Author: Yao-Hua Law / Source: Science News
Vinita Surukan knew the mosquitoes were trouble. They attacked her in swarms, biting through her clothes as she worked to collect rubber tree sap near her village in Sabah, the northern state of Malaysia.
The 30-year-old woman described the situation as nearly unbearable. But she needed the job.There were few alternatives in her village surrounded by fragments of forest reserves and larger swaths of farms, oil palm plantations and rubber tree estates. So she endured until a week of high fever and vomiting forced her to stop.
The night of July 23, Surukan was trying to sleep off her fever when the clinic she visited earlier in the day called with results: Her blood was teeming with malaria parasites, about a million in each drop. Her family rushed her to the town hospital where she received intravenous antimalarial drugs before being transferred to a city hospital equipped to treat severe malaria. The drugs cleared most of the parasites, and the lucky woman was smiling by morning.
Malaria has terrorized humans for millennia, its fevers carved into our earliest writing on ancient Sumerian clay tablets from Mesopotamia. In 2016, four species of human malaria parasites, which are spread by mosquito from person to person, infected more than 210 million people worldwide, killing almost 450,000. The deadliest species, Plasmodium falciparum, causes most of the infections.
But Surukan’s malaria was different. Hers was not a human malaria parasite. She had P. knowlesi, which infects several monkey species. The same parasite had recently infected two other people in Surukan’s village — a man who hunts in the forest and a teenager. Surukan suspects that her parasites came from the monkeys that live in the forest bordering the rubber tree estate where she worked. Some villagers quit working there after hearing of Surukan’s illness.
Monkey malaria, discovered in the early 1900s, became a public health concern only in the last 15 years. Before that, scientists thought it was extremely rare for monkey malaria parasites, of which there are at least 30 species, to infect humans.
Yet since 2008, Malaysia has reported more than 15,000 cases of P. knowlesi infection and about 50 deaths. Infections in 2017 alone hit 3,600.
Emerging threat
Malaysia is close to eliminating human malaria. Yet cases of P. knowlesi malaria transmitted from monkeys are up tenfold since 2008.
Malaria cases in Malaysia, 2007-2017
Source: Ministry of Health Malaysia 2018
People infected with monkey malaria are found across Southeast Asia near forests with wild monkeys. In 2017, another species of monkey malaria parasite, P. cynomolgi, was found in five Malaysians and 13 Cambodians. And by 2018, at least 19 travelers to the region, mostly Europeans, had brought monkey malaria back to their home countries.
The rise of monkey malaria in Malaysia is closely tied to rapid deforestation, says Kimberly Fornace, an epidemiologist at the London School of Hygiene and Tropical Medicine. After testing blood samples of nearly 2,000 people from areas in Sabah with various levels of deforestation, she found that people staying or working near cut forests were more likely than people living away from forests to have P. knowlesi infections, she and colleagues reported in June in PLOS Neglected Tropical Diseases. Stepping over felled trees, humans move closer to the monkeys and the parasite-carrying mosquitoes that thrive in cleared forests.
There’s no feasible way to treat wild monkeys for an infection that they show no signs of. “That’s the problem with P. knowlesi,” says Singapore-based infectious disease specialist Fe Espino, a director of the Asia Pacific Malaria Elimination Network.
In 2015, the World Health Organization set a goal for 2030: to stop malaria transmission in at least 35 of the 91 malaria-endemic countries. WHO targets the four human malaria parasites: P. falciparum, P. vivax, P. malariae and P. ovale. Monkey malaria is excluded from the campaign because the agency regards it as an animal disease that very rarely infects humans.
But as countries reduce human malaria, they will eventually have to deal with monkey malaria, Espino says, echoing an opinion widely shared by monkey malaria scientists.
“Something nasty” could emerge from the pool of malaria parasites in monkeys, says malariologist Richard Culleton of Nagasaki University in Japan. Culleton studies the genetics of human and monkey malaria. Malaria parasites can mutate quickly — possibly into new types that can more easily infect humans (SN: 9/6/14, p. 9). To Culleton, the monkey malaria reservoir “is like a black box. Things come flying out of it occasionally and you don’t know what’s coming next.”
Malaysia is very close to reaching the WHO target of human malaria elimination. In 2017, only 85 people there were infected with human malaria. But that success feels hollow as monkey malaria gains a foothold. And while monkey malaria has swelled into a public health threat only in Malaysia, the same could happen in other parts of Southeast Asia and beyond. Even in southeastern Brazil, where human malaria was eliminated 50 years ago, the P. simium malaria parasite that resides in howler monkeys caused outbreaks in humans in 2015 and 2016.
In the late 1800s, scientists discovered the Plasmodium parasite and its Anopheles mosquito carriers. Humans retaliated by draining marshes to stop mosquito breeding and spraying insecticides over whole communities. Governments and militaries pursued antimalarial drugs as the disease claimed countless soldiers during the two World Wars.
Scientists soon found malaria parasites in birds, rodents, apes and monkeys. To the researchers, the parasites found in monkeys were a tool for testing antimalarial drugs, not a threat. An accident, however, showed otherwise.
INFECTED RESEARCHER
In 1960, biologist Don Eyles had been studying the monkey malaria P. cynomolgi at a National Institutes of Health lab in Memphis, Tenn., when he fell ill with malarial fevers. He had been infected with the parasites found in…
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