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Changing epidemiology of malaria in Sabah, Malaysia: Increasing incidence of Plasmodium knowlesi

William, Timothy, Jelip, Jenarun, Menon, Jayaram, Anderios, F., Mohammad, Rashidah, Mohammad, Tajul, Grigg, Matthew, Yeo, Tsin, Anstey, Nicholas M. and Barber, Bridget (2014). Changing epidemiology of malaria in Sabah, Malaysia: Increasing incidence of Plasmodium knowlesi. Malaria Journal,13(1 - Article No. 390).

Document type: Journal Article
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IRMA ID 84473293xPUB13
Title Changing epidemiology of malaria in Sabah, Malaysia: Increasing incidence of Plasmodium knowlesi
Author William, Timothy
Jelip, Jenarun
Menon, Jayaram
Anderios, F.
Mohammad, Rashidah
Mohammad, Tajul
Grigg, Matthew
Yeo, Tsin
Anstey, Nicholas M.
Barber, Bridget
Journal Name Malaria Journal
Publication Date 2014
Volume Number 13
Issue Number 1 - Article No. 390
ISSN 1475-2875   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84908092609
Total Pages 11
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background: While Malaysia has had great success in controlling Plasmodium falciparum and Plasmodium vivax,
notifications of Plasmodium malariae and the microscopically near-identical Plasmodium knowlesi increased
substantially over the past decade. However, whether this represents microscopic misdiagnosis or increased
recognition of P. knowlesi has remained uncertain.

Methods: To describe the changing epidemiology of malaria in Sabah, in particular the increasing incidence
of P. knowlesi, a retrospective descriptive study was undertaken involving a review of Department of Health
malaria notification data from 2012–2013, extending a previous review of these data from 1992–2011. In addition,
malaria PCR and microscopy data from the State Public Health Laboratory were reviewed to estimate the accuracy
of the microscopy-based notification data.

Results: Notifications of P. malariae/P. knowlesi increased from 703 in 2011 to 815 in 2012 and 996 in 2013. Notifications
of P. vivax and P. falciparum decreased from 605 and 628, respectively, in 2011, to 297 and 263 in 2013. In
2013, P. malariae/P. knowlesi accounted for 62% of all malaria notifications compared to 35% in 2011. Among 1,082
P. malariae/P. knowlesi blood slides referred for PCR testing during 2011–2013, there were 924 (85%) P. knowlesi
mono-infections, 30 (2.8%) P. falciparum, 43 (4.0%) P. vivax, seven (0.6%) P. malariae, six (0.6%) mixed infections,
31 (2.9%) positive only for Plasmodium genus, and 41 (3.8%) Plasmodium-negative. Plasmodium knowlesi mono-infection
accounted for 32/156 (21%) and 33/87 (38%) blood slides diagnosed by microscopy as P. falciparum and P. vivax,
respectively. Twenty-six malaria deaths were reported during 2010–2013, including 12 with ‘P. malariae/P. knowlesi’
(all adults), 12 with P. falciparum (seven adults), and two adults with P. vivax.

Conclusions: Notifications of P. malariae/P. knowlesi in Sabah are increasing, with this trend likely reflecting a true
increase in incidence of P. knowlesi and presenting a major threat to malaria control and elimination in Malaysia.
With the decline of P. falciparum and P. vivax, control programmes need to incorporate measures to protect against
P. knowlesi, with further research required to determine effective interventions.
Keywords Plasmodium knowlesi
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