Abstract
The life-threatening zoonotic malaria cases caused by Plasmodium knowlesi in Malaysia has recently been reported to be the highest among all malaria cases; however, previous studies have mainly focused on the transmission of P. knowlesi in Malaysian Borneo (East Malaysia). This study aimed to describe the transmission patterns of P. knowlesi infection in Peninsular Malaysia (West Malaysia). The spatial distribution of P. knowlesi was mapped across Peninsular Malaysia using Geographic Information System techniques. Local indicators of spatial associations were used to evaluate spatial patterns of P. knowlesi incidence. Seasonal autoregressive integrated moving average models were utilized to analyze the monthly incidence of knowlesi malaria in the hotspot region from 2012 to 2017 and to forecast subsequent incidence in 2018. Spatial analysis revealed that hotspots were clustered in the central-northern region of Peninsular Malaysia. Time series analysis revealed the strong seasonality of transmission from January to March. This study provides fundamental information on the spatial distribution and temporal dynamic of P. knowlesi in Peninsular Malaysia from 2011 to 2018. Current control policy should consider different strategies to prevent the transmission of both human and zoonotic malaria, particularly in the hotspot region, to ensure a successful elimination of malaria in the future.
Highlights
Over the decades, malaria has persisted as one of the major vector-borne parasitic diseases globally
Malaysia is a country in Southeast Asia, and it is separated by the South China Sea into two regions, Peninsular Malaysia and Malaysian Borneo
From 2011 to 2018, 2587 indigenous P. knowlesi cases were reported in Peninsular Malaysia
Summary
Malaria has persisted as one of the major vector-borne parasitic diseases globally. Its impacts are geographically variable, depending on the intensity of transmission and the parasite species involved [1]. According to the World Health Organization report, an estimated million malaria cases were reported in at least 80 countries and territories in 2018 [2]. With the effort of the roll back malaria initiative, there has been a significant progress in reducing malaria morbidity and mortality through strategies such as comprehensive disease surveillance, distribution of insecticide-treated bednets and the use of highly effective artemisinin combination medications [2]. In Malaysia, the Malaria Eradication Program was introduced in 1967, which continued until the 80s. The program has resulted in a significant reduction in malaria cases by approximately
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