Examining the early distribution of the artemisinin-resistant Plasmodium falciparum kelch13 R561H mutation in Rwanda

Abstract Artemisinin resistance mutations in Plasmodium falciparum kelch13 ( Pfk13 ) have begun to emerge in Africa. Pfk13- R561H was the first reported African mutation found in Rwanda in 2014, but limited sampling left questions about its early distribution and origin. We detected 476 parasitemias among 1873 residual blood spots from a 2014-15 Rwanda Demographic Health Survey. We sequenced 351 samples revealing 341/351 were wild type (97.03% weighted) and 4 samples (1.34% weighted) harbored R561H which were significantly spatially clustered. Our study better defines the early distribution of R561H in Rwanda and suggests that the origin may have involved higher-transmission regions.