Artemisinin resistance in falciparum malaria has emerged in western Cambodia. Chloroquine resistance arose in exactly the same place 50 years ago, spread to Africa, and killed millions of children. Resistance to sulfadoxine-pyrimethamine (the antimalarial combination that followed chloroquine) in Africa can be traced to the same origin.The parallels are chilling. If artemisinin resistance spreads widely, it will derail current initiatives to control and eliminate malaria. The consequences will be disastrous. The only way to ensure the rest of the tropical world does not become infected might be to eliminate falciparum malaria in western Cambodia, at least temporarily. That is easier said than done. But, from a malaria perspective, western Cambodia is a land island, geographically separated from other malarious areas, so there are some reasons for optimism. Since news of artemisinin resistance broke 4 years ago, epidemiological, clinical, parasitological, and behavioural research has been done, there has been significant strengthening of malaria-control activities on both sides of the Thai-Cambodian border, and active surveillance has been conducted in some areas. Is this going to eliminate the problem? Will it prevent spread of artemisinin-resistant parasites westward to India and Africa? No-one knows.
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