 SN - 1080-6059 AB - Because of instability in eastern Afghanistan, new refugees crossed into the federally administered tribal areas of northwestern Pakistan in 2002. In 2003, we investigated an epidemic of Plasmodium falciparum malaria in 1 of the camps. Incidence was 100.4 cases/1,000 person-years; in other nearby camps it was only 2.1/1,000 person-years. Anopheline mosquitoes were found despite an earlier spray campaign. Documented clinical failures at the basic health unit prompted a drug resistance survey of locally manufactured sulfadoxine-pyrimethamine used for routine treatment. The in vivo failure rate was 28.5%. PCR analysis of the P. falciparum dihydrofolate reductase and dihyropteroate synthase genes showed no mutations associated with clinical failure. However, chemical analysis of the drug showed that it was substandard. As global incidence decreases and epidemics become more of a threat, enhanced quality assurance of control interventions is essential. KW - Malaria KW - epidemic KW - parasites KW - antimalarial drugs KW - Plasmodium falciparum KW - refugees KW - Pakistan KW - Afghanistan KW - vector-borne infections KW - research DO - 10.3201/eid1511.090886 UR - https://wwwnc.cdc.gov/eid/article/15/11/09-0886_article ER - End of Reference