Emerging infectious diseases--Southeast Asia.

The recent emergence of a new strain (H5N1) of influenza A virus, the so-called avian or bird flu, in Hong Kong underlines the importance of the Southeast Asia region as an epicenter not only for influenza A viruses but also for other microbial agents. In late 1992, Vibrio cholerae O139 appeared on the Indian subcontinent; and within a few months, it had spread to China, Nepal, Pakistan, Malaysia, and as far as Russia. The World Health Organization (WHO) has reported that infectious diseases account for more than 17 million deaths per year worldwide and that at least 30 new infectious diseases have emerged within the last 2 decades. Up to half of the 5.8 billion people on earth are at risk for many endemic diseases, with the most overpopulated and economically depressed countries in Southeast Asia at highest risk. Although vaccines and antibiotics are available for many diseases, in 1995 alone, respiratory infections such as pneumonia killed 4.4 million people, 4 million of them children. Diarrheal diseases, including cholera, typhoid, and dysentery killed 3.1 million, most of them children. Tuberculosis (TB) killed almost 3.1 million, malaria 2.1 million, hepatitis B more than 1.1 million, and measles more than 1 million. Faced with the reality of infectious diseases on a daily basis, Southeast Asian nations have not been able to give emerging disease surveillance the priority status it deserves. Much of the surveillance in the region is centered in a few well-established laboratories where there is adequate expertise, sufficient funding, and personal interest. Because of influenza A, it is widely believed that Asia is the epicenter of new influenza strains; the emergence of the avian influenza strain in Hong Kong supports this contention. As a result of the activities of the Pacific Basin Respiratory Virus Research Group, an excellent surveillance program for respiratory viral infections is in place. If this small cluster of avian flu had occurred elsewhere, it would most likely have been missed. All the 110 WHO Influenza Centers, particularly those in Southeast Asia, have been alerted and are frequently updated about the Hong Kong outbreak. Diagnostic reagents for the identification of the H5N1 strain will be made available to these centers as part of the surveillance program.