IS　国際シンポジウム: The Present Situation of Infectious Diseases in Southeast Asian Countries and Desirable Cooperation from Japan

When we image infectious diseases in the tropics we usually remember two types of infectious diseases, namely, vector-borne diseases such as malaria and dengue fever and water-borne or food-borne diseases such as cholera and dysentery. However, recent socio-economical changes in tropical countries, especially in South-east Asian countries have also changed the situation of communicable diseases. We, members of Japanese society of tropical medicine and Japan association of international health notice the importance of those diseases and are interested in the change that happens in each of South-east Asian countries. To this joint meeting we were able to invite four responsible persons in communicable disease control from Indonesia, Thailand, Philippines and Vietnam. They are concerned with the control activities of infectious diseases at the moment in their countries. We can listen to the real present situation of infectious diseases in four countries in this symposium. Besides, I requested them to propose their desirable cooperative programs to us. We hope this symposium will give us new knowledge of the present situation of infectious diseases in each countries and lead us to take proper cooperative actions.

Emerging diseases control in Indonesia and its challenges

The emergence and re-emergence of infectious diseases reverses our previous belief that communicable diseases have been controlled. Development of antibiotic-resistant pathogens and lack of vaccines for many infectious diseases remind us that we are still at risk. The problems of these emerging and re-emerging infections (ERI) give us several warnings. First, we know quite little about these ERI. Second, many of these ERI are zoonotic and we need to involve non-health sectors in our control efforts. Third, ERI can easily spread across geopolitical boundary. Therefore, control efforts cannot be limited into one’s geographical boundary. Fourth, in addition to fundamental tools in disease control, we have few other tools, e.g. drugs and vaccines. Fifth, ERI could cause many damages in terms of non-health. As a result, the human and health dimensions of ERI could be easily ignored.
There are some guiding principles that we may have to adopt. First, no country can or should be allowed to fight ERI alone. Second, ERI problems need a lot of non-health partners, e.g. business, agriculture. Third, we need to improve our capacity to do surveillance and to respond. Surveillance without response is pointless.
Networking is a mechanism through which countries could work together to fight ERI. There are several existing networks, e.g. WHO, OIE/FAO, ASEAN+3, APEC and ACMECS. In addition, several bilateral frameworks are also in place. It is important to appreciate the particular nature of the ERI and follow the guiding principles.

Public health programs are in place for the prevention and control of well-known infectious diseases with the following general goals to: 1) sustain the polio-free status of the country, 2) decrease mortality and morbidity from vaccine-preventable diseases, tuberculosis, food and water-borne diseases, HIV/AIDS and other infectious diseases and 3) eliminate rabies, malaria, filariasis, schistosomiasis and dengue as a public health problem by 2010.
However, the country and the rest of the world continue to face the threat of emerging and re-emerging infectious diseases. The inherent unpredictability of emergence of previously known and unknown infectious diseases can limit the responsiveness of even the most organized health system. Thus, building on the existing infrastructure and systems, preparedness to unpredictable and severe outbreaks should be a continuing process geared towards strengthening surveillance systems, strengthening of policies, standards, systems and infrastructure, manpower development, resource generation, intersectoral collaboration and improvement of coordinating mechanisms within and outside the country.
The following aspects for possible cooperation between the Philippines and Japan may be explored: strengthening systems for early recognition of disease and response of local units, building diagnostic and management capacities for infectious diseases in designated national and sub-national facilities, establishment of real-time surveillance and information systems, generation of information from research studies that could serve as basis for further formulation of policies, organization and mobilization of rapid response teams who are appropriately trained and well-equipped, preparedness assessment through simulation and other similar exercises and development of new technologies for the prevention and control of infectious diseases.

In the last ten years in Vietnam, due to great efforts on public health activities, the mortality and morbidity of several infectious diseases have been decreased remarkably such as poliomyelitis, cholera, typhoid, shigellosis, pertussis, meningitis, diphtheria, measles, mumps, hepatitis, plague, rabies, malaria. Poliomyelitis and neonatal tetanus were eradicated in the year 2000 and 2005 respectively. However some infectious diseases such as HIV/AIDS, tuberculosis, dengue fever, encephalitis, rubella, have tendency to increase and still the major public health problem. Especially, SARS and avian influenza have been emerged in 2003 and 2004. But so far, they were controlled in 2003 and 2005 respectively. In the framework of the JSPS program on "Analysis of various factors on emergence and re-emergence of tropical infectious diseases and their control strategy"; and the collaborative project between National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam and Institute of Tropical Medicine, Nagasaki University, Japan on "The collaborative study on emerging and re-emerging infectious diseases in Vietnam: Enhancement of Research Capacity", following issues have been concerning : (1) "mosquito-borne infectious diseases", (2) "human to human infections", (3) "food born infectious diseases", (4) "zoonotic infectious diseases", and (5) "public health". JICA is supporting NIHE to build up Bio-safety level 3 Laboratory for testing dangerous infectious agents.