Falling Plasmodium knowlesi Malaria Death Rate among Adults despite Rising Incidence, Sabah, Malaysia, 2010-2014

• Published in: Emerging infectious diseases Vol. 22; no. 1; pp. 41 - 48
• Main Authors: Rajahram, Giri S, Barber, Bridget E, William, Timothy, Grigg, Matthew J, Menon, Jayaram, Yeo, Tsin W, Anstey, Nicholas M
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01.01.2016; Centers for Disease Control and Prevention
• Subjects: Adult; Aged; Causes of; Control; deaths; Falling; fatal malaria; Female; Humans; Incidence; Malaria; Malaria - epidemiology; Malaria - mortality; Malaria Death Rate among Adults despite Rising Incidence, Sabah, Malaysia, 2010–2014; Malaysia - epidemiology; Male; Middle Aged; Physiological aspects; Plasmodium; Plasmodium falciparum; Plasmodium knowlesi - pathogenicity; Plasmodium vivax; severe malaria. Plasmodium knowlesi; Malaysia; Australia; artesunate; severe malaria. Plasmodium knowlesi; parasitemia; death rate; Malaysia; malaria; fatality rate; fatal malaria; Plasmodium falciparum; Plasmodium vivax; parasites; incidence; deaths
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2201.151305

Deaths from Plasmodium knowlesi malaria have been linked to delayed parenteral treatment. In Malaysia, early intravenous artesunate is now recommended for all severe malaria cases. We describe P. knowlesi fatalities in Sabah, Malaysia, during 2012-2014 and report species-specific fatality rates based on 2010-2014 case notifications. Sixteen malaria-associated deaths (caused by PCR-confirmed P. knowlesi [7], P. falciparum [7], and P. vivax [1] and microscopy-diagnosed "P. malariae" [1]) were reported during 2012-2014. Six patients with severe P. knowlesi malaria received intravenous artesunate at hospital admission. For persons ≥15 years of age, overall fatality rates during 2010-2014 were 3.4, 4.2, and 1.0 deaths/1,000 P. knowlesi, P. falciparum, and P. vivax notifications, respectively; P. knowlesi-associated fatality rates fell from 9.2 to 1.6 deaths/1,000 notifications. No P. knowlesi-associated deaths occurred among children, despite 373 notified cases. Although P. knowlesi malaria incidence is rising, the notification-fatality rate has decreased, likely due to improved use of intravenous artesunate.