1. MONKEYBAR
The ecological and environmental determinants of
the zoonotic malaria P. knowlesi in Palawan, The Philippines
and Sabah, Malaysia

2. Plasmodium knowlesi
• Identified in 1930s and shown to have contrasting virulence in
different simian hosts
• Little evidence of widespread infection in humans until 2004; PCR
revealed 80% of infections were P. knowlesi not P. Malariae
• Increasing epidemiological evidence of P. knowlesi as an emerging
public health problem
• Increased priority for local governments
– Routine screening for Pk in Philippines

3. Plasmodium knowlesi/ malarie
cases notifications, 2001-2011

4. MONKEYBAR
Multidisciplinary approach to understand the effects of land use
change on zoonotic malaria risk
• What is the extent of the problem?
(burden of P. knowlesi disease in humans on a regional scale)
• What are the risk factors for exposure/ infection?
(same as Pf & Pv? Is there Human to Human transmission?)
• If and how can we control the vectors?
(integrated into current vector control, or new strategy needed?)
• How Pk affects the elimination strategies of WPRO countries
(realistic aim given the potential increase of this zoonotic species?)
• How Pk control can be implemented at the regional level
(considerable unmonitored population movement)

5. Case Control study
• Current progress
– Testing and validation of case
control questionnaires
– Training and recruitment of local
fieldworkers
– Recruitment of 30+ cases with
controls, on-going data collection
in two sites (MAP)
– RCT - treatment options for Pk
• Next steps
– Optimising ELISA to measure
serological exposure to Pk
– Molecular characterisation of
parasites from cases - differences
in phylogeny/clinical outcomes

6. Entomology
• Current progress
– First training and use of e-nets in
SE Asia in the Philippines
• Allows collection of vectors
suitable for morphological
identification and
sequencing
• Next steps
– E-net training in Sabah
– Comparison of mosquito
collection methods using
monkey and human baited
traps

7. Primatology
• Current progress
– Partnership with Sabah Wildlife
Department / Danau Girang Field
Centre
– Protocols under review with
relevant authorities
– Initial transect mapping
• Next steps
– Primatology census, transects
and behavioural observations
and GPS tracking
– Optimising faecal sampling for
parasite prevalence and genetics
in macaque populations

8. Social Science
• Current progress
– Refining questionnaires and tools
for focus group discussions
– Joint training sessions and
development of protocols for
Photovoice
• Next steps
– Active fever surveillance in
Palawan
– Land use/ land cover mapping
– GPS tracking of human
movements

9. Stakeholder engagement
• APMEN - RCT for Pk treatment options
• UBS Social Science - use of Photovoice to
understand risk perceptions
• Multidisciplinary stakeholder meetings
– Ministries of Health, Philippines and
Malaysia
– Wildlife Departments
– Palawan Sustainable Development Council
• Regional stakeholders
– WHO - epidemiology of P. knowlesi
– EcoHealth Alliance

10. Training
• PhD students:
– Malaysia: U of Malaya/ U Malaysia, Sabah
– Philippines: U of Philippines, Los Banos
– UK: additional funding applied for through
other research councils
• UK / Malaysian MSc students
• Photovoice workshops
• Training on entomological techniques with Department of Health
• Microscopy training and molecular characterisation of infections for
local public health workers
• Primate ecology and behaviour field course at
Danau Girang Field Centre

11. Next activities
• Collection of land use data to classify entomological and primate
habitats
• Overlaying of movement patterns onto maps to identify likely points
of encounter between humans, primates and vectors
• Re-evaluation of parameters for mathematical models of Pk
transmission
• Integrated fieldwork to start June/ July 2013