Zoonotic malaria requires new policy approaches to malaria elimination

Fornace, Kimberly M.; Drakeley, Chris J.; Lindblade, Kim A.; Jelip, Jenarun; Ahmed, Kamruddin

doi:10.1038/s41467-023-41546-6

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Despite significant progress towards the elimination of the major causes of human malaria, P. falciparum and P. vivax , antimalarial drug resistance remains a major public health threat (60). However, as P. knowlesi transmission appears to remain exclusively zoonotic (2), drug-resistance mutations are less likely to emerge. Despite this, we observed several SNPs in orthologue genes previously highlighted as potential drug resistance markers, including dihydropteroate synthase ( dhps ), dihydrofolate reductase ( dhfr ) and the multidrug resistance-associated protein ( mrp1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Zoonotic transmission of the macaque parasite Plasmodium knowlesi has emerged as the most common cause of human malaria in Malaysia and parts of western Indonesia (1, 2, 3). P. knowlesi infections can cause severe, life-threatening malaria, with a case fatality similar to that of P. falciparum in Southeast Asia despite comparatively lower levels of parasitemia (4, 5).…”

Section: Introductionmentioning

confidence: 99%

“…Zoonotic transmission of P. knowlesi is thought to occur largely in response to increasingly fragmented landscapes as a result of land clearing and associated agricultural activities, with increased exposure in at-risk workers and local populations in endemic areas to both pig-tailed ( Macaca nemestrina) and long-tailed ( M. fascicularis) macaques, and the Anopheles Leucosphyrus Group mosquito vectors (7, 8). Worryingly, in contrast to other human Plasmodium species, national WHO malaria elimination goals in Southeast Asia are threatened by the inability of public health measures to target macaque host reservoirs for P. knowlesi (2). Furthermore, conventional prevention measures such as insecticide-treated bed nets used successfully for other Plasmodium Spp in the region are limited for P. knowlesi zoonotic infections, primarily acquired at the forest-edge during agricultural work activities (9, 10).…”

Section: Introductionmentioning

confidence: 99%

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Genomic epidemiology ofPlasmodium knowlesireveals putative genetic drivers of adaptation in Malaysia

Westaway,

Diez Benavente,

Auburn

et al. 2024

Preprint

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Sabah, Malaysia, has amongst the highest burden of human Plasmodium knowlesi infection in the country, associated with increasing encroachment on the parasite’s macaque host habitat. However, the genomic make-up of P. knowlesi in Sabah was previously poorly understood. To inform on local patterns of transmission and putative adaptive drivers, we conduct population-level genetic analyses of P. knowlesi human infections using 52 new whole genomes from Sabah, Malaysia, in combination with publicly available data. We identify the emergence of distinct geographical subpopulations within the macaque-associated clusters using IBD-based connectivity analysis. Secondly, we report on introgression events between the clusters, which may be linked to differentiation of the subpopulations, and that overlap genes critical for survival in human and mosquito hosts. Using village-level locations from P. knowlesi infections, we also identify associations between several introgressed regions and both intact forest perimeter-area ratio and mosquito vector habitat suitability. Our findings provide further evidence of the complex role of changing ecosystems and sympatric macaque hosts in Malaysia driving distinct genetic changes seen in P. knowlesi populations. Future expanded analyses of evolving P. knowlesi genetics and environmental drivers of transmission will be important to guide public health surveillance and control strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Genomic epidemiology ofPlasmodium knowlesireveals putative genetic drivers of adaptation in Malaysia

Westaway,

Diez Benavente,

Auburn

et al. 2024

Preprint

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Mitigating risks of malaria and other vector-borne diseases in the new capital city of Indonesia

Surendra,

Djaafara,

Prameswari

et al. 2024

Nat Commun

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Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria

Naserrudin,

Adhikari,

Culleton

et al. 2024

BMC Public Health

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Background Zoonotic malaria is a growing public health threat in the WHO Southeast Asia (SEA) and Western Pacific (WP) regions. Despite vector-control measures, the distribution of Macaque fascicularis and M. nemestrina, and Anopheles mosquitoes carrying non-human simian malaria parasites poses challenges to malaria elimination. The systematic review assesses the literature on knowledge and malaria-preventive practices in zoonotic malaria-affected areas across the WHO SEA and WP, aiming to identify challenges for malaria control. Methods Peer-reviewed articles published in English, Malay and Indonesian between January 2010 and December 2022 were searched in OVID Medline, Scopus, Web of Science, and Google Scholar. Studies of any design—excluding reviews, conference proceedings, and reports from all WHO SEA and WP countries vulnerable to zoonotic malaria—were included. Backwards-reference screening and thematic analysis were conducted. Results Among 4,174 initially searched articles, 22 peer-reviewed articles met the inclusion criteria. An additional seven articles were identified through backwards-reference screening, resulting in a total of 29 articles for this review. Half of these studies were conducted in Cambodia, Myanmar, Malaysia, and Thailand, mainly in forests and remote communities. The review highlighted inconsistencies in the operationalization of knowledge, and five major themes were identified related to knowledge: causation and transmission, symptoms, treatment, severity and complications, and malaria prevention. While participants generally had some understanding of malaria causation/transmission, minority and indigenous ethnic groups demonstrated limited knowledge and held misconceptions, such as attributing malaria to drinking dirty water. Preventive practices included traditional and non-traditional or modern methods—with a preference for traditional approaches to avoid mosquito bites. Challenges to malaria control included feasibility, cost, and access to healthcare services. Conclusion This review provides insights into knowledge, local understandings, and preventive practices related to malaria in the WHO SEA and WP regions. The findings highlight the need for future research to explore the knowledge of at-risk communities regarding zoonotic malaria, their perceive threat of the disease and factors exposing them to zoonotic malaria. New strategies must be developed for zoonotic malaria programs tailored to local contexts, emphasizing the significance of community participation, health education, and socio-behavioural change initiatives. It is important to consider the interconnectedness of human health, environmental and non-human primates conservation. Socio-cultural nuances should also be carefully considered in the design and implementation of these programs to ensure their effect tailored to local contexts.

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Zoonotic malaria requires new policy approaches to malaria elimination

Cited by 3 publications

References 13 publications

Genomic epidemiology ofPlasmodium knowlesireveals putative genetic drivers of adaptation in Malaysia

Genomic epidemiology ofPlasmodium knowlesireveals putative genetic drivers of adaptation in Malaysia

Mitigating risks of malaria and other vector-borne diseases in the new capital city of Indonesia

Knowledge, compliance, and challenges in anti-malarial products usage: a systematic review of at-risk communities for zoonotic malaria

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