Although malaria is not a threat, doctors advise those living or working near forest fringes to take precautions
IN CONJUNCTION with World Malaria Day on May 12, Dr Sukhvinder Singh Sandhu, a public health physician from the Selangor Health Department said in a radio interview that malaria should be taken seriously although it is not a threat.
“When we talk about malaria, the awareness is quite low. It is only when we raise the awareness can we come up with the actions to prevent it,” he said.
In Malaysia none of the cases were locally transmitted, he said.
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Malaysia saw imported cases where the parasite was introduced by travellers from endemic countries.
Dr Sukhvinder added that there was no direct infection from human to human as malaria is a vector-borne disease spread by the Anopheles mosquito.
“We have successfully eliminated human malaria that is transmitted locally.
“However, now the issue is locally transmitted zoonotic malaria. These numbers are creeping up,” he said.
Of the 3,628 cases reported last year, he said 79% were zoonotic, meaning the host was not human but found in macaques.
At risk were those living near forest fringes such as Orang Asli, armed forces personnel and those working in plantations and logging areas. So are travellers to endemic countries, hikers and campers, he added.
For prevention, Dr Sukhvinder has recommend- ed those in the at-risk group to cover up and to use mos- quito repellents.
“When detected early, malaria is treatable and curable. The mortality percentage is low and it is only high if no treatment is sought in time.
“Here, anyone diagnosed with malaria is admitted to government hospitals. That is the beauty of Malaysia. In no other country are patients admitted as they can seek treatment from outside.
“In Malaysia, it is compulsory because we want to be sure that no patient misses or do not comply with treatment. They are only allowed to go home after they have been treated.
“That is the extent of our concern to make sure the country is malaria-free,” he said.
In terms of advancements in the research of malaria, Dr Sukhvinder said one of them was the capacity to detect zoonotic malaria by using the polymerase chain reaction (PCR) test.
“We are the pioneer in this because most of the zoonotic malaria cases are detectable in Malaysia compared to other countries.
“We have developed this PCR method with our local research institutes. So, to identify the finer type of species, we will use the PCR test with blood samples taken from pricking the finger or taking it from the vein,” he said.
Dr Sukhvinder said although there was a vaccine development for malaria, it was only used in African regions because the burden there was high.
“In Malaysia we are not looking into vaccines because we don’t have any locally transmitted malaria, mostly imported. We can treat it with the local treatment that we have right now,” he said.
Zoonotic malaria
Dr Tam Jenn Zhueng, who is a public health physician in the Health Ministry’s disease control division, said apart from primates, malaria parasites can also be found in chickens, reptiles and rodents.
Zoonotic malaria infections have been commonly seen in communities living at forest fringes typically in Sabah, Sarawak and the interior forest reserves of Kelantan and Pahang.
In Malaysia, if a patient has been tested for malaria – human or zoonotic – every physician in the country must notify the Health Ministry.
Zoonotic malaria presents differently from human malaria because the vector, Anopheles balabecensis, are predominantly outdoor biters while the Anopheles mosquitoes that cause human malaria are found inside the house, Dr Tam said.
The peak biting time of the mosquito is between midnight and early hours in the morning.
“Therefore, they will most likely strike when an individual is asleep outdoor enjoying nature.
“From my experience working in Sabah, Anopheles balabecensis are found and well-documented along the higher altitudes such as the Crocker Range.
“Their habitat can be found in stagnant water that has collected in deep footprints made by large and heavy animals like elephants as well as in river streams during the dry season.
“So, with the monkeys plus humans coming in close proximity of each other, there is active, spillover transmission,” he said, adding that infected primates caused human infection.
Precautionary measures
In addition to using mosquito repellent, wearing long sleeves and long pants while sleeping, Dr Tam said that sleeping under mosquito nets was also vital.
“Currently, these nets are given to selected individuals in communities that are vulnerable to malaria.
“These nets are registered and our people will go and check on the condition of the nets every six months. If they find the nets are spoiled, they will be replaced,” he added.
Dr Tam said the level of severity in zoonotic and human malaria was similar.
“The key is to present yourself early and if you have been to a forest where you have also seen a large number of monkeys, it is important to tell this to your physician so that they would be triggered and be suspicious of zoonotic malaria, apart from leptospirosis and other infectious tropical diseases,” he added.
