{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:54:13Z","timestamp":1790920453551,"version":"4.1.0"},"reference-count":148,"publisher":"American Society of Tropical Medicine and Hygiene","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,19]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The elimination of\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    malaria in Eswatini remains elusive because of ongoing importation and sustained local transmission. The current status of antimalarial and diagnostic resistance in the country remains unknown. Genomic surveillance can complement routine surveillance by characterizing the prevalence and distribution of resistance markers and revealing granular patterns of transmission. Between March and December 2023, dried blood spots, demographic data, and travel history were collected from individuals who tested positive for malaria on a rapid diagnostic test (RDT) and from symptomatic RDT-negative individuals across Eswatini. Multiplexed amplicon deep sequencing was used to genotype 12 genes associated with antimalarial resistance, detect histidine-rich protein (\n                    <jats:italic>hrp<\/jats:italic>\n                    )\n                    <jats:italic>2<\/jats:italic>\n                    \/\n                    <jats:italic>3<\/jats:italic>\n                    deletions, estimate genetic relatedness, and detect non-\n                    <jats:italic>falciparum<\/jats:italic>\n                    species. Data from 437 samples revealed significant clustering of parasites carrying resistance markers. A validated marker of artemisinin partial resistance,\n                    <jats:italic>kelch13<\/jats:italic>\n                    P553L, was identified in a cluster of four infections (0.9% of all samples), likely linked to importation. The dihydropteroate synthase\/dihydrofolate reductase sextuple mutant haplotype, associated with high-level sulfadoxine\u2013pyrimethamine resistance, was found in 7.8% of the samples, also within clusters. The multidrug resistance 1 N86 genotype associated with reduced susceptibility to lumefantrine was nearly fixed. More than 60% of the infections were polyclonal, with higher complexity observed in imported cases. No\n                    <jats:italic>hrp2<\/jats:italic>\n                    \/\n                    <jats:italic>3<\/jats:italic>\n                    deletions were detected; most false-negative RDTs were attributed to subpatent parasitemia. Non-\n                    <jats:italic>falciparum<\/jats:italic>\n                    coinfections were rare (&lt;1%). These findings shed light on the dynamics of resistance emergence in low-transmission settings. Integrating routine genomic surveillance into national malaria programs is essential for detecting, tracking, and responding to resistance threats in countries nearing elimination.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0487","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:41:28Z","timestamp":1779208888000},"source":"Crossref","is-referenced-by-count":1,"title":["Genomic Surveillance Reveals Clusters of Plasmodium falciparum Antimalarial Resistance Markers in Eswatini, A Low-Transmission Setting"],"prefix":"10.4269","author":[{"given":"Nomcebo","family":"Nhlengethwa","sequence":"first","affiliation":[{"name":"Laboratory Department, National Malaria Programme, Manzini, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Aranda-D\u00edaz","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA;"},{"name":"Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, California, USA;"},{"name":"ISGlobal, Barcelona, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibonakaliso","family":"Vilakati","sequence":"additional","affiliation":[{"name":"Laboratory Department, National Malaria Programme, Manzini, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isobel","family":"Routledge","sequence":"additional","affiliation":[{"name":"Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja B.","family":"Lauterbach","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takalani I.","family":"Makhanthisa","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith","family":"De Amaral","sequence":"additional","affiliation":[{"name":"EPPIcenter Research Program, Department of Medicine, University of California, San Francisco, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukosha","family":"Chisenga","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brighton","family":"Mangena","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chadwick","family":"Sikaala","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chimumbwa","sequence":"additional","affiliation":[{"name":"SADC Malaria Elimination Eight Secretariat, Windhoek, Namibia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinton","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Laboratory Department, National Malaria Programme, Manzini, Eswatini;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaishree","family":"Raman","sequence":"additional","affiliation":[{"name":"Laboratory for Antimalarial Resistance Monitoring and Malaria Operational Research, Centre of Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa;"},{"name":"Wits Research Institute for Malaria, University of Witwatersrand, Johannesburg, South Africa;"},{"name":"University of Pretoria Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, California, USA;"},{"name":"Department of Epidemiology & Biostatistics, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabelo V.","family":"Dlamini","sequence":"additional","affiliation":[{"name":"Parasitology Department, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Eswatini Malaria Strategic Plan 2024\u20132028.","year":"2022"},{"key":"b2","article-title":"Strategy to Respond to Antimalarial Drug Resistance in Africa.","year":"2022"},{"key":"b3","article-title":"Response Plan to pfhrp2 Gene Deletions, Second Edition.","year":"2024"},{"key":"b4","series-title":"N Engl J Med","first-page":"455","article-title":"Artemisinin resistance in Plasmodium falciparum malaria","volume":"361","author":"Dondorp","year":"2009"},{"key":"b5","series-title":"Lancet Infect Dis","first-page":"1043","article-title":"Novel phenotypic assays for the detection of artemisinin-resistant Plasmodium falciparum 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