title: Is there a risk of suburban transmission of malaria in Selangor, Malaysia?
abstract: BACKGROUND
  The suburban transmission of malaria in Selangor, Malaysia's most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests.
  
  
  RESULTS
  A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor's nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients' showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas.
  
  
  CONCLUSIONS
  Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria surveillance in Peninsula Malaysia.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Kamil A
authors.initials: KA
authors.lastname: Braima
authors.forename: Jia-Siang
authors.initials: JS
authors.lastname: Sum
authors.forename: Amir-Ridhwan M
authors.initials: AR
authors.lastname: Ghazali
authors.forename: Mustakiza
authors.initials: M
authors.lastname: Muslimin
authors.forename: John
authors.initials: J
authors.lastname: Jeffery
authors.forename: Wenn-Chyau
authors.initials: WC
authors.lastname: Lee
authors.forename: Mohammed R
authors.initials: MR
authors.lastname: Shaker
authors.forename: Alaa-Eldeen M
authors.initials: AE
authors.lastname: Elamin
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Jamaiah
authors.forename: Yee-Ling
authors.initials: YL
authors.lastname: Lau
authors.forename: Mahmud
authors.initials: M
authors.lastname: Rohela
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
authors.forename: Frankie
authors.initials: F
authors.lastname: Sitam
authors.forename: Rosnida
authors.initials: R
authors.lastname: Mohd-Noh
authors.forename: Noraishah M
authors.initials: NM
authors.lastname: Abdul-Aziz
mesh_terms: D000367:Age Factors; D000818:Animals; D062665:Epidemiological Monitoring; D006801:Humans; D008252:Macaca fascicularis; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission* / Q000662:veterinary*; D008296:Malaysia / Q000453:epidemiology; D008992:Monkey Diseases / Q000453:epidemiology* / Q000635:transmission*; D010961:Plasmodium / Q000302:isolation & purification*; D015995:Prevalence; D013045:Species Specificity; D018881:Suburban Health / Q000706:statistics & numerical data*