Proposed Integrated Control of Zoonotic Plasmodium knowlesi in Southeast Asia Using Themes of One Health

Abstract

Zoonotic malaria, Plasmodium knowlesi, threatens the global progression of malaria elimination. Southeast Asian regions are fronting increased zoonotic malaria rates despite the control measures currently implemented—conventional measures to control human-malaria neglect P. knowlesi’s residual transmission between the natural macaque host and vector. Initiatives to control P. knowlesi should adopt themes of the One Health approach, which details that the management of an infectious disease agent should be scrutinized at the human-animal-ecosystem interface. This review describes factors that have conceivably permitted the emergence and increased transmission rates of P. knowlesi to humans, from the understanding of genetic exchange events between subpopulations of P. knowlesi to the downstream effects of environmental disruption and simian and vector behavioral adaptations. These factors are considered to advise an integrative control strategy that aligns with the One Health approach. It is proposed that surveillance systems address the geographical distribution and transmission clusters of P. knowlesi and enforce ecological regulations that limit forest conversion and promote ecosystem regeneration. Furthermore, combining individual protective measures, mosquito-based feeding trapping tools and biocontrol strategies in synergy with current control methods may reduce mosquito population density or transmission capacity.

Preliminary review on the prevalence, proportion, geographical distribution, and characteristics of naturally acquired Plasmodium cynomolgi infection in mosquitoes, macaques, and humans: a systematic review and meta-analysis

“…Although cases in macaques have been reported in the Philippines, Laos, Singapore, and Indonesia, there is a curiosity as to why there is a lack of reports on infected Anopheles mosquitoes and humans. The results of the present study indicated that in areas where a high prevalence of P. cynomolgi was seen in macaques, sustained public information and advocacy in the affected areas is still necessary even if public advocacies have already been performed since 2014 [27][28][29][30].…”

The Role of Human Behavior in Plasmodium knowlesi Malaria Infection: A Systematic Review

“…It is clear that P. knowlesi control is challenging, thus, individuals and communities need to culturally adapt to preventative measures, have sufficient knowledge about the issues, develop a positive attitude toward adopting health-supportive behaviors, gain support from and interact with others, and feel good about performing the behaviors [ 47 , 48 , 49 ]. Stakeholders must provide support to ensure a multi-collaborative effort in controlling this vector-borne disease [ 51 ], for example, by improving the housing structures, designing an innovative tool to avoid mosquito bites, and implementing the One Health approach [ 52 ].…”

Reimagining zoonotic malaria control in communities exposed to Plasmodium knowlesi infection

“…Complementary vector control tools that are feasible and acceptable to higher-risk individuals and communities should be developed and deployed. Insecticide-treated clothing and hammocks are some of the possible alternative measures that are already available and could be deployed more broadly for personal protection [ 37 ]. For communities that keep monkeys as pets and are involved in forest activities where Macaques monkeys are present, additional strategies targeting the malaria parasite might also be considered [ 10 , 25 , 26 ].…”