Shoklo Malaria Research Unit (SMRU)

Significant  achievements at SMRU 2009-2014

smru_achievements
Drawing a blood sample at SMRU’s Maela refugee camp clinic (left) and TB patients at Wangpa

Malaria

  1. Documented the emergence of artemisinin resistant falciparum malaria on the Thai-Myanmar border, and showed that genetically determined artemisinin resistance in P. falciparum emerged along the Thailand–Myanmar border at least 8 years ago. Also documented the decline in the efficacy of mefloquine-artesunate, the first-line ACT in Thailand, and the contributions of the polymorphisms in Pfmdr1 and the Kelch propeller domain (K-13) to this decline, and contributed to the TRAC study
  2. Completed a phase II trial on the new antimalarial KAE609. This new compound of the spiroindolone family appears to be safe and is rapidly active against falciparum (and vivax). Additionally conducted Phase II studies on two other new antimalarials: OZ439(a synthetic trioxolane with inhibition of PfATP6) and KAF156
  3. Vivax malaria: Documented the emergence of resistance to chloroquine and improved the in vitro culture method. Defined the epidemiology of relapses and characterized the haemolytic risk associated with primaquine in G6PD deficient individuals. Characterised the different stages of reticulocytes isolated from cord blood and their susceptibility to invasion by P. vivax and studied the effect of drugs on P. vivax rosetting and deformability. Successfully infected hepatocyte lines with P. vivax sporozoites and produced “small forms” suspected to be hypnozoites
  4. Discovered a large sub-microscopic reservoir of healthy carriers using an ultra-sensitive qPCR assay and piloted the elimination studies by MDA in four Karen villages in Myanmar

Maternal & Child health

  1. Documented the effects of malaria on fetal growth and the effects of malaria in the first trimester of pregnancy: even a single episode of malaria was associated with fetal growth restriction; asymptomatic infections were associated with an increased risk of miscarriage and provided the most compelling detailed evidence to date of the lack of adverse effects from first trimester artemisinins
  2. Described the decline of maternal mortality in the border population and the contributing factors to the residual mortality, analyzing 27 year prospective cohort study
  3. Working with the Pharmacology Department to describe the pharmacokinetics of antimalarials in pregnancy, suggesting the need for dose adjustments (see above)
  4. Completed studies on respiratory infections and neonatal sepsis in infants and reduced the neonatal mortality. A S. pneumoniae carriage cohort study was completed in 2013 showing high carriage rates early in life and highlighted the importance of non-typable S. pneumoniae in the acquisition of resistance to antibiotics. A 2 year prospective birth cohort of 955 children born in Maela camp showed a high incidence of RSV infection, highlighting the need to diagnose correctly the cause of respiratory infections to reduce the unnecessary use of antibiotics

Others

  1. We initiated a programme of detection and treatment of tuberculosis, showing an MDR-TB rate of 25/275 (14%)
  2. A study on the causes of fever has been completed successfully in 1030 febrile patients, using molecular and serological testing. Apart from malaria the main causes of fever were dengue, leptospirosis and rickettsiosis