A multi-pronged approach in combating knowlesi malaria

In the past 15 years, P. knowlesi, a malaria parasite of longtail and pigtail monkeys, was reported to cause a significant number of human infections in Malaysia. In 2017, P. knowlesi accounted for 88% (1813) of all malaria cases in the country. Sabah recorded the most number of cases (1965), followed by Sarawak (1225). In Peninsular Malaysia, all states except Kuala Lumpur FT reported knowlesi malaria in 2017. More worryingly, an increase in severe knowlesi malaria has been seen in Malaysia Borneo over the past recent years.

Recent reports from Perak described an increasing number of knowlesi malaria cases involving several fatal cases. Another concern which has economic impact to Malaysia is that knowlesi malaria is recognised as a traveller’s disease. Visitors or tourists from all over the world to ecotourism attractions such as National Parks and forests in Malaysia have been known to bring knowlesi malaria to their home countries in Europe, the US, the Far East, and Australasia.

Transmission of this zoonotic disease involves humans, monkeys as primary hosts, and mosquitoes as vectors. Combating or controlling knowlesi malaria is indeed challenging, mainly because of the role of monkeys as reservoir of the parasite. Nevertheless, the challenge can be overcome with a proper and effective multi-pronged approach. This proposed research programme is an endeavour encompassing several key areas that fill in the fundamental knowledge gaps in the disease’s risks and transmission, parasite characterisation and diagnosis.

The focus of this programme includes the following: genetic diversity of P. knowlesi invasion-related proteins; distribution and bionomics of mosquito vector; primate zoogeographical distribution; rapid point-of-care (PoC) molecular test for diagnosis of malaria; social study on risk populations and mathematical modelling of knowlesi malaria transmission. Hence, this programme is comprehensive in nature that covers pure, applied and social and behavioural research.

The research team will comprise academic members from public (UM, UKM, UPM, IIUM) and private (Sunway University) universities. In addition, inter-agency collaboration is also emphasized with the involvement of experts from the Ministry of Health (MOH), and the Department of Wildlife and National Parks.

This will be a 4-year research programme, with a proposed budget of RM 3.459 million.

The programme outputs are as follow:
(i) 10 PhD and 5 Masters level graduates
(ii) 50 publications in ISI-WOS indexed journals
(iii) 3 IPs (malaria rapid diagnosis kit; subunit candidate vaccine constructs)
(iv) genetic characterisation/diversity and distribution of P. knowlesi, monkey and mosquito vectors
(v) knowlesi malaria transmission dynamics
(vi) predictive indices and dynamics of knowlesi malaria outbreaks
(vii) intervention measures for control of knowlesi malaria

Study design will be provided under each project

Diagnostics
Epidemiology
Genetics and Genomics
Modeling
Social Science

Jan 2019 — Dec 2022

$847,453

Malaysia

Plasmodium knowlesi