Prévalence des marqueurs moléculaires de résistance de Plasmodium falciparum à la Sulfadoxine-Pyriméthamine et à l’Amodiaquine au début de la chimioprévention du paludisme saisonnier au Togo
Abstract
Objectif: Déterminer la prévalence des marqueurs de résistance de P.falciparum à la Sulfadoxine-Pyriméthamine et à l’Amodiaquine au début de la mise en œuvre de la chimioprévention du paludisme saisonnier (CPS) au Togo. Méthodes: Une enquête transversale conduite dans la région des Savanes, zone éligible, et dans une zone témoin hors de la zone éligible, a porté sur des enfants âgés de 3 à 59 mois, symptomatiques ou non, résidant depuis plus de 6 mois dans les localités tirées. L’analyse moléculaire a recherché les mutations sur les codons 51, 59 et 108 de Pfdhfr, et 437 et 540 de Pfdhps pour la sulfadoxine-pyriméthamine ; ainsi que les mutations sur le codon 76 de Pfcrt et 86 de Pfmdr1 pour l’amodiaquine. Résultats: La prévalence de l’allèle triple mutant Pfdhfr était élevée avec 86,4% en zone CPS et 77,9% en zone non-CPS avec une différence significative (p=0,008). La prévalence de la mutation 437G Pfdhps était élevée dans les deux zones (83,2% et 78,2%). Par contre, celle de la mutation 540E était faible (1,8% et 4,3%). La prévalence de l’allèle double mutant Pfdhps en a été impacté avec 1,4% et 4,3%, et une différence significative (p=0,04). Les prévalences des mutations sur Pfcrt et Pfmdr1 étaient inférieures à la moyenne en Afrique. Conclusion: L’utilisation de sulfadoxine-pyriméthamine et amodiaquine pour la CPS n’était pas compromise. Des données de base de la surveillance moléculaire de la résistance de P.falciparum aux antipaludiques au Togo sont disponibles.
Objective: To determine the prevalence of P.falciparum resistance markers to Sulfadoxine-Pyrimethamine and Amodiaquine at the start of the implementation of seasonal malaria chemoprevention (SMC) in Togo. Methods: A cross-sectional survey conducted in the Savanes region, an eligible area, and in a control area outside the eligible area, focused on children aged 3 to 59 months, symptomatic or not, residing for more than 6 months in the selected localities. Molecular analysis was performed to screen for mutations at codons 51, 59, and 108 of Pfdhfr, and 437 and 540 of Pfdhps for sulfadoxine-pyrimethamine; as well as mutations at codon 76 of Pfcrt and codon 86 of Pfmdr1 for amodiaquine. Results: Triple mutant Pfdhfr allele prevalence was high, 86.4% in SMC area and 77.9% in the non-SMC area, with a significant difference (p=0.008). Prevalence of 437G Pfdhps mutation was high in both areas (83.2% and 78.2%). In contrast, prevalence of 540E mutation was low (1.8% and 4.3%). Double mutant Pfdhps allele prevalence was impacted by this, 1.4% and 4.3%, with a significant difference (p=0.04). Prevalence of mutations in Pfcrt and Pfmdr1 was lower than the average observed in Africa. Conclusion: The use of sulfadoxine-pyrimethamine and amodiaquine for SMC was not compromised. Baseline data from molecular surveillance of P. falciparum resistance to antimalarial drugs in Togo are available.
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