Malaysia was able to control the spread of Malaria Disease throughout the years with the various initiatives taken by the Ministry of Health programs. However, it still remains as one of the main public health concerns in this country. Recently, the health authority is most concerned about a type of Plasmodium species that before this only infect monkey (long-tailed and pig-tailed macaques) but now had evolved and proven to infect human as well. The parasite is known as Plasmodium knowlesi. It was first isolated and studied in the early 1930 at Kolkata School of Tropical Medicine in India from a long-tailed macaques and a rhesus macaque (Macacamulatta) imported from Singapore. Large cases of human infection were reported in 2004 in the state of Sarawak. Since then P. Knowlesi becomes the fifth species of Plasmodium causing Malaria in humans, and becomes a new challenge to public health in controlling Malaria in Malaysia, especially in the state of Sabah and Sarawak. Forest lands reclamation and forest clearing efforts were still actively ongoing in both states for development or plantation purposes that increases the exposure to the human population during such activities. In addition, the ecotourism industry among the major sources of income in both states involving forestry and wildlife such as river boat wildlife cruises, forest nature walks, wildlife observation also increase the risk of exposure to Malaria infection if necessary precautions are not taken.
What Is Monkey Malaria ?
There are 5 species of Plasmodium parasite that cause Malaria, P. falciparum, P. vivax, P. malariae, P. ovale and P. Knowlesi. The P. knowlesi also known as a monkey Malaria a new emerging zoonotic disease (a disease that normally exists in animals but that can infect humans) in South East Asian country including Malaysia. The incubation period (the period between exposure to an infection and the appearance of the first symptoms) of P. Knowlesi is between 9 to 12 days. The signs and symptoms are similar to the other Plasmodium infection. The patient will begin to have a fever, which may come and go, or may be constant, chills, profuse sweating, malaise (feeling of unwellness), muscle, and joint pain, headache, nausea, loss of appetite, diarrhea, abdominal pain, cough, anemia. myalgia, headache, and low back pain. The local health authority reported that P. knowlesi accounted for 817 (80%), 677 (88%), and 2030 (98%) malaria cases in 2015, 2016, and 2017 some of which were fatal.
Who will be exposed?
People at the risk of Malaria infection is predominantly local resident living in malarial areas and localities that has previously recorded malaria infection. Occupational risk factors such as logging and plantation worker who ventured out into the forest and travelers involved in forest activities are at risk too, especially if preventative measures are not taken to prevent mosquito bite.
What Precaution can be taken?
People involved in forest-area activities, particularly area where malaria infection was reported should take necessary precautions to prevent mosquito bite. The basic information or knowledge about malaria – how the malaria spread, the incubation period, and mosquito (the carrier of malaria infection), the possibility of delayed onset and the main sign and symptoms of malaria infection are easily available nowadays from the social media. Using a mosquito repellent and avoiding being bitten by mosquitoes is the most effective and cheapest precautionary measure, especially between dusk and dawn. The antimalarial medicines are available and can also be taken to prevent infection from developing into a clinical disease. But the most fundamental thing to do is to seek immediate diagnosis and treatment if a fever develops one week or longer after entering an area where malaria cases had been reported.
Destruction Of Disease-Bearing Insects Act 1975 (DDBIA 1975).
DDBIA 1975 is one of the provisions of the law can be enforced to control the spread of vector-borne illnesses including malaria. This Act clearly states under the provisions of section 11, requiring individuals or companies wishing to commence construction work, advance land, to redeem land use, excavate, mine or work that may breed or give protection against disease-bearing insects must submit a work plan to the director’s head or health officer, and failure to comply with this provision is to commit an offense under the act. The local public health authority will work under this Act in the event of reported malaria cases for prevention and control purposes. It is clearly stated under section 10 which authorizes the director-general or Medical Officers to perform medical examinations against any person’s suspected or likely to be infected with insect-borne disease. The contravention of this Act liable to be fined under the section 23.
Hiruan Md Ideris
Senior Assistant Environmental Health Officer
Sipitang District Health Office
References
- Singh B Daneshvar C. (2013) Human infections and detection of Plasmodium knowlesi. ClinMicrobiolRev2013;26:165–
- Public Health England Malaria Reference Laboratory. Imported malaria cases and deaths in the United Kingdom, 1994–2013.Data from the Public Health England Malaria Reference Laboratory. 2014. http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733773780.
- Singh,B. et al. (2004) A large focus of naturally acquired Plasmodium knowlesi infections in human beings. Lancet 363, 1017–1024.
- Vythilingam et al. Parasites & Vectors 2014, 7:436 http://www.parasitesandvectors.com/content/7/1/436.
- H. Ooi et al. (2017)Over two decades of Plasmodium knowlesi infections in Sarawak: Trend and forecast
- WHO International travel and health https://www.who.int/ith/diseases/malaria/en/
- Government of Destruction Of Disease-Bearing Insects Act 1975
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