Association between Landscape Factors and Spatial Patterns of Plasmodium knowlesi Infections in Sabah, Malaysia.

The zoonotic malaria species Plasmodium knowlesi has become the main cause of human malaria in Malaysian Borneo. Deforestation and associated environmental and population changes have been hypothesized as main drivers of this apparent emergence. We gathered village-level data for P. knowlesi incidence for the districts of Kudat and Kota Marudu in Sabah state, Malaysia, for 2008-2012. We adjusted malaria records from routine reporting systems to reflect the diagnostic uncertainty of microscopy for P. knowlesi. We also developed negative binomial spatial autoregressive models to assess potential associations between P. knowlesi incidence and environmental variables derived from satellite-based remote-sensing data. Marked spatial heterogeneity in P. knowlesi incidence was observed, and village-level numbers of P. knowlesi cases were positively associated with forest cover and historical forest loss in surrounding areas. These results suggest the likelihood that deforestation and associated environmental changes are key drivers in P. knowlesi transmission in these areas

Increasing Incidence of Plasmodium knowlesi Malaria following Control of P. falciparum and P. vivax Malaria in Sabah Malaysia

BackgroundThe simian parasite Plasmodium knowlesi is a common cause of human malaria in Malaysian Borneo and threatens the prospect of malaria elimination. However, little is known about the emergence of P. knowlesi, particularly in Sabah. We reviewed Sabah Department of Health records to investigate the trend of each malaria species over time.MethodsReporting of microscopy-diagnosed malaria cases in Sabah is mandatory. We reviewed all available Department of Health malaria notification records from 1992–2011. Notifications of P. malariae and P. knowlesi were considered as a single group due to microscopic near-identity.ResultsFrom 1992–2011 total malaria notifications decreased dramatically, with P. falciparum peaking at 33,153 in 1994 and decreasing 55-fold to 605 in 2011, and P. vivax peaking at 15,857 in 1995 and decreasing 25-fold to 628 in 2011. Notifications of P. malariae/P. knowlesi also demonstrated a peak in the mid-1990s (614 in 1994) before decreasing to ≈100/year in the late 1990s/early 2000s. However, P. malariae/P. knowlesi notifications increased >10-fold between 2004 (n = 59) and 2011 (n = 703). In 1992 P. falciparum, P. vivax and P. malariae/P. knowlesi monoinfections accounted for 70%, 24% and 1% respectively of malaria notifications, compared to 30%, 31% and 35% in 2011. The increase in P. malariae/P. knowlesi notifications occurred state-wide, appearing to have begun in the southwest and progressed north-easterly.ConclusionsA significant recent increase has occurred in P. knowlesi notifications following reduced transmission of the human Plasmodium species, and this trend threatens malaria elimination. Determination of transmission dynamics and risk factors for knowlesi malaria is required to guide measures to control this rising incidence

Avian Influenza (H7N9) Virus Infection in Chinese Tourist in Malaysia, 2014

Of the ≈400 cases of avian influenza (H7N9) diagnosed in China since 2003, the only travel-related cases have been in Hong Kong and Taiwan. Detection of a case in a Chinese tourist in Sabah, Malaysia, highlights the ease with which emerging viral respiratory infections can travel globally

A study protocol for a randomised open-label clinical trial of artesunate-mefloquine versus chloroquine in patients with non-severe Plasmodium knowlesi malaria in Sabah, Malaysia (ACT KNOW trial)

Introduction Malaria due to Plasmodium knowlesi is reported throughout South-East Asia, and is the commonest cause of it in Malaysia. P. knowlesi replicates every 24 h and can cause severe disease and death. Current 2010 WHO Malaria Treatment Guidelines have no recommendations for the optimal treatment of non-severe knowlesi malaria. Artemisinin-combination therapies (ACT) and chloroquine have each been successfully used to treat knowlesi malaria; however, the rapidity of parasite clearance has not been prospectively compared. Malaysia\u27s national policy for malaria pre-elimination involves mandatory hospital admission for confirmed malaria cases with discharge only after two negative blood films; use of a more rapidly acting antimalarial agent would have health cost benefits. P. knowlesi is commonly microscopically misreported as P. malariae, P. falciparum or P. vivax, with a high proportion of the latter two species being chloroquine-resistant in Malaysia. A unified ACT-treatment protocol would provide effective blood stage malaria treatment for all Plasmodium species.Methods and analysis ACT KNOW, the first randomised controlled trial ever performed in knowlesi malaria, is a two-arm open-label trial with enrolments over a 2-year period at three district sites in Sabah, powered to show a difference in proportion of patients negative for malaria by microscopy at 24 h between treatment arms (clinicaltrials.gov #NCT01708876). Enrolments started in December 2012, with completion expected by September 2014. A total sample size of 228 is required to give 90% power (α 0.05) to determine the primary end point using intention-to-treat analysis. Secondary end points include parasite clearance time, rates of recurrent infection/treatment failure to day 42, gametocyte carriage throughout follow-up and rates of anaemia at day 28, as determined by survival analysis.Ethics and dissemination This study has been approved by relevant institutional ethics committees in Malaysia and Australia. Results will be disseminated to inform knowlesi malaria treatment policy in this region through peer-reviewed publications and academic presentations.Trial registration number NCT01708876

Lessons learned about the effect of reduced anthropogenic activities on water quality in a large lake system and opportunities towards sustainable management

Despite considerable efforts to protect vulnerable marine, coastal, and freshwater ecosystems, anthropogenic activities remain one of the main causes of poor water quality in rivers, lakes and wetland systems worldwide [1]. To move towards the sustainable management of coastal and aquatic ecosystems, it is important to understand how both natural and anthropogenic processes affect water quality. In 2020, a unique opportunity arose to study water quality in a large lake system in the southwest of India during a period when anthropogenic pressures were reduced due to a nationwide lockdown in response to the COVID-19 pandemic. Using remote sensing and in situ observations to analyse changes in five different water quality indicators, we showed that water quality improved in large areas of Lake Vembanad during the lockdown in 2020 [2]. The lessons learned illustrate that a coordinated response in reducing anthropogenic activities, as seen during the lockdown, could help achieve the targets set out in United Nation’s Sustainable Development Goals 3, 6 and 14 and significantly reduce aquatic pollution and improve water quality by 2030

Effect of Reduced Anthropogenic Activities on Water Quality in Lake Vembanad, India

The United Nation’s Sustainable Development Goal Life Below Water (SDG-14) aims to “conserve and sustainably use the oceans, seas, and marine resources for sustainable development”. Within SDG-14, targets 14.1 and 14.2 deal with marine pollution and the adverse impacts of human activities on aquatic systems. Here, we present a remote-sensing-based analysis of short-term changes in the Vembanad-Kol wetland system in the southwest of India. The region has experienced high levels of anthropogenic pressures, including from agriculture, industry, and tourism, leading to adverse ecological and socioeconomic impacts with consequences not only for achieving the targets set out in SDG-14, but also those related to water quality (SDG-6) and health (SDG-3). To move towards the sustainable management of coastal and aquatic ecosystems such as Lake Vembanad, it is important to understand how both natural and anthropogenic processes affect water quality. In 2020, a unique opportunity arose to study water quality in Lake Vembanad during a period when anthropogenic pressures were reduced due to a nationwide lockdown in response to the global pandemic caused by SARS-CoV-2 (25 March–31 May 2020). Using Sentinel-2 and Landsat-8 multi-spectral remote sensing and in situ observations to analyse changes in five different water quality indicators, we show that water quality improved in large areas of Lake Vembanad during the lockdown in 2020, especially in the more central and southern regions, as evidenced by a decrease in total suspended matter, turbidity, and the absorption by coloured dissolved organic matter, all leading to clearer waters as indicated by the Forel-Ule classification of water colour. Further analysis of longer term trends (2013–2020) showed that water quality has been improving over time in the more northern regions of Lake Vembanad independent of the lockdown. The improvement in water quality during the lockdown in April–May 2020 illustrates the importance of addressing anthropogenic activities for the sustainable management of coastal ecosystems and water resources

Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and Predictors of Severity.

Background: Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Methods: Over 3.5 years, we prospectively assessed patients of any age with molecularly-confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia. Results: Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538-8481/μL]) than in falciparum (9600/μL; P 15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P 15000/μL