Malaria threat in Malaysia currently comes from macaques
World Malaria Day is observed every year on April 25, with the World Health Organization (WHO) selecting a different theme each year to highlight key aspects of malaria prevention and control.
For 2025, the theme is 'Malaria Ends with Us: Reinvest, Reimagine, Reignite', calling for renewed global commitment and innovation in the fight to eliminate malaria.
While significant progress has been made, challenges such as drug resistance, climate change and zoonotic malaria continue to threaten malaria control efforts.
To achieve a malaria-free future, there is an urgent need to reinvest in research and healthcare, reimagine new solutions, and reignite a global commitment to reduce the burden of this disease worldwide.
From macaques to humans
Zoonotic malaria, primarily caused by the parasite Plasmodium knowlesi , is transmitted to humans when an Anopheles mosquito feeds on infected macaques and subsequently bites a human.
It represents a significant challenge because zoonotic malaria introduces a new dynamic in malaria transmission, where the primary host is not human, but wildlife, making it more difficult to control and predict.
Countries such as Malaysia, Indonesia and Thailand have seen an increase in P. knowlesi malaria cases, often in forested areas where humans and macaques share habitats.
The rise in zoonotic malaria has been linked to factors such as deforestation, land-use changes, and the expansion of human settlements into previously untouched wildlife areas.
These environmental changes facilitate closer contact between humans, mosquitoes and macaques, increasing the likelihood of zoonotic transmission.
As such, this form of malaria presents a unique public health challenge that requires a broader focus on environmental health and wildlife conservation.
In Malaysia
Malaysia has made remarkable progress in the fight against malaria, particularly with the successful eradication of indigenous human malaria since 2018.
The country has significantly reduced malaria transmission, largely due to improved public health measures, widespread use of insecticide-treated bed nets, indoor residual spraying and effective antimalarial treatments.
However, the rise of zoonotic malaria is increasingly challenging this success.
This shift highlights the complex nature of malaria transmission and the evolving landscape of the disease in Malaysia.
The rise in P. knowlesi malaria has been particularly pronounced in East Malaysia, where the infection is closely linked to deforestation, agricultural expansion and human encroachment into macaque habitats.
The close proximity of humans to macaques and their shared environments has significantly increased the risk of zoonotic transmission.
P. knowlesi , which naturally infects macaques, is now the dominant malaria species in this region.
Several states in Peninsular Malaysia, such as Kelantan, have also reported an increasing number of zoonotic malaria cases, particularly in rural areas.
While P. knowlesi remains the primary zoonotic malaria parasite of concern in Malaysia, the emergence of other zoonotic malaria species, such as Plasmodium cynomolgi and Plasmodium inui in humans, has added a new dimension of complexity to the country's malaria elimination efforts.
Influencing factors
The factors contributing to the increase in zoonotic malaria are complex and multifactorial, encompassing environmental, ecological, socioeconomic and behavioural elements.
One of the most significant factors contributing to the rise of zoonotic malaria is deforestation and human encroachment into wildlife habitats.
As human populations expand and agricultural activities increase, forests are being cleared for farming, logging and infrastructure development.
This land-use change brings humans into closer proximity with macaques, increasing the likelihood of zoonotic spillover.
Climate change also plays a critical role in shaping the spread of zoonotic malaria.
Temperature, rainfall patterns and humidity affect the lifecycle and distribution of both mosquitoes and the Plasmodium parasite.
Rising temperatures and unpredictable rainfall patterns can expand the geographical range of Anopheles mosquitoes, bringing them into new areas where malaria was not previously a concern.
Additionally, climate change can alter macaque behaviour and migration patterns, pushing these animals into new areas where they come into contact with human populations and increasing the risk of zoonotic transmission, especially with the presence of Anopheles mosquitoes in these areas.
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While traditional vector control measures such as insecticide-treated nets, indoor residual spraying and larval source management have been effective in controlling human malaria, they may be less effective against zoonotic malaria.
This is mainly because the primary mosquito vectors are outdoor biters (exophagic) and typically feed outside human dwellings.
As a result, indoor-based strategies like insecticide-treated nets and indoor residual spraying, offer limited protection against these vectors.
Preventive methods
Preventing zoonotic malaria requires proactive measures to reduce exposure to infected mosquitoes and macaques in areas where the disease is prevalent.
Many ecotourism activities, such as hiking and wildlife observation, take place in forested or jungle areas that can be high-risk zones for zoonotic malaria transmission.
One of the most effective ways to prevent such infections is to avoid entering forested areas, especially during the peak mosquito-biting times, which are typically at dawn and dusk.
If entering such areas is unavoidable, it is crucial to take the necessary precautions, such as taking prophylactic drugs.
Wearing the right protective clothing is also a simple, yet highly effective measure against mosquito bites.
When entering a jungle where zoonotic malaria is a risk, it is important to wear long-sleeved shirts, long pants and socks to minimise exposed skin.
Light-coloured clothing is also recommended, as mosquitoes are generally more attracted to dark colours.
Clothing made from tightly woven fabrics provides an added barrier against mosquito bites, further reducing the risk of infection.
In addition, using insect repellents containing DEET or picaridin can significantly reduce the chances of mosquito bites.
These repellents should be applied to exposed skin, especially when hiking or engaging in other outdoor activities in areas with a high risk of zoonotic malaria.
It is also advisable to treat clothing and gear with insect repellent to provide additional protection.
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If someone develops a fever, chills, headache or other symptoms resembling malaria after engaging in jungle-related activities or visiting areas where zoonotic malaria is known to occur, it is crucial to seek medical attention immediately.
Early diagnosis and prompt treatment are vital in preventing the progression of the disease to more severe forms.
Stronger multi-sectoral collaborations in combating zoonotic malaria through the integration of the One Health approach are also vital.
This includes strengthening surveillance and diagnostic capabilities in the human health sector, monitoring infection in macaque populations and implementing targeted vector control strategies.
Environmental management, such as reducing deforestation and limiting human-wildlife contact, also plays a key role.
By fostering collaboration among public health, veterinary and environmental agencies, the One Health approach offers a comprehensive and sustainable solution to reduce the risk of transmission and support long-term control of zoonotic malaria.
Dr Nantha Kumar Jeyaprakasam is a senior lecturer of parasitology and medical entomology at University Kebangsaan Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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