The Ministry of Health Malaysia (MOH) takes note of the article entitled “Malaysia is ground zero for the next malaria menace” which was published in ScienceNews on the 4th November 2018 and a report published by The Malay Mail entitled “Next global malaria threat will happen in Malaysia”, on 6th November 2018. The MOH acknowledges that while the number of locally acquired human Malaria has plummeted from 6,071 in 2008 to 85 cases in 2017, the number of knowlesi Malaria (or monkey Malaria in human) increased from 376 cases in 2008 to 3,614 cases in 2017. These were contributed by multiple factors. It is important to highlight that among the reasons for this increase were due to improvement in diagnosis capacity to differentiate knowlesi Malaria from the other human Malaria variants.
The MOH Malaysia had introduced molecular based diagnosis for Malaria in 2009 which is more sensitive in diagnosing knowlesi Malaria. Since then, more knowlesi Malaria were detected instead of it previously being classified as human malaria (which are done through microscopic identification). On the other hand, the implementation of Malaria Elimination Program by MOH in 2011 had resulted in reduction of human Malaria and had improved awareness amongst the medical practitioner to be more on the look for knowlesi Malaria. Apart from that, reduction in malaria cases means there is less exposure to human malaria infection among community, subsequently led to loss or reduced of immunity amongst the community member in general, including against knowlesi Malaria infection. Another contributing factor for the increase in cases is the change in land use patterns creating increased opportunity for spill over of infections to humans through closer associations with natural reservoir hosts or access to infected vectors.
Based on data from MOH surveillance system, people involved with forest related activities are at higher risk of contracting knowlesi Malaria. Among the high risk activities which are common to the cases are farming, working in plantations, logging, collecting forest produce, hunting and forest related recreational activities.
Realising the potential threat posed by knowlesi Malaria, Ministry of Health Malaysia has undertaken the following pragmatic steps:
- Since 2009, MOH has strengthened its surveillance for monkey Malaria in human by making molecular diagnosis for Malariaavailable in all Public Health Laboratories including the National Public Health Laboratory in Sungai Buluh, regional Public Health Laboratories in Johor, Perak, Kelantan and Sabah. The molecular diagnosis is also made available at the referral hospitals since 2014. Where else Institute for Medical Research (IMR) has established the molecular diagnosis test for malaria much earlier as the research centre of Malaria for Ministry of Health.
- MOH has developed a National Guidelines for Treatment of Malaria including treatment for monkey Malaria since 2014 and has been used nationwide in all hospitals.
- MOH has intensified health education amongst the people at risk of knowlesi Malaria such as distribution of educational leaflets and installation of Malaria billboards in high risk areas to advise people on use of personal protection against mosquito bites when they enter these areas.
- In 2016, MOH Malaysia established collaboration with the Malaysian Remote Sensing Agency (MRSA) and developed risk maps of knowlesi Malaria in Malaysia which is to be used for planning and implementation of control programme.
- Knowlesi Malaria has become key agenda in an Inter-Ministerial Committee for Control of Zoonotic Diseases in Malaysia which isco-chaired by the Director General of Ministry of Health and the Director General of Department of Veterinary Services, Malaysia. Under the purview of this high level committee, MOH is collaborating with various Ministries especially with the Wildlife Department in identifying hotspots of knowlesi carrier macaque population and identify steps that can be implemented to mitigate them.
- Knowing that anopheles vectors for monkey Malaria primarily bite outdoor, MOH via IMR is studying the effectiveness of insecticide Outdoor Residual Spraying in the control of monkey Malaria.
- MOH is embarking on a study to determine effectiveness of repellent for prevention of knowlesi Malaria especially in the states reporting of high burden of knowlesi Malaira.
- In collaboration with local universities spearheaded by UM, MOH is participating in a large scale study on A multi-pronged approach in combating knowlesi Malaria in Malaysia.
Ministry of Health would like to encourage the involvement of the employers from Agricultural and Plantation sector in providing protection to their workers such as the use of insecticide nets and repellent, as prevention of knowlesi Malaria. MOH also encourage local researcher to conduct study on monkey malaria including its natural host which is the macaques. Interagency involvement in the prevention of knowlesi Malaria is important in reducing the burden of this disease.
DATUK DR. NOOR HISHAM ABDULLAH
DIRECTOR GENERAL OF HEALTH MALAYSIA