Background Malaria is a major public-health problem, with over 40% of the world’s population (more than 3.3 billion people) at risk from the disease. Malaysia has committed to eliminate indigenous human malaria transmission by 2020. The objective of this descriptive study is to understand the epidemiology of malaria in Malaysia from 2000 through 2018 and to highlight the threat posed by zoonotic malaria to the National Malaria Elimination Strategic Plan. Methods Malaria is a notifiable infection in Malaysia. The data used in this study were extracted from the Disease Control Division, Ministry of Health Malaysia, contributed by the hospitals and health clinics throughout Malaysia. The population data used in this study was extracted from the Department of Statistics Malaysia. Data analyses were performed using Microsoft Excel. Data used for mapping are available at EPSG:4326 WGS84 CRS (Coordinate Reference System). Shapefile was obtained from igismap. Mapping and plotting of the map were performed using QGIS. Results Between 2000 and 2007, human malaria contributed 100% of reported malaria and 18–46 deaths per year in Malaysia. Between 2008 and 2017, indigenous malaria cases decreased from 6071 to 85 (98.6% reduction), while during the same period, zoonotic Plasmodium knowlesi cases increased from 376 to 3614 cases (an 861% increase). The year 2018 marked the first year that Malaysia did not report any indigenous cases of malaria caused by human malaria parasites. However, there was an increasing trend of P. knowlesi cases, with a total of 4131 cases reported in that year. Although the increased incidence of P. knowlesi cases can be attributed to various factors including improved diagnostic capacity, reduction in human malaria cases, and increase in awareness of P. knowlesi, more than 50% of P. knowlesi cases were associated with agriculture and plantation activities, with a large remainder proportion linked to forest-related activities. Conclusions Malaysia has entered the elimination phase of malaria control. Zoonotic malaria, however, is increasing exponentially and becoming a significant public health problem. Improved inter-sectoral collaboration is required in order to develop a more integrated effort to control zoonotic malaria. Local political commitment and the provision of technical support from the World Health Organization will help to create focused and concerted efforts towards ensuring the success of the National Malaria Elimination Strategic Plan.

In South East Asia, dengue epidemics have increased in size and geographical distribution in recent years. We examined the spatiotemporal distribution and epidemiological characteristics of reported dengue cases in the predominantly rural state of Sabah, in Malaysian Borneo-an area where sylvatic and urban circulation of pathogens are known to intersect. Using a public health data set of routinely notified dengue cases in Sabah between 2010 and 2016, we described demographic and entomological risk factors, both before and after a 2014 change in the clinical case definition for the disease. Annual dengue incidence rates were spatially variable over the 7-year study period from 2010-2016 (state-wide mean annual incidence of 21 cases/100,000 people; range 5-42/100,000), but were highest in rural localities in the western districts of the state (Kuala Penyu, Nabawan, Tenom and Kota Marudu). Eastern districts exhibited lower overall dengue rates, although a high proportion of severe (haemorrhagic) dengue cases (44%) were focused in Sandakan and Tawau. Dengue incidence was highest for those aged between 10 and 29 years (24/100,000), and was slightly higher for males compared to females. Available vector surveillance data indicated that during large outbreaks in 2015 and 2016 the mosquito Aedes albopictus was more prevalent in both urban and rural households (House Index of 64%) than Ae. aegypti (15%). Demographic patterns remained unchanged both before and after the dengue case definition was changed; however, in the years following the change, reported case numbers increased substantially. Overall, these findings suggest that dengue outbreaks in Sabah are increasing in both urban and rural settings. Future studies to better understand the drivers of risk in specific age groups, genders and geographic locations, and to test the potential role of Ae. albopictus in transmission, may help target dengue prevention and control efforts.

3435 In South East Asia, dengue epidemics have increased in size and geographical distribution in 36 recent years. Most studies investigating dengue transmission and control have had an urban 37 focus, while less consideration is currently given to rural settings, or where urban and rural 38 areas overlap. We examined the spatiotemporal distribution and epidemiological 39 characteristics of reported dengue cases in the predominantly rural state of Sabah, in 40 Malaysian Borneo -an area where sylvatic and urban circulation of pathogens are known to 41 intersect. We found that annual dengue incidence rates were spatially variable over the 7-42 year study period from 2010-2016 (state-wide mean annual incidence of 21 cases/100,000 43 people; range 5-42/100,000), but were highest in rural localities in the western districts of 44 the state (Kuala Penyu, Nabawan, Tenom and Kota Marudu). The eastern districts exhibited 45 lower overall dengue rates; however, we noted a concentration of severe (haemorrhagic) 46 dengue cases (44%) in Sandakan and Tawau districts. Dengue incidence was slightly higher 47 for males than females, and was significantly higher for both genders aged between 10 and 48 29 years (24/100,000; p=0.029). The largest ever recorded outbreaks occurred during 2015-49 2016, with the vector Aedes albopictus found to be most prevalent in both urban and rural 50 households (House Index of 64%), compared with Ae. Aegypti (15%). These findings suggest 51 that dengue outbreaks in Sabah are driven by the sporadic expansion of dengue virus in both 52 urban and rural settings. This may require tailoring of preventative strategies to suit 53 different transmission ecologies across Sabah. Further studies to better understand the 54 drivers of dengue in Sabah may aid dengue control efforts in Malaysia, and more broadly in 55 South East Asia.3 56 Author summary 57 58 In order to combat the rising regional incidence of dengue in South East Asia, the drivers of 59 transmission must be better characterised across different environmental settings. We 60 conducted the first retrospective analysis of dengue epidemiology in the predominantly rural 61 state of Sabah, Malaysia, where both urban and sylvatic transmission cycles exist. Human 62 notification data over a 7-year period were reviewed and spatiotemporal and demographic 63 risk factors identified. We found: 64 1. Urban habitats and population density are not the only determinants mediating the 65 spread of epidemic dengue in Sabah. Case from both urban and rural localities 66 contributed equally to dengue outbreaks. 67 2. Human demographic risk factors included being aged between 10 and 29 years, and 68 being male. 69 3. High incidence areas for dengue do not predict the occurrence of severe dengue. Severe 70 dengue was largely localised to lower incidence districts in the east of the state. 71 4. The sole presence of Aedes albopictus in and around the majority of urban and rural 72 case households suggests that this vector may play a major role in facilitating outbr...

Japanese encephalitis (JE) is endemic in Malaysia. Although JE vaccination is practiced in the neighboring state of Sarawak for a long time, little is known about JE in Sabah state in Borneo. As a result, informed policy formulation for JE in Sabah has not been accomplished. In the present study, we have analyzed JE cases that have been reported to the Sabah State Health Department from 2000 to 2018. A total of 92 JE cases were reported during 19 years, and three-fourths of the cases were attributed to children. The estimated mean incidence for JE cases is 0.161/100,000 population. Japanese encephalitis was predominant in Sabah during June, July, and August, peaking in July. In most cases, pigs were absent within a 400-m radius of the place of residence. We could not establish any relationship between the mapping of JE cases and the number of piggeries in each district. We could not establish a relationship between average rainfall and JE cases, either. We propose the cases reported are possibly showing the tip of an iceberg and continuous surveillance is needed, as JE is a public health challenge in Sabah.

Background: Dengue fever infection has become a major public health concern in Malaysia with frequent epidemics occurring in urban areas. In Sabah, Dengue fever is among the 5 most reported communicable diseases and the district of Kota Kinabalu is among the top 3 districts with the highest number of dengue cases with 563 cases recorded in 2016. Aims and Methodolgy: This study aimed to determine the factors contributing or associated with dengue fever occurrence in Kota Kinabalu. A cross- sectional study was conducted among the primary health care clinic attendees in Kota Kinabalu. Data was collected via a set of structured questionnaires focusing on socio-demographic characteristic of participants, environmental characteristic of households, history of previous exposure to dengue fever, knowledge towards dengue fever and its vector, awareness on dengue fever and mosquito control and dengue fever prevention practices. Results and Recommendations: Among the 350 individual’s that participated in the interview, 53 were dengue fever cases. Subsequently, the prevalence of Dengue fever cases among the study population was calculated with prevalence in percentage concluded as 15.1%. Further analysis revealed that factors such as aged group by years, number of household occupants, staying at dengue outbreak areas, self – reported history of recent mosquito bites, indoor and outdoor storage of open water containers, installed house window screens, knowledge on dengue fever and its vector, practices of wearing protective clothing outdoor and usage of mosquito repellent ointment or creams showed significant association with dengue fever outcomes. However, further studies would need to be conducted to determine if these factors possess a higher threat or risk for dengue fever. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.878-886