The dangerous form of the malaria parasite which cannot be killed with the main anti-malaria drugs emerged in Cambodia but has since spread through parts of Thailand, Laos and has arrived in southern Vietnam.
Researchers at Oxford Tropical Medicine Research Unit in Bangkok in a letter, published in The Lancet Infectious Diseases, detail the "recent sinister development" that has seen resistance to the drug artemisinin emerge.
The first choice treatment for malaria is artemisinin in combination with piperaquine. But as artemisinin has become less effective, the parasite has now evolved to resist piperaquine too, researchers said.
There have now been alarming rates of failure. The treatment was failing around a third of the time in Vietnam while in some regions of Cambodia the failure rate was closer to 60 per cent, Dondorp said.
About 212 million people are infected with malaria each year. It is caused by a parasite that is spread by blood- sucking mosquitoes and is a major killer of children.
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