21st International Congress for Tropical Medicine and Malaria (ICTMM) – 2024: Day 5

MESA Correspondents bring you cutting-edge coverage from the ICTMM 2024 Congress “Global Responses and Interdisciplinary Research Towards Eliminating Tropical Diseases”.

Malaria – Epidemiology 2

Yee Ling Lau (University Malaya, Malaysia) explained new diagnostic options to detect malaria in Southeast Asia and beyond. In 2022 based on WHO information, there were an estimated 5.2 million malaria cases and 90,000 deaths in South East Asia. Existing diagnostic methods including microscopy, rapid diagnostic tests (RDTs), and nested PCR have disadvantages. Lau talked about a new method very sensitive and specific, and cheaper than the existing ones called loop-mediated isothermal amplification (LAMP) which is based on the amplification of the DNA. Some advantages of this technique are that it requires a short time, does not need a thermocycler, is cost effective, and can detect 0.001% parasitemia. Based on a clinical evaluation in the Kapit Hospital in Sarawak from April to September 2022, it had 100% sensitivity and 97.8% specificity.

Tam Thanh Le (Ministry of Health, Vietnam)  (Ministry of Health, Vietnam) analyzed malaria trends in Central Vietnam from 2018 to 2022 using a Bayesian approach. Malaria remains a major public health issue worldwide. Le collected data on malaria cases, environment, climate, and population from 2018-2022, and used zero-inflated Poisson regression with a Bayesian framework for spatio-temporal modeling. The results showed a decrease in malaria incidence over this period. The modeling also showed the risk of Plasmodium falciparum increased fivefold with a 1-unit rise in the normalized difference vegetation index (NDVI) and by 8% for every 1ºC rise in maximum temperature (TMAX) with a 6-month lag. A 1 mm increase in precipitation with a 6-month lag reduced risk by 1%. For P. vivax, a 1-unit NDVI increase at a 1-month lag raised risk fourfold, with an additional 6% and 3% risk increase for each 1ºC rise in daytime land surface temperature and TMAX at a 6-month and 4-month lag, respectively. Spatial analysis showed higher malaria risk in the Central Highlands and southeast regions of Central Vietnam. These findings are important for planning strategies to eliminate malaria in Vietnam.

Win Han Oo (Burnet Institute, Australia) discussed a personal protection package aimed at reducing malaria transmission among forest-going mobile and mobile and migrant populations (MMPs) in Cambodia and Lao PDR. This package was tested using a cluster-randomized controlled trial with a nested mixed methods study. He mentioned that countries in the Greater Mekong Subregion (GMS) were committed to eliminating malaria by 2030, but current vector control interventions were insufficient, especially in preventing early outdoor biting by dominant vector species. The trial, conducted in 488 villages, distributed a personal protection package, including long-lasting insecticidal hammock nets, picaridin insect repellent, and health communication pamphlets, to MMPs. He noted that knowledge, attitudes, and personal protection practices among MMPs improved by the end of the trial compared to the baseline. Furthermore, MMPs expressed a willingness to continue using the package due to its convenience in their workplace. Overall, he concluded that the personal protection package was effective in reducing malaria prevalence among MMPs, acceptable to both the MMPs and health stakeholders, and could be considered for national and regional scale-up to support regional malaria elimination efforts.

Wilson Tavares (University of Maryland, United States) described the population structure of P. falciparum in southwestern Africa, using data from Angola. He explained that malaria is a major cause of mortality and morbidity in Angola, with over 9 million cases and more than 13,000 deaths in 2022. Tavares collected dried blood spot samples between January and April 2022, after which DNA was extracted and sequenced using the Illumina NovaSeq 6000. He reported that the results indicated low but significant genetic differentiation. Tavares noted that clinical isolates from provinces with unstable transmission exhibited very low complexity, and population analysis revealed low but significant genetic differentiation. He further mentioned that these results, combined with additional samples from Angola, would be used for a detailed study of migration within the country.

Zulkarnain Md Iris (Universiti Kebangsaan Malaysia, Malaysia) stressed the need for new and improved screening tools and strategies for detection and management of very low-density parasitemia in the field. Therefore, the objective was to evaluate malaria prevalence by integrating molecular and serological measures among hard-to-reach indigenous Orang Asli communities. Samples of 1954 individuals who appeared healthy showed no malaria parasites found with microscopy, but molecular testing revealed 7 cases of P. knowlesi mono-infection (0.4%), with no human malaria detected. This highlighted the importance of molecular detection among the hard-to-reach Orang Asli population in Malaysia. Besides there were higher proportions of P. knowlesi observed in the 19-40 age group of Orang Asli communities. The Basic Local Alignment Search Tool (BLAST)search of cox3 sequences of Plasmodium spp. also revealed identity ranges from 99.31% to 99.77%, showing high sequence similarity that reflects common ancestry to other P. knowlesi isolates. It was also found that humoral antibodies against P. falciparum antigens were higher than P. vivax antigens since P. falciparum circulates at higher parasite density that induces higher antibody levels, making it more detectable.

Sophie Zaloumis (University of Melbourne, Australia) created a mock study to predict the artemisinin resistance status of P. falciparum malaria isolates utilizing in vivo transcription data. The simulation was based on published transcriptomic data and tracking resistance to artemisinin collaboration (TRAC). The predictors were simulated in vivo transcriptomics data from a multivariate normal distribution with 1043 participants and an abundance of 5061 mRNA transcripts. The outcome was a slow clearing P. falciparum infection expressed as parasite clearance half life. This resulted in training data that fit well with machine learning methods (low bias). The test achieved a min of ~0.101 error at the largest training set size of 835. The gap between training and test curves was small at the largest training set signifying low variance. In conclusion, a minimum data set of 1043 (training set, 835 and test set, 208) was required to develop a prediction model that can achieve a balanced error rate of 0.101 for the prediction of slow clearing P. falciparum infections using in vivo transcriptomics data.

Rita Reyburn (World Health Organization, Lao People’s Democratic Republic) reported a decline in malaria cases from 2018 to 2022. However, persistent localized transmission hotspots within high-risk populations remained a challenge. Interventions were introduced in target villages which include political advocacy, community engagement, village census, top up of long-lasting insecticidal nets, targeted drug administration, and monthly intermittent preventive treatment for forest goers. After implementation, the target districts reported 81% fewer cases of P. falciparum in 2022 and 47% fewer cases of P. falciparum, compared to 2019-2020. A time series analysis was done to assess the impact of these strategies from 2019 to 2024. For the P. falciparum and P. vivax results, the model demonstrated no significant immediate effect, showing a sustained decline in cases after implementation of 10% and 12% respectively. The declines were also due to strong routine interventions and the depletion of the parasite reservoir in the source communities within the district.

Frantisek Stejskal (Charles University, Czech Republic) spoke on malaria imported to the Czech Republic, specifically in the University Hospital Bulovka. With a total of 260 patients with malaria from 2006 to 2024, it represented 55.6% of all cases imported to the Czech Republic.  P. falciparum was the dominant species at 77.7% followed by P. vivax (16.5%), P. ovale (3.5%) and P. malariae (2.3%). The origin of patients with malaria were mostly from Africa (75%), Southeast Asia (15.7%) followed by South Asia (4%), Latin America (4%), and the airport (<1%). Severe falciparum malaria was reported in 46 cases with a male:female ratio of 3.2:1 at median age of 44 years old which contributed to 4 deaths. The highest complications for patients with severe malaria were hyperparasitaemia and jaundice. It was observed that the laboratory parameters for patients with severe falciparum malaria who died showed higher levels of white blood cell counts, hemoglobin levels, C reactive protein, and lactate levels.

Symposium P19 – Japanese innovations for the global malaria elimination: Zero malaria campaign by 2030

Shigeyuki Kano (National Center for Global Health and Medicine, Japan) addressed the global issues of malaria elimination, to which Japan can contribute. The Okinawa Infectious Diseases Initiative and the Global Fund were introduced in 2002 as a result of the G8 Kyushu-Okinawa Summit. In 2014, Asia-Pacific leaders committed to achieving a malaria-free region by 2030 at the East Asian Summit, a goal also adopted by the African Union in 2016. Kano addressed several challenges to malaria elimination, such as drug resistance, asymptomatic reservoirs, infections caused by P.  knowlesi, and the presence of P. vivax hypnozoites. He also highlighted strategies for malaria elimination, including vector control for prevention, case management, chemotherapeutic interventions, new diagnostic tools or vaccines, surveillance, monitoring and evaluation, and the strengthening of health systems for resilient, sustainable health and universal health coverage. These strategies were developed in depth by the following speakers. He then briefly introduced two organizations involved in malaria elimination in Japan: Malaria No More Japan (MNMJ) and the National Center for Global Health and Medicine (NCGM).

Ray Nishimoto (Koei Chemical Co. Ltd., Japan) provided an overview of integrated vector management by discussing the history of Sumitomo Chemical products recommended by the World Health Organization (WHO). The company produces insecticide-treated nets (ITNs), larvicides, space sprays, and indoor residual sprays. Insecticide resistance in mosquitoes has spread widely in the African and Asia-Pacific regions. WHO has recommended seven classes of insecticides: organochlorines, organophosphates, carbamates, pyrethroids, pyrroles, neonics, and meta-diamides. The private sector faces challenges such as a small market with fierce competition, expensive R&D and registration costs. Nishimoto highlighted that continuous innovation is essential to eliminate malaria, and improved tools and approaches are needed to manage resistance. Therefore, product development partnerships have become the driving force in developing new tools. With political will and regulatory harmonization, the Asia-Pacific region has the opportunity to demonstrate global leadership in eliminating malaria.

Aya Konishi (Sysmex Corporation, Japan) introduced the XN-31, an automated hematology analyzer. This analyzer can provide qualitative results for malaria-infected red blood cells, including counting and percentage, automatically within one minute. It offers a sensitivity of 20 parasites/μL and requires only a low level of expertise. On the contrary, utilizing flow cytometry techniques, it produces results in a scattergram pattern. In a study conducted in Thailand to assess the performance of the XN-31 in detecting both symptomatic and asymptomatic malaria infections, the results indicated that in symptomatic patients, the sensitivity of the XN-31 was comparable to microscopy and superior to rapid diagnostic tests. Thus, the instrument can support early diagnosis and treatment of malaria.

Keiko Watanabe (Eiken Chemical Co. Limited, Japan) discussed a simple and rapid diagnostic method for malaria elimination. Loop-mediated isothermal amplification (LAMP) addresses many of the problems associated with commonly used diagnostic methods such as RDTs, microscopy, and PCR. Among the advantages of this molecular method is its ability to detect asymptomatic cases in patients with low parasitemia that go undetected by other methods. The LAMP Test Kit comes with free maintenance, an 18-month shelf life, a five-year life expectancy, and flexible storage conditions. Watanabe further discussed the operating procedure and reported the performance of the test kit. She concluded that LAMP is a new and promising tool for the diagnosis and surveillance of malaria in elimination settings.

Kazuhiko Yano (National Center for Global Health and Medicine, Japan) presented a promising antigen that can be used in malaria vaccine development and also serve as a target for monoclonal antibody drug development. Enolase is an enzyme that acts as an antigen in malaria infections. The antigen has been reported to be easily recognized by antibodies in malaria patients. Patients’ sera were used in their study to extract and screen proteins for the specific enolase antigen, 47 kD. Rabbits were immunized with the synthesized form of the antigen, leading to the production of polyclonal antibodies. The antibodies were found to significantly inhibit Plasmodium falciparum in vivo. To validate effectiveness, Yano introduced the synthesized antigen AD22 into mice and monkeys. All animals produced antibodies that reduced parasitemia levels and delayed disease severity. The study also developed a human monoclonal antibody targeting AD22, with potential for use in the treatment of drug-resistant malaria. He regarded this finding as an innovative contribution to the fight against malaria.

Symposium P18 – Ivermectin and Malaria Elimination

Kevin Kobylinsky (Mahidol Oxford Tropical Medicine Research Unit – MORU, Thailand) presented the use of ivermectin in the fight against malaria. Ivermectin is an antiparasitic drug that has been successfully used to control diseases such as onchocerciasis and lymphatic filariasis, among others. Surprisingly, ivermectin was found to have a lethal effect on malaria vectors. He shed light on the lethal effect of ivermectin on Anopheles mosquitoes feeding from long-lasting ivermectin-injected cattle and buffalo. Their study found that ivermectin caused mortality in mosquitoes for over 70 days post-treatment in cattle. In buffalo, however, some mosquitoes resisted the treatment; thus, he recommended further studies to determine the ideal dosage of long-lasting ivermectin.

Joel Tarning (Oxford University, United Kingdom) presented a study that investigated ivermectin’s pharmacometric properties and its lethal effect on mosquitoes. Their previous study observed differences in mosquito mortality, in vitro and in vivo. As such, they used in vitro and clinical samples to isolate, characterize, and measure ivermectin metabolites. The study also investigated ivermectin’s lethality on mosquitoes and drug interactions in human volunteers. Three novel ivermectin metabolites were isolated and synthesized which were found to have a similar mortality effect on mosquitoes as ivermectin. Additionally, the study modeled pharmacometrics and pharmacodynamics to predict drug dosing scenarios for ivermectin administration in treatment and mass drug administration. 

Achaporn Yipsirimetee (Mahidol Oxford Tropical Medicine Research Unit – MORU, Thailand) discussed the activity of ivermectin against the asexual and sexual stages of Plasmodium falciparum and its interactions with antimalarial drugs. Ivermectin is a complementary malaria vector control agent that reduces Anopheles mosquito survivorship, subsequently decreasing malaria incidence and prevalence. Ivermectin acts on the mosquito, liver, and blood stages of Plasmodium. A study on the asexual and sexual blood stages of artemisinin-sensitive and artemisinin-resistant P. falciparum showed no difference in half-maximal inhibitory concentration (IC50) values between the two. Male gametocytes were more susceptible to ivermectin than female gametocytes. In vitro, drug interaction tests between ivermectin and eight antimalarial drugs resulted in no interactions. Thus, Yipsirimetee concluded that ivermectin was unlikely to interfere with the antimalarial activity of commonly used antimalarial drugs.

Wang Nguitragool (Mahidol University, Thailand) presented a cluster-randomized trial of mass ivermectin administration in Surat Thani, Thailand, from 2017 to 2023. Surat Thani was selected due to low migration, the presence of Plasmodium falciparum and P. vivax in the area, and its homogeneous ecology. A baseline survey was conducted in 2019, and mass drug administrations (MDAs) of ivermectin began in 2022. This trial aimed to evaluate the impact of repeated ivermectin MDAs on malaria transmission. Ten treatment and ten control clusters were formed, with each cluster containing 300 participants. Three rounds of MDAs were performed. Adverse events such as dizziness, drowsiness, and diarrhea were reported among the participants, leading to a decrease in participation in the second and third rounds of MDAs. No impact was observed in the trial, which might have been due to the relapse of P. vivax, the low prevalence of malaria, migration of participants and mosquitoes, as well as low treatment coverage, which was only 60% to 70%.

Malaria – Epidemiology 3

Chua Hock Hin (Sarawak General Hospital, Malaysia) addressed that the malaria cases in Sarawak were mostly zoonotic in origin from P. knowlesi, followed by imported human malaria of either P. vivax or P. falciparum. The study objective was to assess the epidemiology and risk factors for malaria deaths from 2014 to 2023 in Sarawak. A total of 27 deaths were reviewed, where 92.6% of them were local natives, median age of 63 years old and male:female ratio of 10:17. Fever was reported as the most common symptom (85%). A big obstacle was the mean time from patient symptom onset to first presentation to health care which was ~ 5.3 days while to malaria diagnosis was ~ 5.5 days. This contributed to some patients experiencing death which took less than 3 days (from presentation to death) due to prolonged time before first presentation and diagnosis. The mean malaria parasite count was 157,879/uL of blood which was high. The treatment that was given to all the patients was IV artesunate, with one exception of oral chloroquine.

Odai Sichanthongthip (Centre for Malariology, Parasitology and Medical Entomology – CMPE, Lao People’s Democratic Republic) conducted a surveillance assessment in Lao PDR with the WHO Malaria Surveillance Assessment Toolkit, about 1) performance, 2) context and infrastructure, 3) technical and process and 4) behavior to provide a set of evidence-based recommendations to identify surveillance issues and bottlenecks. Sites that were selected for data collection were provinces with burden reduction districts, only elimination districts, and with no reported malaria cases in the previous 5 years. The overview result of the surveillance assessment showed 1) performance at 76% which recommended transitioning towards a single data storage system, 2) context and infrastructure at 70% with collection of case investigation and travel history, expansion of malaria surveillance with Mobile Malaria Workers, 3) technical and process at 67%, with new dashboards and validation rules to be entered in data storage system to avoid transcription errors and 4) behavior was at 70%, with supervision form included in the data storage and refresher trainings. The new surveillance system was updated based on these recommendations for 2024.

Hyun-Il Shin (Korea Disease Control and Prevention Agency, Republic of Korea) performed molecular analysis using four genes to determine patient cases and a mdr-1 gene to find drug resistance for P. vivax malaria patients in the Republic of Korea. The four protein subtypes found were PvMSP-1, PvAMA- 1, PvCSP, and PvDBP. In 2023, out of the 14 recurrence cases, 1 case of recurrence and 13 cases of relapses were found. Out of the 33 suspected cluster cases, 13 cases were confirmed to have the same genotype between patients. Through cluster analysis identified with the same genotype, it was possible to identify areas where patients and vectors should be intensively managed. Besides, no drug resistance mutation (PvMDR y976F) was found. Although no mutation in the resistance gene to chloroquine has been observed, there is still a need for continuous molecular epidemiological surveillance annually.

Nisa Fauziah (Universitas Padjadjaran, Indonesia) addressed how Indonesia still faces challenges in imported malaria cases, which originated from endemic areas like Eastern Indonesia. The study focused on malaria surveillance data in West Java, focusing on specific challenges encountered for improved insights and strategies. From 2019 to 2023, a total of 2013 cases were reported, where six were indigenous from the Pangandaran regency, and the rest were imported. Pangadaran is a coastal area with high population mobility and tourist activities, making it an ideal breeding ground for malaria vectors. Furthermore, Cimahi City and Depok City gave the highest number of malaria cases with all cases being imported, because they serve as major military bases, often deploying soldiers to malaria-endemic regions. Men had higher cases than women, because of their higher involvement in outdoor occupations. The age group of 15-64 years old was also highly infected with malaria because of their activity and mobile segment. Besides, soldiers and police officers had the highest risk among other occupations due to the deployment nature of their work to malaria-endemic areas.

Fedri Rinawan (Universitas Padjadjaran, Indonesia) stressed that host migration and cases from work travel or tourism could potentially cause local transmission. The relationship between malaria and natural environmental risk factors (NERFs) was investigated in this study. The malaria data came from the malaria information system (e-SISMAL) from 2019 to 2021. The distribution mapping of the estimated regression coefficients and the standard deviation of the residuals was then analyzed using Ordinary Least Square (OLS) in ArcGIS Pro. Results showed the Koenkers test of p-value 0.055620, with stationarity (p>0.05), which implies stable relationships in the spatial context and good linear models for the predictions. Additionally, the Jacque-Bera test result (p-value 0.000000) indicated a non-normal residual. Malaria was explained by 4.03% (R2) of the NERFs. Almost all NERFs contributed significantly. From the analysis results, household and personal factors were suggested as the main parts of the prevention. Rinawan provided a recommendation that emphasized advocacy to the government regarding the risk areas (collaborative surveillance) to prepare for future malaria cases.

Henry Surendra (Monash University, Indonesia) discussed the application of serological surveillance to assess malaria transmission in areas with varying endemicity across Indonesia. He explained that to achieve elimination, it is becoming increasingly important to identify and target transmission foci. Surendra proposed using serological assessments to estimate malaria transmission intensity in three endemic settings in Indonesia, utilizing both ELISA and Luminex MAGPIX. He reported varying results across these settings. According to him, this method allows for the analysis of community-based serological data to confirm malaria elimination and to identify clusters with high exposure in areas that have reported zero cases over the last three consecutive years, health facility-based serological surveillance can predict receptive areas at risk of malaria and seropositivity to Etramp5.Ag1 in children is a potential marker of recent P. falciparum exposure in the population.

Nur Faeza Abu Kassim (Universiti Sains Malaysia, Malaysia) spoke about the application of alginate-gelatin hydrogel beads (AGHB) in controlling mosquito populations within high-risk building areas. She explained that mosquito-borne diseases have been a serious global issue for the past 50 years, causing 390 million infections per year in humans. According to her, communities in high-risk buildings are more vulnerable to these diseases, and traditional mosquito control methods have become less effective. Kassim conducted a study in a rural area near a forest with dense vegetation, which provided a strategic environment for the Aedes mosquito population. She used hydrogel sugar bait technology, which offers several advantages, and followed three steps: pre-treatment, treatment, and post-treatment. Data analysis, performed using the Kruskal-Wallis H test, revealed a statistically significant difference between indoor and outdoor environments. Kassim concluded that AGHBs were more effective indoors, particularly against the targeted species Aedes aegypti.

Olawale Quazim Junaid (Universiti Malaya, Malaysia) discussed the prevalence and risk factors of non-febrile malaria co-infection with hepatitis B virus (HBV) antigen among pregnant women seeking antenatal care in Damaturu, northeast Nigeria. He noted that in 2022, malaria accounted for an estimated 608,000 deaths worldwide, with 96% of these deaths occurring in Africa, and that it can cause prenatal mortality during pregnancy. According to Junaid, blood samples were collected and processed using hematology analysis, HBV antigen tests, thin and thick film microscopy, and rapid diagnostic tests (RDTs), while volunteers also completed questionnaires. The results revealed that 129 (33.6%) of the women tested positive for malaria, 25 (6.5%) for HBV, and 20 (5.2%) had co-infection. Junaid reported that pregnant women over the age of 38 showed the highest prevalence of malaria at 43.5%, HBV at 13.0%, and co-infection at 13.0%. He concluded that while the high prevalence of malaria among pregnant women could be fatal, the low prevalence of HBV infection and co-infection with malaria could still negatively impact pregnancy outcomes.

Eddy Octavio Martinez Avendaño (Universidad Mayor de San Andrés, Bolivia) described the situation of P. falciparum in Bolivia, from its imminent elimination to its reintroduction and rapid spread. He explained that the Amazon is the most malaria-endemic region of the Americas, and northern Bolivia, being part of this region, accounts for over 90% of malaria cases, primarily due to P. vivax and P. falciparum. According to Avendaño, P. falciparum was reintroduced in 2019 by an infected individual from Brazil, which led to local transmission and a subsequent rise in cases. He highlighted that the exclusion of support from collaborators (volunteers) in the diagnosis and treatment of cases, along with socio-political conflicts related to the 2019 government change and the COVID-19 pandemic, may have compromised achievements in malaria control. Avendaño reported that, currently, about 90% of malaria cases are concentrated in just nine Amazonian municipalities. However, he emphasized that the reintroduction and reestablishment of P. falciparum transmission serves as a reminder that malaria surveillance requires significant effort, even when cases are sporadic or reporting remains at zero.

Keynote 2 – Antimalarial Drugs: Past, Present and Future

Sir Nicholas White (Mahidol Oxford Tropical Medicine Research Unit – MORU, Thailand) explained the antimalarial drugs: past, present, and future. In 2022, there were an estimated 249 million malaria cases and 608,000 deaths. White dwelled into the history of antimalarial drug discovery addressing ongoing challenges in controlling malaria. He emphasized that despite current efforts, malaria mortality is still not accurately estimated and called for more funding and new tools but questioned how effectively they are being utilized. The history of plant-based treatments, starting with quinolines from the cinchona tree, was discussed along with William Henry Perkin’s attempt to synthesize quinine, which failed but led to the discovery of a dye instead. Charles Ledger later found an abundance of quinine-producing plants in the Peruvian forest and sold seeds to the Dutch, who dominated 90% of the market, benefiting global supply. White noted that methyl chloroquine and quinidine were more effective but toxic, leading to the widespread use of chloroquine. When resistance emerged, the focus shifted back to quinine, and later to artemisinin, discovered through Project 523 in China. Artemisinin, particularly artesunate, proved highly potent, with artesunate reducing malaria mortality by one-third compared to quinine. When ACT (artemisinin-based combination therapy) was introduced, questions remained about proper dosage and patient suitability. White raised concerns about artemisinin resistance and concluded that combining existing medications could be the way forward in combating malaria.

Closing Ceremony

The 21st International Conference of Tropical Medicine and Malaria 2024 (ICTMM 2024), held in Kuching, Malaysia, from 19-23 September 2024, concluded with a closing ceremony where notable individuals—including leading experts in malaria research, poster presenters, and contributors to both ICTMM 2024 and malaria research—along with esteemed institutions, were honored for their exceptional contributions. Prof. Dr. Siti Nursheena Mohd Zain, Organizing Chair of ICTMM 2024, expressed her appreciation to sponsors, partners, and the Malaysian Government for their support in making the event a success. She stressed the importance of collective efforts to speed up the fight against malaria. Dr. Lucas Low Van Lun, President of the Malaysian Society of Parasitology and Tropical Medicine (MSPTM), used the occasion to thank everyone involved in organizing ICTMM 2024 and acknowledged the contributions of all the participating scientists. He also mentioned that MSPTM will hold the 4th Asia Pacific Rickettsial Conference (APRC4) from 29 September to 1 October 2025 in Penang, Malaysia. The conference was officially closed by Prof. Dr. Malcolm Jones, President of the International Federation for Tropical Medicine (IFTM), who also announced that ICTMM 2028 will take place in Liverpool, United Kingdom.