Background: Since a large focus of human infection with Plasmodium knowlesi, a simian malaria parasite naturally found in long-tailed and pig tailed macaques, was reported in Sarawak, Malaysian Borneo, it was pertinent to study the situation in peninsular Malaysia. A study was thus initiated to screen human cases of Plasmodium malariae using molecular techniques, to determine the presence of P. knowlesi in non-human primates and to elucidate its vectors.

Singapore reported its first locally acquired human Plasmodium knowlesi infection in 2007, involving a soldier who had undergone training in a forested area where long-tailed macaques are frequently seen. Comprehensive disease surveillance and monitoring system that was set up after the initial case detected four additional human P. knowlesi cases in 2007 and one in 2008. All involved military personnel who had undergone training in the forested area, and none had traveled out of Singapore 1 month before the onset of symptoms. Screening for malaria parasites on blood obtained from long-tailed macaques revealed that wild monkeys (n=3) caught from the forested area were infected with P. knowlesi, whereas peri-domestic monkeys (n=10) caught from a nature reserve park were not infected with any malaria parasites. Phylogenetic analysis of the nonrepeat region of the P. knowlesi csp genes showed that the sequences obtained from the human cases were not distinct from those obtained from wild monkeys. Further, certain genotypes were shared between samples from humans and macaques. Our findings provide evidence that long-tailed macaques are the natural hosts of P. knowlesi in Singapore and the human cases acquired their infection in the same vicinity where these monkeys are found. Further, the risk of acquiring P. knowlesi infection among the general population of Singapore is small as evident from the absence of P. knowlesi in peri-domestic monkeys.

The insect growth regulator pyriproxyfen was tested against Aedes aegypti at 0.01 and 0.02 mg of active ingredient (AI) per liter of water in 60-liter earthern jars. Both concentrations provided 100% control for 4 months. In additional experiments where 10 liters of water were replaced fortnightly, 100% control was still obtained over 4 months with 0.02 mg AI/liter and greater than 93-100% control was obtained over 4 months with 0.01 mg AI/liter. In less-controlled field-trial conditions, pyriproxyfen at a dosage of 0.02 mg AI/liter provided 100% control for 10 wk against Aedes albopictus even though water was replaced either daily or weekly. Although the activity of pyriproxyfen declines after 10 wk, those tests in the plastic tubs showed much higher levels of sustained residual activity compared to those in the earthern jars. Pyriproxyfen did not have an impact on nontarget organisms.