Sunset over Borneo rainforest with mosquito silhouette symbolizing Zika virus.

Zika Virus in Borneo: What You Need to Know About the Outbreak

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Theo Raines in Health & Wellness October 2026 • 4 min read.

"Understanding the autochthonous outbreak of Zika virus in Sabah, Malaysia and its implications for public health."


Zika virus (ZIKV) is a mosquito-borne virus that has gained international attention due to its association with microcephaly in infants born to infected mothers. While many ZIKV infections are asymptomatic, the potential consequences for pregnant women and their babies have made it a significant public health concern.

In 2014, the presence of ZIKV antibodies was first noted in a traveler returning from Sabah, Malaysia, raising concerns about the virus's presence in the region. Further investigations revealed the presence of antibodies in both humans and orangutans, suggesting an ongoing cycle of transmission.

This article delves into the details of the first confirmed autochthonous (locally acquired) Zika virus outbreak in Sabah, Malaysia. We will explore the investigations undertaken to determine the extent of the outbreak, identify potential sources of the virus, and understand the implications for public health in the region.

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Available Zika Data

A 2022 dataset provides baseline information on knowledge of Zika virus infection among forest-fringe and rural residential communities in Sabah. WHO’s May 7, 2026 epidemiology update describes a global review of Zika transmission data through the end of 2025. The listed sources do not provide current Zika case totals for Sabah or Malaysia. KKMNOW is Malaysia’s Ministry of Health platform for making health data accessible, but the supplied description does not identify Zika-specific figures there.

Outbreak Investigation and Testing

The WHO Zika Outbreak Toolbox points to interim laboratory-testing guidance issued in 2016 and surveillance guidelines for Zika disease and its complications. In the 2016 Sabah investigation, researchers examined the extent of the outbreak and potential sources of Zika virus. The report says its phylogenetic tree was constructed with MEGA 5.05 using the neighbour-joining method. The supplied source descriptions do not specify limitations of these methods.

Zika’s Long History in Sabah

The sources describe evidence of Zika in Malaysian Borneo well before the 2016 outbreak: the first Zika virus outside Africa was detected in a mosquito in Malaysia, and serological surveys indicated human infection in Sabah more than six decades ago. Orangutans in Sabah have also been shown to have antibodies against the virus. The 2016 Sabah outbreak report concluded that the detected viruses belonged to the Asian lineage and were not related to the recent outbreak strains in the Americas and Singapore. It characterized infection in Sabah as sporadic and said further studies were needed to clarify the virus’s evolutionary history there.

Unveiling the Sabah Zika Virus Outbreak: Key Findings

Sunset over Borneo rainforest with mosquito silhouette symbolizing Zika virus.

In September 2016, the first autochthonous case of ZIKV infection in Malaysia was detected in Kota Kinabalu, Sabah. This discovery prompted a collaborative investigation to understand the scope of the outbreak and identify potential sources of the virus.

The investigation focused on identifying individuals with ZIKV infection in the Damai area, as well as those with recent travel history to areas known to have ZIKV transmission. Researchers looked for ZIKV RNA in serum samples collected between September and October 2016. Cases were identified through record reviews at health facilities, surveillance systems, and active case-finding activities. Clinical records were reviewed to determine common exposures.

  • Mosquitoes: Mosquitoes, primarily female Aedes albopictus, were collected from 30 locations where patients resided or visited.
  • Sample Analysis: Nucleic acid was extracted from collected mosquitoes using the QIAamp Viral RNA Mini Kit.
  • Animal Samples: Serum samples were also collected from 4 wild M. Fascicularis (long-tailed macaques) by a veterinarian.
  • Genetic Sequencing: Nucleotide sequences were determined by BigDye terminator v3.1 cycle sequencing kit.
  • Phylogenetic Analysis: A phylogenetic tree was constructed using Mega 5.05 using the neighbour-joining method.
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Research on Zika in the Region

A 2023 narrative review examines recent Zika outbreaks, transmission dynamics, public-health consequences, clinical manifestations, diagnosis, treatment, and control challenges. A study of 188 serum samples from acute febrile patients in Kota Kinabalu and Lahad Datu detected Zika virus genomes in 13 samples (6.9%); the abstract notes dengue among the infections considered. Another regional study reports that Zika virus had been detected in Aedes aegypti mosquitoes in Malaysia in 1966, before its 2007 re-emergence. These sources address different evidence and settings, so the patient-sample finding should not be read as a population-wide prevalence estimate.

Evidence from Communities and Global Studies

A cross-sectional surveillance study sampled 706 people from 10 Orang Asli villages and peripheral communities in Perak, Pahang, and Sabah to investigate Zika seroprevalence. Its abstract notes that Zika has been documented in Malaysia since its first isolation there in 1966, while immunity in forest-fringe communities may be underreported. Separately, a 2026 systematic review and meta-analysis included 574 studies and examined Zika transmissibility, epidemiological delays, and outbreaks at a global scale. The supplied summaries describe different scopes and do not provide comparable prevalence estimates.

The results of the investigation identified two cases of ZIKV infection in Damai residents and one Taiwanese traveler. One of the infected individuals unfortunately passed away. Both local cases resided within one kilometer of each other, and only the first case had a history of travel to Southern Peninsular Malaysia. Further testing revealed that all household members of the local cases and volunteers living within a 400-meter radius of the two cases were negative for ZIKV. Additionally, serum samples from M. Fascicularis and mosquitoes collected from different locations were also negative for ZIKV.

Moving Forward: Understanding and Preventing Zika Virus in Sabah

The investigation concluded that ZIKV infection in Sabah is sporadic, potentially due to limited transmission of the virus. However, ongoing surveillance is crucial to monitor the situation and prevent future outbreaks.

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Challenges in Zika Control

A 2023 narrative review frames Zika outbreaks as a public-health challenge involving evolving transmission dynamics, health consequences, clinical manifestations, diagnosis, treatment, and efforts to control spread. Its stated aim is to analyze recent outbreaks and their implications for public health. The supplied summary identifies these areas as topics of review but does not specify particular control failures or quantify their impact.

To gain a comprehensive understanding of ZIKV epidemiology in Sabah, it is essential to implement a prospective surveillance program that encompasses humans, animals, and vectors (mosquitoes). This will help to identify potential sources of the virus, understand transmission patterns, and develop effective control strategies.

The findings of this investigation highlight the importance of vigilance and preparedness in the face of emerging infectious diseases. By continuing to monitor and study ZIKV in Sabah, we can better protect the health of the population and prevent future outbreaks.

What the Sabah findings establish

The investigation linked locally identified cases with a broader search for possible sources, including mosquitoes and macaques. That search describes what was sampled; it does not by itself establish an animal or mosquito source of infection.[1]

The paper characterized infection in Sabah as sporadic and possibly reflecting limited transmission. That conclusion is a description of the observed situation, not proof that transmission was absent elsewhere or at other times.[1]

A case investigation in Damai, Kota Kinabalu

Sample sizeTwo cases of ZIKV infection were identified in Damai residents and one Taiwanese traveller[1]
SettingDamai area, Kota Kinabalu, Sabah, Malaysia[1]
DurationSept-Oct 2016[1]
Main outcomeExtent of the ZIKV outbreak and potential sources of ZIKV in Sabah[1]
Times cited8[1]

Sabah evidence in regional context

A separate Malaysian analysis reported eight positive tests among 4,043 cases tested, while active detection screened 2,767 cases with all samples negative. These results come from a different analysis and testing context, so they are not direct estimates for the Sabah investigation.[2]

Later sources place Malaysian and Sabah cases among reports of autochthonous transmission across Southeast Asia and describe Sabah cases in people without travel histories. These citations situate the Sabah report within regional accounts, but do not add a new estimate of its outbreak size.[3] [4]

Other regional evidence includes antibody findings in historical human sera, Zika-positive samples from suspected dengue patients in Laos, and a Zika infection found through retrospective testing in Indonesia. These different populations and tests provide context, not directly comparable rates for Sabah.[5]

Questions the Sabah investigation leaves open

  • How well did the sampled mosquitoes and macaques represent the locations and potential sources relevant to the identified cases?[1]
  • What additional evidence would clarify how the Sabah viruses relate to the region’s longer record of Zika detection?[1] [3] [5]

Questions about interpreting the findings

Does a negative test rule out recent Zika infection?

Not necessarily. A negative nucleic-acid test may fail to detect recent infection when the testing period is short or viral RNA levels are low.[6]

Sources

  1. The first outbreak of autochthonous Zika virus in Sabah, Malaysian Borneo (Elsevier BV, 2018)
  2. Zika virus infection in Malaysia: an epidemiological, clinical and virological analysis (pmc.ncbi.nlm.nih.gov)
  3. Hyperendemic Dengue and Possible Zika Circulation in the Westernmost Region of the Indonesian Archipelago (2022)
  4. Spatial epidemiology of Plasmodium knowlesi in Sabah, Malaysia. (2019)
  5. An Update on Zika Virus in Asia (pmc.ncbi.nlm.nih.gov)
  6. Clinical Testing and Diagnosis for Zika Virus Disease | Zika Virus | CDC (www.cdc.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.ijid.2018.04.3899, Alternate LINK

Title: The First Outbreak Of Autochthonous Zika Virus In Sabah, Malaysian Borneo

Subject: Infectious Diseases

Journal: International Journal of Infectious Diseases

Publisher: Elsevier BV

Authors: S.M. Jeffree, J. Julian Frederick Dony, K. Ahmed

Published: 2018-08-01

Everything You Need To Know

1

What exactly is Zika virus (ZIKV), and why is it such a concern?

Zika virus (ZIKV) is a mosquito-borne virus that has gained international attention due to its association with microcephaly in infants born to infected mothers. The virus can cause severe health complications, especially for pregnant women and their unborn children. While many ZIKV infections are asymptomatic, the potential for severe birth defects highlights the importance of understanding and controlling its spread.

2

What does it mean that the Zika virus outbreak was 'autochthonous' in Sabah?

The first autochthonous case of ZIKV infection in Malaysia was detected in Kota Kinabalu, Sabah. Autochthonous means the infection was locally acquired, indicating the virus was transmitted within the region rather than brought in by a traveler. This discovery was a critical event because it confirmed that ZIKV was actively circulating within Sabah, necessitating further investigation and public health measures to contain the outbreak.

3

What were the main steps taken to investigate the Zika virus outbreak in Sabah?

The investigation into the ZIKV outbreak in Sabah involved several key steps. Researchers identified individuals with ZIKV infection in the Damai area, and those with recent travel history to known ZIKV transmission locations. They collected and analyzed serum samples, focusing on record reviews at health facilities, surveillance systems, and active case-finding activities. Mosquitoes, primarily female Aedes albopictus, were collected, and genetic sequencing was conducted. Samples from wild M. Fascicularis were also analyzed. These diverse methods aimed to understand the extent of the outbreak, identify potential sources, and trace the virus's spread.

4

What were the key findings of the Zika virus outbreak investigation?

The investigation identified two cases of ZIKV infection in Damai residents and one Taiwanese traveler. These cases confirmed the presence and transmission of the virus within Sabah. Notably, one of the infected individuals passed away. The geographic proximity of the local cases and the travel history analysis helped to narrow down potential sources of infection and understand the pattern of spread within the community. These findings emphasized the need for ongoing surveillance to monitor the situation and prevent future outbreaks.

5

What are the implications of the Zika virus outbreak for the people of Sabah?

The investigation concluded that ZIKV infection in Sabah is sporadic, likely due to limited transmission. The presence of autochthonous cases, however, indicates the virus is still a public health concern. Ongoing surveillance is therefore crucial to monitor for future outbreaks and prevent potential harm, particularly to pregnant women and their babies. This includes monitoring mosquito populations, tracking new infections, and implementing public health interventions to control the spread of ZIKV within the region.

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