GenRe-Mekong (Genetic Reconnaissance of Malaria in the Greater Mekong Subregion) is a genetic surveillance project, aiming to provide National Malaria Control Programmes (NMCPs) in the Greater Mekong Subregion and other public health stakeholders with timely and actionable knowledge to support their decision-making in activities relevant to malaria elimination efforts.
In the Greater Mekong Subregion (GMS, comprising Cambodia, Vietnam, Laos, Thailand, Myanmar and parts of China), National Malaria Control Programs (NMCPs) are called upon to take difficult policy decisions in the face of a rapidly changing epidemiological landscape. These decisions include: assessing treatment efficacy, reviewing frontline drug policies, assessing the effectiveness of targeted interventions, identifying transmission hubs to target, and monitoring imported cases. To support their decision-making, NMCPs make use of clinical and epidemiological data, as well as results of therapeutic efficacy studies. GenRe-Mekong adds to this evidence base by providing comprehensive genetic information about the parasite populations.
GenRe-Mekong analyzes small dried blood spots samples, collected using a simple standardised operating procedure that is easy to implement at public health sites, even in resource-constrained endemic regions. Samples are processed by the SpotMalaria genotyping platform, which leverages on leading-edge high-throughput technologies to extract large amounts of parasite genetic information from each sample. The results are captured in Genetic Report Cards (GRCs), datasets regularly delivered to NMCPs to keep them abreast of rapid epidemiological changes. The underlying technological platform is designed to keep sample processing costs low, enabling large-scale genetic epidemiology survey with dense geographical coverage and large sample sizes.
The most urgent problem faced by NMCPs in the GMS is the rapid emergence and spread of strains resistance to antimalarial drugs. Accordingly, GenRe-Mekong has focussed in its first phase on use cases relevant to drug resistance, by genotyping variants known to be associated with resistance to several antimalarials. To facilitate integration into NMCP decision-making workflows, our analysis pipelines translate genotypes associated with drug resistance into phenotype predictions, producing maps which can be more easily interpreted by public health officials.
GenRe-Mekong protects individual patient privacy, but encourages aggregation and sharing of standardized data across national borders, to answer regional questions about epidemiology, gene flow and parasite evolution. To maximize benefits to the research community, GenRe-Mekong also conducts whole-genome sequencing of selected high-quality samples, which are contributed to the MalariaGEN Plasmodium falciparum Community Project to support high-resolution genetic epidemiology analyses of population structure, gene flow and association with phenotypes.
For in-depth details of the project, please refer to the preprint of the first GenRe-Mekong publication.
We use ‘Genetic Report Cards‘ to provide information on genetic variation relevant to drug resistance for each sample. Currently, we report on genetic variations that are relevant to resistance to several antimalarial drugs:
- artemisinin (kelch13, arps10, mdr2, fd, crt genes)
- piperaquine (plasmepsin2-3, exo)
- chloroquine, amodiaquine, mefloquine (crt, mdr1)
- sulfadoxine, pyrimethamine (dhfr, dhps)
In addition, we report on other genetic variations relevant to parasite epidemiology:
- Detection of additional species of Plasmodium in a P. falciparum infection, such as P. vivax, P. knowlesi, P. malariae, P. ovale
- Genetic barcodes (101 high-diversity SNPs across the genome), used to estimate complexity of infection (COI), identify expanding strains and reconstruct the geographic origins of samples.
GenRe-Mekong is funded by the Bill & Melinda Gates Foundation.
Bangladesh, Cambodia, India, Laos, Myanmar, Thailand, Vietnam.
We routinely release genotype data to our partner studies; in addition, we periodically release public access datasets. This is the first public release of the GenRe-Mekong v1.0 data set and samples from this collection contribute to the P. falciparum community project data release
The DBS collection protocol for GenRe-Mekong is available in parasite partner study resources.
Additionally, video guides specific to GenRe-Mekong sample collection are available with subtitles in English.
- A Thai subtitled video guide to GenRe-Mekong 2 dot collection of DBS
- A Vietnamese subtitled video guide to GenRe-Mekong 2 dot collection of DBS
- A video guide to GenRe-Mekong 2 dot collection of DBS
- A video guide to GenRe-Mekong 3 dot collection of DBS
To date, GenRe-Mekong has worked with NMCPs in seven countries (Lao PDR, Vietnam, Cambodia, Myanmar, Thailand India and Bangladesh), and supported large-scale multisite research and elimination projects across the region.
Partner study description Plasmodium falciparum resistance to artemisinin derivatives emerged on the Thai Myanmar border between 2000 and 2010. The Shoklo Malaria Research Unit (SMRU) has collected phenotypic data on more than 3,000…
This study measured population movement by travel surveys and mobile phone call record data and combined these with parasite genotype data and malaria incidence to examine the role of population movement on the…
Investigating clinical and molecular aspects of resistance to artemisinin and ACT partner drugs, in particular piperaquine.
Targeted Malaria Elimination (TME) studies took place in western Myanmar, Vietnam, Cambodia, and Laos during 2013-17, led by the Mahidol-Oxford Tropical Medicine Research Unit. This project consisted of 2 stages. Firstly, multiple malaria…
A multi-centre, open-label randomized trial to assess the efficacy, safety and tolerability of Triple Artemisinin-based Combination Therapies (TACTs) compared to Artemisinin-based Combination Therapies (ACTs) in uncomplicated falciparum malaria and to map the geographical…
Routine monitoring of the efficacy of anti-malarial drugs used is necessary for effective case management, early detection of drug resistance and to provide background information for the development and evaluation of drug policies.…
The objectives of this programme were to scale-up the targeted mass drug administration strategy regionally, and measure its effect on the incidence of clinical malaria in eastern Karen/Kayin state, Myanmar, a difficult-to-access hilly…
Genetic surveillance project conducted by the National Malaria Control Programme in partnership with GenRe-Mekong in endemic regions of Cambodia. This is part of a large project of genetic surveillance of malaria in the…
Genetic surveillance project conducted by the National Malaria Control Programme in partnership with GenRe-Mekong in endemic region of the Lao PDR. This is part of a large project of genetic surveillance of malaria…
Genetic surveillance project conducted by the National Malaria Control Programme in partnership with GenRe-Mekong in endemic region of Vietnam. This is part of a large project of genetic surveillance of malaria in the…
This study aimed to determine risk factors for catching malaria in northeast Thailand, including travel, to identify where people were likely being infected and determine how much antimalarial drug resistance there is.
Genetic surveillance project conducted by the National Malaria Control Programme in partnership with GenRe-Mekong in endemic regions of Vietnam. The study aimed to determine risk factors for catching malaria in high endemic areas…
Given the emergence of Plasmodium falciparum (Pf) artemisinin resistance Médecins sans Frontières launched in May 2014 a research programme in Chey Saen district (Cambodia), aimed at preventing its spread. The activities of passive…
- Genetic Epidemiology Use Cases for Malaria Control Programmes: A MethodologyOlivo Miotto, Principal Investigator, GenRe-Mekong ProjectGenetic Epidemiology Use Cases for Malaria Control Programmes: A Methodology, 2023;
- Pf7: An open dataset of Plasmodium falciparum genome variation in 20,000 worldwide samplesMalariaGEN et. alWellcome Open Research, 2023; 8 22
- Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion: an observational studyImwong et alThe Lancet Infectious Diseases, 2020; 20(12) 1470-1480
- Genetic surveillance in the Greater Mekong Subregion and South Asia to support malaria control and elimination: about the dataJacob CG, Thuy-Nhien N, Mayxay M, et al.eLife, 2021; 10:e62997
- Mass drug administration for the acceleration of malaria elimination in a region of Myanmar with artemisinin-resistant falciparum malaria: a cluster-randomised trialMcLean ARD et alThe Lancet Infectious Diseases, 2021; 21 1579
- Mapping the travel patterns of people with malaria in BangladeshSinha et al.BMC Medicine, 2020; 18(1) 45
- Mass drug administrations with dihydroartemisinin-piperaquine and single low dose primaquine to eliminate Plasmodium falciparum have only a transient impact on Plasmodium vivax: Findings from randomised controlled trialsPhommasone K et al.PloS One, 2020; 15 e0228190
- Intracluster correlation coefficients in the Greater Mekong Subregion for sample size calculations of cluster randomized malaria trialsPeerawaranun P et al.Intracluster correlation coefficients in the Greater Mekong Subregion for sample size calculations of cluster randomized malaria trials, 2019; 18 428
- Mapping imported malaria in Bangladesh using parasite genetic and human mobility dataChang et al.eLife, 2019; 8 e43481
- The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia: A cluster randomised trialvon Seidlein L et alPLOS Medicine, 2019; 16 e1002745
- Safety and effectiveness of mass drug administration to accelerate elimination of artemisinin-resistant falciparum malaria: A pilot trial in four villages of Eastern MyanmarLandier J et alWellcome Open Research, 2017; 2 81
- Persistent Plasmodium falciparum and Plasmodium vivax infections in a western Cambodian population: implications for prevention, treatment and elimination strategiesTripura R et al.Persistent Plasmodium falciparum and Plasmodium vivax infections in a western Cambodian population: implications for prevention, treatment and elimination strategies, 2016; 15 181
We are working with partners to ensure that the list of people associated with a partner study is up-to-date. People involved in this project include:
- Keobouphaphone Chindavongsa
- Prof Nicholas Day
- Prof Arjen Dondorp
- Dr Rick Fairhurst
- Dr Borimas Hanboonkunupakarn
- Prof Tran Tinh Hien
- Mallika Imwong
- Dr Rapeephan Maude
- Prof Richard Maude
- Assoc Prof Mayfong Mayxay
- Olivo Miotto
- Dr Thuy‐Nhien Nguyen
- Prof Francois Nosten
- Tom Peto
- Huynh Hong Quang
- Ngo Viet Thanh
- Tuyen Nguyen Thi Kim
- Aung Myint Thu
- Rupam Tripura
- Rob van der Pluijm
- Lorenz von Seidlein
- Dr Thomas E Wellems
- Prof Nicholas J White