Emergence and Rising Prevalence of Artemisinin Partial Resistance Marker Kelch13 P441L in a Low Malaria Transmission Setting in Southern Zambia

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Abstract Increasing artemisinin partial resistance (ArtR) due to mutations in the gene encoding Kelch13 ( Pfk13 ) protein in eastern Africa is of urgent concern, and mutations, such as Pfk13 P441L, continue to emerge. We used an amplicon deep-sequencing panel to estimate the prevalence of ArtR Pfk13 mutations in samples collected between 2018 and 2023 in southern Zambia. Pfk13 P441L was present in 30 of 501 samples (6%), and prevalence increased over time (0% to 7.2%). Further studies of the P441L mutation are needed to document its geographical origin, distribution and impact on treatment outcomes.