Estimating Geographical Variation in the Risk of Zoonotic Plasmodium knowlesi Infection in Countries Eliminating Malaria

Citation: Shearer FM, Huang Z, Weiss DJ, Wiebe A, Gibson HS, Battle KE, et al. (2016) Estimating Geographical Variation in the Risk of Zoonotic Plasmodium knowlesi Infection in Countries Eliminating Malaria. PLoS Negl Trop Dis 10(8): e0004915. doi:10.1371/journal.pntd.0004915
Published: August 5, 2016

Abstract
anopheles_stephensiBackground: Infection by the simian malaria parasite, Plasmodium knowlesi, can lead to severe and fatal disease in humans, and is the most common cause of malaria in parts of Malaysia. Despite being a serious public health concern, the geographical distribution of P. knowlesi malaria risk is poorly understood because the parasite is often misidentified as one of the human malarias. Human cases have been confirmed in at least nine Southeast Asian countries, many of which are making progress towards eliminating the human malarias. Understanding the geographical distribution of P. knowlesi is important for identifying areas where malaria transmission will continue after the human malarias have been eliminated.
Methodology/Principal Findings: A total of 439 records of P. knowlesi infections in humans, macaque reservoir and vector species were collated. To predict spatial variation in disease risk, a model was fitted using records from countries where the infection data coverage is high. Predictions were then made throughout Southeast Asia, including regions where infection data are sparse. The resulting map predicts areas of high risk for P. knowlesi infection in a number of countries that are forecast to be malaria-free by 2025 (Malaysia, Cambodia, Thailand and Vietnam) as well as countries projected to be eliminating malaria (Myanmar, Laos, Indonesia and the Philippines).
Conclusions/Significance: We have produced the first map of P. knowlesi malaria risk, at a fine-scale resolution, to identify priority areas for surveillance based on regions with sparse data and high estimated risk. Our map provides an initial evidence base to better understand the spatial distribution of this disease and its potential wider contribution to malaria incidence. Considering malaria elimination goals, areas for prioritised surveillance are identified.

Author Summary: Plasmodium knowlesi is a malaria parasite found in wild monkey populations and transmitted from this animal reservoir to humans via infected mosquitoes. It causes severe and fatal disease in humans, and is the most common cause of malaria in parts of Malaysia. The geographical distribution of this disease is largely unknown because it is often misdiagnosed as one of the human malarias. Human malaria parasites are primarily transmitted between humans via mosquitoes and are not frequently transmitted from other animals to humans. Many countries in Southeast Asia, where P. knowlesi infections have been reported, are making progress towards eliminating the human malarias. Understanding the geographical distribution of P. knowlesi is important for identifying areas where malaria transmission will continue after the human malarias have been eliminated. In locations that have high volumes of P. knowlesi infection data, we modelled patterns of variation in the data linked to environmental predictors, and used this to estimate P. knowlesi infection risk in locations where data is lacking. The resulting map represents an initial evidence-base for identifying areas of human disease risk that should be prioritized for surveillance, particularly in the context of malaria elimination in the region.

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