Exposure and infection to Plasmodium knowlesi in case study communities in Northern Sabah, Malaysia and Palawan, The Philippines

Fornace, K. M. et al. (2018) Exposure and infection to Plasmodium knowlesi in case study communities in Northern Sabah, Malaysia and Palawan, The Philippines. PLoS Neglected Tropical Diseases, 12(6), e0006432. (doi: 10.1371/journal.pntd.0006432) (PMID:29902171) (PMCID:PMC6001952)

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Background: Primarily impacting poor, rural populations, the zoonotic malaria Plasmodium knowlesi is now the main cause of human malaria within Malaysian Borneo. While data is increasingly available on symptomatic cases, little is known about community-level patterns of exposure and infection. Understanding the true burden of disease and associated risk factors within endemic communities is critical for informing evidence-based control measures. Methodology/Principal findings: We conducted comprehensive surveys in three areas where P. knowlesi transmission is reported: Limbuak, Pulau Banggi and Matunggung, Kudat, Sabah, Malaysia and Bacungan, Palawan, the Philippines. Infection prevalence was low with parasites detected by PCR in only 0.2% (4/2503) of the population. P. knowlesi PkSERA3 ag1 antibody responses were detected in 7.1% (95% CI: 6.2–8.2%) of the population, compared with 16.1% (14.6–17.7%) and 12.6% (11.2–14.1%) for P. falciparum and P. vivax. Sero-prevalence was low in individuals <10 years old for P. falciparum and P. vivax consistent with decreased transmission of non-zoonotic malaria species. Results indicated marked heterogeneity in transmission intensity between sites and P. knowlesi exposure was associated with agricultural work (OR 1.63; 95% CI 1.07–2.48) and higher levels of forest cover (OR 2.40; 95% CI 1.29–4.46) and clearing (OR 2.14; 95% CI 1.35–3.40) around houses. Spatial patterns of P. knowlesi exposure differed from exposure to non-zoonotic malaria and P. knowlesi exposed individuals were younger on average than individuals exposed to non-zoonotic malaria. Conclusions/Significance: This is the first study to describe serological exposure to P. knowlesi and associated risk factors within endemic communities. Results indicate community–level patterns of infection and exposure differ markedly from demographics of reported cases, with higher levels of exposure among women and children. Further work is needed to understand these variations in risk across a wider population and spatial scale.

Item Type:Articles
Additional Information:This study was funded by the Medical Research Council, Natural Environmental Research Council, Economic and Social Research Council and Biotechnology and Biosciences Research Council for the funding received for this project through the Environmental and Social Ecology of Human Infectious Diseases Initiative (ESEI). Grant number: G1100796.
Glasgow Author(s) Enlighten ID:Fornace, Dr Kimberly
Creator Roles:
Fornace, K. M.Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft
Authors: Fornace, K. M., Herman, L. S., Abidin, T. R., Hing Chua, T., Daim, S., Lorenzo, P. J., Grignard, L., Afizah Nuin, N., Tiek Ying, L., Grigg, M. J., William, T., Espino, F., Cox, J., Tetteh, K. K. A., and Drakeley, C. J.
College/School:College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:PLoS Neglected Tropical Diseases
Publisher:Public Library of Science
ISSN (Online):1935-2735
Published Online:14 June 2018
Copyright Holders:Copyright © 2018 Fornace et al.
First Published:First published in PLoS Neglected Tropical Diseases 12(6): e0006432
Publisher Policy:Reproduced under a Creative Commons License

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