Artemisinin-Resistant Plasmodium falciparum K13 Mutant Alleles, Thailand–Myanmar Border

Area and Costa Rica in general, free-ranging dogs are common , including at playgrounds and school yards, sites also vulnerable to nocturnal visits by raccoons. Dogs can have patent B. procyonis parasite infections and can play a role in transmission of the parasite from raccoons to humans. In Costa Rica, cases of larva migrans have been reported. The Unidad de Investigación y Análisis, Regis-tros y Estadísticas de Salud at the National Children's Hospital, San José, Costa Rica, reported 135 cases of larva migrans ocularis and 21 cases of visceral larva mi-grans caused by nonspecifically identified ascarids during 2005–2014 (unpub. data). However, these diagnoses were based on IgG serologic testing results (Martinez J., National Children's Hospital; pers. comm., 2015), which do not identify ascarid species. Western blot testing would improve accuracy (10). The eco-epidemiology of B. procyonis parasites in tropical settings is relevant to public health because it might play a yet-unrecognized role in larva migrans pathology, which can be severe. Increased contact between raccoons and humans also warrants further investigation to improve understanding and minimize zoonotic risk. Levee DJ, Kazacos KR. Raccoon roundworm eggs near homes and risk for larva migrans disease, California communities. To the Editor: Artemisinin resistance (ART-R) in Plasmodium falciparum phenotypes may have evolved independently in various areas of the Greater Mekong Sub-region (1,2), prompting the World Health Organization to change its regional policy from containment to elimination (3). Risks associated with ART-R include compromised use of artemisinin combined therapy, partner drug resistance selection, total ART-R resistance, and geographic extension