New Partners Join the Asia Pacific Malaria Elimination Network (APMEN)

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The Asia Pacific Malaria Elimination Network (APMEN) has announced two new Partner Institutions have joined the organization: The Mahidol Vivax Research Center and the Malaria Research Centre, Universiti Malaysia Sarawak.

The Mahidol Vivax Research Center (MVRC) established in March 2011 is dedicated to the study of Plasmodium vivax and non falciparum malaria. Its establishment at Mahidol University in Thailand is important to the region, as Mahidol has a long record in the field of tropical disease medicine and research. Mahidol Vivax Research Center was initiated by the Dean of the Faculty of Tropical Medicine, Mahidol University, Associate Professor Pratap Singhasivanon and is directed by Dr. Jetsumon Prachumsri, formerly the leader of malaria research at the Armed Forces Research Institutes of Medical Sciences (AFRIMS) and APMEN Partner Institution representative.

The Malaria Research Centre was established at the Universiti Malaysia Sarawak in 2006 in recognition of the major contribution to malaria research by Professor Balbir Singh, Professor Janet Cox-Singh, and co-researchers at the Malaria Research Laboratory in the Faculty of Medicine and Health Sciences. MRC-UNIMAS is known for its work on Plasmodium knowlesi that was recognised by the World Health Organization (WHO) in 2008 as the fifth species of Plasmodia parasite to infect humans in the wild.

MRC-UNIMAS found that many malaria infections in Sarawak, Malaysia, had been incorrectly diagnosed and a major cause of malaria was Plasmodium knowlesi that is transmitted via the bit of an Anopheline mosquito from long-tail and pig-tail macaques. P knowlesi has also been reported in other parts of Malaysia, Indonesia, and Philippines and may be endemic in more countries in Southeast Asia. The final elimination of malaria in the Asia Pacific region will depend on a greater understanding of P knowlesi and how we can target this zoonosis.

The Malaria Research Centre, Universiti Malaysia Sarawak and the Mahidol Vivax Research Center have already supported APMEN through their active participation at last year’s annual meeting in Kota Kinabalu, Malaysia.

The fourth annual APMEN Annual Meeting will be held in May 2012 in Seoul, Republic of Korea. This year’s meeting will focus on how to sustain the gains made in the elimination of malaria and the importance in the coming years of maintaining successful approaches and their support. The region has many challenges to face in malaria elimination, in particular P. vivax, a type of malaria that is more difficult to diagnose and treat than P falciparum, the type of malaria most often discussed at a global level. APMEN through its information exchange, capacity building, and evidence building and advocacy activities is committed to supporting and maintaining elimination efforts in the Asia Pacific Region.

About the Asia Pacific Malaria Elimination Network
The Asia Pacific Malaria Elimination Network (APMEN) was established in 2009 to bring attention and support to the under-appreciated and little-known work of malaria elimination in Asia Pacific, with a particular focus on Plasmodium vivax.

APMEN is composed of 12 Asia Pacific countries (Bhutan, Cambodia, China, Democratic People’s Republic of Korea, Indonesia, Malaysia, Philippines, Republic of Korea, the Solomon Islands, Sri Lanka, Thailand, and Vanuatu) that are pursuing malaria elimination, as well as leaders and experts from key multilateral and academic agencies. The mission of this diverse but cohesive Network is to collaboratively address the unique challenges of malaria elimination in the region through leadership, advocacy, capacity building, knowledge exchange, and building the evidence base.

Development of the Network took place in 2008 through the leadership of the UCSF Global Health Group (GHG) and the School of Population Health, University of Queensland (SPH/UQ). APMEN collaborates closely with the WHO and is supported by the Australian Government through its international aid agency AusAID with a commitment of nearly $7 million for ongoing support to the Network. This complements Australia’s overall support for malaria control and elimination in the Asia Pacific and globally.

Source: Asia Pacific Malaria Elimination Network (APMEN)

Paludrine/Avloclor Anti Malaria Travel Pack

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QUESTION

Is this anti malaria travel pack suitable for Borneo?

ANSWER

This kit is NOT appropriate for preventing malaria in Borneo. Avloclor contain chloroquine phosphate, and some types of malaria present in Borneo are resistant to chloroquine.

The CDC recommends that travelers to Malaysian or Indonesian Borneo should use atovaquone-proguanil (Paludrine contains proguanil, but the drug Malarone contains the combination of proguanil and atovaquone in one pill), mefloquine (sold under the brand name Lariam) or doxycycline.

Each of these different types of prophylaxis (preventative medication) has its advantages and disadvantages: Malarone is very expensive but many people consider it to have the fewest side effects; Lariam has been associated with severe side effects and is not recommended for people with a history of mental illness, but only needs to be taken once a week (the others require a daily pill); and doxycycline is cheap but may produce sun sensitivity.

When you return from your trip, please take a moment to share your experiences with anti-malarial medication by taking our malaria survey. We will compile all the results and post them on MALARIA.com, so visitors to the site can be informed about the preferences and side effects experienced by other members of the public who have used different forms of prophylaxis.

What countries have malaria?

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QUESTION

In which countries can it be found?

ANSWER

Malaria is found in many parts of Africa, Latin America, Asia, and Oceania. The exact distribution depends on climatic variables (namely heat and sufficient rainfall, for the development of the mosquitoes which transmit malaria) and also how successful a particular country or region has been at controlling malaria.

For example, malaria was once found in parts of the U.S. and Europe, but successful campaigns to control mosquitoes and treat cases led to elimination of transmission. The same is true in other parts of the world; for example, in Malaysia, transmission is successfully controlled in Kuala Lumpur, but malaria can still be found in many parts of the surrounding countryside.

Please visit the CDC website for an interactive map of malaria distribution around the world.

Tested Positive for Malaria

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QUESTION

I was found with malaria 0.25% positive in my test report….. will this make to reject my application from a Malaysian university?

ANSWER

Malaria is an infection with a parasite of the genus Plasmodium; all types are very treatable, and so even if you have tested positive, you can easily get medication which will allow you to recover fully from the disease. While some  universities require a health test, since malaria is completely treatable, a positive test for this disease should not stop you from being admitted to the university. However, you should get treated as soon as possible; ask your doctor what kind of medication is most appropriate for the type of malaria you have.

Does Malaria Still Exist?

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QUESTION

does malaria still exist?

ANSWER

Yes, malaria still exists, and is responsible for 250 million cases of illness every year, of which about 700,000 result in death. So it is a very serious global health problem!

Some countries, such as the United States, have managed to successfully eliminate malaria through a combination of vector control strategies (i.e. spraying for mosquitoes, reducing the presence of water bodies where mosquitoes breed, etc) and better health infrastructure for diagnosis and treatment. This strategy has also been successful in other settings, such as the Mediterranean and much of the Middle East, as well as even in some high transmission tropical settings such as Malaysia (particularly in urban areas).

The widespread distribution of long-lasting insecticide treated bednets has further assisted in malaria prevention in high transmission areas. However, much of the rest of the world is still struggling to control malaria, though the number of deaths is dropping every year, and some organisations hope to reduce malaria mortality to zero by the year 2015.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Survey. Thank you!

Diagnosing Malaria

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QUESTION

Where in Malaysia (Kuala Lumpur) can I diagnose malaria? Is it possible within 24 hours?

ANSWER

Given that malaria is endemic in Malaysia (though not usually found in Kuala Lumpar) you should be able to get a malaria test at most clinics or hospitals. The most common test is a thick and thin blood film, read under the microscope by a qualified technician—in some places, clinics are also using rapid diagnostic tests (RDTs). Both of these methods are rapid to prepare and analyse—microscopy may take a couple of hours, depending on the business of the medical staff, whereas an RDT should be ready in about half an hour. In some areas, you can also buy RDTs over the counter at a pharmacy for self-testing.

Malaria in Africa

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QUESTION

Why do Africans catch malaria more than others?

ANSWER

There are a number of reasons why malaria is more widespread in Africa than in many other parts of the world. However, it is worth mentioning that other parts of the world, such as India and south-east Asia, also have very high prevalence of malaria, especially in rural areas.

The high transmission of malaria is Africa is predominantly due to two factors: climate and control measures, or rather, the lack of them.

Malaria is spread by mosquitoes of the genus Anopheles, and so in order to persist, an area must have a suitable temperature for the development of both the mosquito as well as the malaria parasite. This limits malaria transmission to the sub-tropics and tropics, primarily. The area must also have sufficient rainfall and areas of standing water, since the malaria mosquitoes lay their eggs in stagnant water, which the larvae live in until they pupate into adults. This means that malaria transmission cannot occur in desert regions.

Unfortunately, a large portion of Africa, and particularly West, Central and East Africa, are climatically very well suited to the development of mosquitoes and thus the transmission of malaria.

In addition, many countries in Africa are not as developed as other tropical countries. This means that health resources have not been as focused on control efforts in Africa—for example, Malaysia very successfully reduced malaria transmission by a huge amount through a combination of vector control (namely spraying households with insecticides and filling up stagnant water pools so larvae couldn’t develop), distribution of bednets (which reduces mosquito biting rate) and better diagnoses and treatment facilities.

All of these efforts are beginning to be developed and rolled out in Africa as well, so hopefully in the near future we will also see a dramatic reduction in malaria transmission in Africa.

Malaria in Malaysia

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QUESTION:

Is there malaria in Malaysia?

ANSWER:

Yes, there is malaria in Malaysia, although efficient vector control campaigns, alongside a well-functioning health system which effectively diagnoses and treats malaria cases has vastly reduced the transmission of the disease in peninsular Malaysia at least. Transmission is still a problem in rural, interior areas, and especially in Sabah and Sarawak.

The history of malaria control in Malaysia is actually something of a success story; back in 1961, there were over 240,000 reported cases of malaria across the country; this was reduced to about 40,000 cases by 1980, due to the measures mentioned briefly above, and in 2008, that number had further dropped to only about 7,000 cases a year.

The fatality rate of malaria in Malaysia is also very low, being about 0.09%, or about 50 deaths a year, which is a testament to the effectiveness of national health systems at monitoring for the disease. Having said that, Plasmodium falciparum, the most severe type of malaria, is present in Malaysia—it was this that was responsible for all the reported fatalities in 2008. As such, if you are visiting or living in rural regions of Malaysia, where malaria transmission still is relatively high, it is recommended that you take preventative measures against the disease, such as sleeping under an insecticide-treated bednet, or taking prophylactic (preventative) medicine. This latter measure is usually only worthwhile if you are visiting a malaria area for a relatively short time, as the drugs can be quite expensive.

If you have visited these rural areas, and have symptoms of malaria, such as fever and chills, within two weeks of returning, you should go to the hospital or visit a physician immediately for diagnosis. If it is malaria, the doctor will be able to provide you with the most appropriate medicine for the type of malaria that you have.

Monkeys Provide Malaria Reservoir for Human Disease in South-East Asia

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Macaque Monkey

Juvenile Macaque - Sandakan, Malaysia. Photo by Frances Williams (Sandakan-Travel.com).

Monkeys infected with an emerging malaria strain are providing a reservoir for human disease in Southeast Asia, according to recent research. The study confirms that the species has not yet adapted to humans and that monkeys are the main source of infection.

Malaria is a potentially deadly disease that kills over a million people each year. The disease is caused by malaria parasites, which are transmitted by infected mosquitoes and injected into the bloodstream.

There are five species of malaria parasite that are known to cause disease in humans, of which Plasmodium knowlesi is the most recently identified. Previously thought to only infect monkeys, researchers have shown that human P. knowlesi infections are widely distributed in Southeast Asia and that it is a significant cause of malaria in Malaysian Borneo. Until now, it was not clear whether the infection is transmitted from person to person, or is passed over from infected monkeys.

Researchers led by Professor Balbir Singh at the Malaria Research Centre, Universiti Malaysia Sarawak, collaborating with Sarawak State Health Department, St George’s University of London and the London School of Hygiene and Tropical Medicine, examined blood samples from 108 wild macaques from different locations around the Sarawak division in Malaysian Borneo. Their results reveal that 78% were infected with the P. knowlesi species of malaria parasite, and many were infected with one or more of four other species of monkey malaria parasites that have not yet been found in humans.

By comparing the molecular identity of the parasites from monkeys and those isolated from patients with knowlesi malaria, the team were able to build a picture of the evolutionary history of the parasite and its preferred host. Their analysis reveals that transmission of the knowlesi species is more common amongst wild monkeys, than from monkeys to humans, and that monkeys remain the dominant host.

“Our findings strongly indicate that P. knowlesi is a zoonosis in this area, that is to say it is passed by mosquitoes from infected monkeys to humans, with monkeys acting as a reservoir host,” explains Professor Singh. “However, with deforestation threatening the monkeys’ habitat and increases in the human population, it’s easy to see how this species of malaria could switch to humans as the preferred host. This would also hamper current efforts aimed at eliminating malaria.”

Based on the molecular data, the researchers estimate that the knowlesi malaria species evolved from its ancestral species between 98 000 and 478 000 years ago. This predates human settlement in the area, meaning that monkeys are mostly likely to have been the initial host for the parasite when the species first emerged. This estimate also indicates that the species is as old as, or older than, the two most common human malaria parasites, P. falciparum and P. vivax.

The study was funded by the Wellcome Trust, a global charitable foundation that supports biomedical research and the medical humanities. It was published today in the journal PLoS Pathogens.

Source: The Wellcome Trust

Of Macaques and Men

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Plasmodium knowlesi —a new challenge in the Roll Back Malaria Program?

Deforestation oil palm Malaysia

Oil palm plantation in Malaysia: Such land-use change may be affecting malaria transmission. Photo courtesy of Yusmar Yahaya (http://www.flickr.com/photos/leafbug/4880638055/sizes/m/)

Mention of malaria often conjures images of infants hospitalized in Africa. Although most deaths from malaria are children under 5 in sub-Saharan Africa, there are many different types of malaria that put over half of the world’s population at risk in subtropical and tropical regions worldwide.

There have historically been four species of Plasmodium parasites that cause malaria humans.  P. falciparum is the most lethal species that infects humans, whereas P. vivax is the most widespread.  P. vivax and P. ovale also cause clinical symptoms and decreased economic potential in certain regions.

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