DRUG-RESISTANT MALARIA, TB, RABIES AND OTHER DISEASES IN SOUTHEAST ASIA

DISEASES IN SOUTHEAST ASIA

Major infectious diseases found in Southeast Asia include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis. Schistosomiasis (bilharziasis) is present in Thailand but the chances of getting it are relatively low. High risk areas include the southern parts of the Mekong River and lakes in northeastern Thailand. There are lots of leeches in the jungle in the wet season bu they generally don't cause any disease.

Liver Flukes occasionally infect people in Laos and northeastern Thailand. They are picked up primarily from eating raw or uncooked fish. Some people get them from eating uncooked paa daek (unpasteurized ferment fish used in many Thai foods). Japanese Encephalitis is occurs, particularly in the rainy season. It is said the highest risk areas are around rice fields and places where pigs are raised since pigs and wild birds (that hang out in rice fields) serve as reservoirs for the disease.

Rabies carried by rodents and dogs has been reported in the countryside. In 2001 there was a report of a rabid dog biting 52 people in three-hour rampage in Thailand. Fifty people died from rabies in Thailand in 2000 and 29 died in the first nine months of 2001, according to the Public Health Ministry.

The number of cases of leprosy has decreased from 5.4 million cases worldwide in 1987 to 940,000 cases in 1997. Most cases are in India and Southeast Asia. Caused by a bacterium in the skin and never tissues, leprosy symptoms include nerve damage, thickening and fold of skin, and atrophy of hands and feet. Most people with leprosy don't know they have had it and have few symptoms.

Tuberculosis in Asia

Reuters reported in 2005: “The Asia-Pacific region accounts for a third of global TB cases, with China, Cambodia, Vietnam and the Philippines representing 80 percent of the region’s tuberculosis, said the U.N. health body. The WHO estimates tuberculosis is spreading globally at a rate of one person per second. Every year eight to 10 million people contract the disease and two million die, it said. [Source: Reuters, September 23, 2005]

“The WHO said a global target of reducing tuberculosis prevalence and deaths by half from 1999 to 2010 was in jeopardy because of a rise in TB-HIV, warning tuberculosis deaths could rise significantly unless the fight against TB-HIV was intensified. “TB-HIV co-infection threatens to reverse the steady progress towards achieving this goal,” said Dr Shigeru Omi, WHO Regional Director for the Western Pacific. [Ibid]

“The WHO said greater surveillance of the deadly co-infection and better access to medicines in developing countries was required to stem the spread of tuberculosis and reduce the death rate. WHO’s Western Pacific regional adviser on tuberculosis, Dr Dongil Ahn, said the emergence of multi-drug resistant (MDR) tuberculosis, particularly in China and Mongolia, was making the fight against the disease more difficult. [Ibid]

“Ahn said that in three of the Chinese provinces where MDR surveys were undertaken, up to 10 percent of new patients were due to MDR. In Mongolia, around 18 percent of prisoners with TB had multi-drug resistance. “It is very hard to treat and the cost of TB medication for MDR is very high, about 100 times the cost of medicine for ordinary TB,” Ahn said. The cost of treating ordinary tuberculosis is about $240 a year, compared with $1,500 to $2,000 for MDR/TB, he said. [Ibid]

Sources: World Health Organization, Center for Disease Control (www.cdc.gov/cdctext.htm

Diabetes Becoming a Serious Health Threat in Asia

Once considered a 'western' disease, diabetes has become an increasingly a global problem. The International Diabetes Federation predicts that the number of individuals with the disease will increase from 240 million in 2007 to 380 million by 2025. An estimated 60 percent of those cases will be in Asia.

Reuters reported: “In China, diabetes has become a serious health problem with the World Health Organisation predicting that by 2030 diabetes cases will have doubled to 42 million cases. In India, the world diabetes capital with 40 million cases, a number expected to double by 2025, the market for health foods is estimated at $200 million per year, according to consulting firm Frost & Sullivan, which predicts it will grow to over $1 billion by 2012. [Source: Ralph Jennings, Reuters, July 8, 2009]

Asians are four to six times more likely to get diabetes than Caucasians, experts say. In the Western Pacific, a region stretching from Mongolia and Japan in the north to New Zealand in the south, the number of diabetics is expected to hit 100 million in 2025 from 67 million in 2007 Reuters reported that health experts are concerned that diabetes, a chronic and potentially fatal disease, could reach near epidemic proportions across Asia and among affluent Asian communities living abroad. [Source: Tan Ee Lyn, Reuters March 12, 2007]

In October 2005, AP reported: Diabetes looms as a larger health threat to Asians than bird flu, the World Health Organization (WHO) said, with data showing the disease will cause millions more deaths worldwide in the coming decades. "This is a global diabetes tsunami, a catastrophe, that will become the health crisis of the 21st century and could reduce life expectancy globally for the first time in 200 years," said Paul Zimmet, director of the WHO's Collaborating Center for Diabetes and the International Diabetes Institute in Australia. [Source: AP, October 27, 2005]

“A new WHO report, Preventing Chronic Diseases: A Vital Investment, shows that chronic diseases, dominated by diabetes, cause twice as many deaths as infectious diseases, maternal perinatal conditions and malnutrition combined. Without action, WHO said 388 million people globally will die from chronic diseases such as diabetes and heart disease in the next decade. Zimmet said that Asia was at the heart of a new global health crisis, brought about by the "Coca-Colanization" and "Nintendoization" of its countries. Based on current trends, Asia is likely to suffer social and economic devastation from an escalating diabetes epidemic, he said in a statement. [Ibid]

“Zimmet said at a conference of the International Diabetes Federation Western Pacific Congress in Bangkok that new research shows worse medical outcomes for patients with both infectious disease and diabetes. For example, medications for HIV are causing diabetes and increased risk of heart attacks, he said. [Ibid]

“Diabetes is a chronic disease that is caused by an inherited or acquired inability to produce enough insulin. It results in high concentrations of glucose in the blood, which can damage many of the body's systems, in particular blood vessels and nerves. Diabetes is among the leading causes of kidney failure, and heart disease accounts for 50 percent of all deaths of people with diabetes in industrialized countries, WHO figures show.

Some Asian ethnic groups are particularly susceptible to Type II diabetes which associated with obesity and lack of exercise. Reuters reported: “In Britain, doctors are seeing a steep rise in diabetes sufferers among Asians, especially of Indian and Pakistani origin. According to Dr Shirine Boardman, a diabetes expert at Warwick Hospital in England, one in four Asians aged over 40 in Britain will get diabetes and 40 percent of people of Pakistani origin in Britain will contract the disease. "(Asian communities) are looking at a huge epidemic coming along as these communities become affluent and have enough to eat and are too busy working to exercise," said Boardman. [Source: Tan Ee Lyn, Reuters March 12, 2007]

Time reported: The cost is huge. Type II diabetes is linked to a host of illnesses including heart disease, stroke and kidney failure. The World Health Organization predicts these diabetes-linked chronic diseases will cost China alone about $558 billion in lost productivity and healthcare costs over the next decade, taking a large bite out of the country's hard-fought economic gains. The good news, he says, is that Type II Diabetes can be controlled with prevention and treatment. [Source: Emily Rauhala, Time, June 01, 2009]

High-Fat Western Diet and Lifestyle Blamed for Increasing Rates of Diabetes in Asia

Tan Ee Lyn of Reuters wrote: “A cheese burger one day, lasagna the next and chicken nuggets instead of a bowl of noodles. Across the continent, a newly-affluent Asian middle class is splurging after centuries of deprivation, shaking off a diet traditionally high in vegetables and rice and low in meat and opting instead for food loaded with saturated fat. But the new variety of foods available to affluent Asians, coupled with a less active lifestyle, has a price -- diabetes. [Source: Tan Ee Lyn, Reuters March 12, 2007]

“Health experts say Asians are especially at risk for diabetes -- caused by excess weight, fatty foods and lack of exercise -- as the Asian metabolism has over the centuries adapted to a frugal diet and a hard-working lifestyle. "If you have a poor early life and you then rapidly move into the direction of plenty, you may be more at risk," said Clive Cockram, a professor of medicine at the Chinese University in Hong Kong. [Ibid]

“The rise in diabetes cases comes hand-in-hand with an economic boom in China and India that has brought prosperity to many poor families. The growing affluence among many in the world's two most populated countries, experts say, could be causing the jump in diabetes cases as people in China and India have more money to spend on food and are less likely to toil in fields. [Ibid]

"There is a theory that famine actually protects people from diabetes," said Kirpal Marwa, a diabetes expert in Britain. Cockram agrees. "The human organism has evolved with a lot of protective mechanisms that are basically developed over millennia to protect us from starvation and deprivation and from being hunted down and killed," Cockram said. "They are not there to protect us from the effects of the current environment which is the exact opposite, where we have plentiful supply of food," he added. [Ibid]

According to his "thrifty gene" theory, a malnourished fetus is likely to have a smaller pancreas that would be less able to cope with a plentiful and sugar-rich diet later in life. The pancreas produces insulin, which helps to use or store sugar. But when the body doesn't make enough insulin or can't properly use insulin, sugar cannot be properly stored or used and it builds up in the bloodstream, resulting in diabetes. Karen Lam, a professor at the University of Hong Kong's Department of Medicine, said the solution is the same regardless of the theories about Asians' susceptibility to diabetes. "At the end of the day how you tackle it is still the same. You eat less, you may have plenty, but you don't need to eat all of it, and you do more exercise," she said.

“Hong Kong chef Cheung Kin-wai discovered he had diabetes when he nicked his finger at work a few years ago. "The wound didn't heal and I had to undergo surgery at once because the bacteria had gone right into my bones. I was confirmed with diabetes," said Cheung, 51. It's not just Cheung's age group that is at risk. Diabetes, for which there is no cure, is striking at more younger people. In Japan, type 2 diabetes among junior high school students doubled to 13.9 per every 100,000 in that age group in 1991-1995 from 7.3 in 1976-1980. [Ibid]

Young Asians Prone to Diabetes

Emily Rauhala wrote in Time: “For Asians, it seems, being young and thin isn't enough to ward off Type II diabetes. Though the disease is typically associated with old age and obesity, a study published May 27, 2009 in the Journal of the American Medical Association (JAMA) shows that Asia's growing number of diabetics are relatively young and well under weights traditionally matched with the disease. [Source: Emily Rauhala, Time, June 01, 2009]

“In North America and Europe the disease most often hits people in their 60s and 70s, but in Asia, it is increasingly hitting the young and middle aged. Asia's diabetics are also thinner: Reviewing 20 years of research on diabetes in Asia, the study's authors, scientists Frank Hu of Harvard's School of Public Health and Juliana Chan of the Chinese University of Hong Kong, found that in Asian populations the risk of diabetes starts at a lower Body Mass Index, or BMI, a measure calculated by dividing weight in kilograms by height in meters squared. [Ibid]

“In Asia, as elsewhere, weight still does matter; obesity and diabetes are clearly linked. The problem, the study found, is that measures of obesity are one-size-fits-all. People with a BMI above 25 are generally considered "overweight," and those with a score above 30 are labeled "obese" and therefore generally considered more at risk for the disease. But focusing on fat alone misses a chunk of Asia's epidemic, says Hu. "BMI doesn't tell the whole story." [Ibid]

“Reviewing over 200 studies on diabetes in Asia, researchers looked at a host of socio-political and cultural shifts that have changed the way Asian people live and eat. The twin processes of rapid economic development and urbanization are partly to blame, says Chan. Changes that took place over 200 years in Europe have been accelerated in Asia, leading to what she describes as a "mismatch" between people's genetic make-up and their habits. Food is more abundant today across Asia than it was, say, 100 years ago, but bodies have yet to adapt. Says Chan: "We are five foot three, but we eat like we are six feet tall." [Ibid]

“Though packing six feet worth of food into a five-foot frame is never advisable, it may be particularly dangerous for Asians, the study found. Because of the metabolic mismatch Chan describes, some people may lack the cells to store excess fat. Instead of bunching around the buttocks or amassing on the arm, extra fat builds in other places, like the liver. Many Asian people, particularly South Asians, are also more prone to abdominal obesity, the study noted. Skinny people with thick middles are particularly prone to developing Type II Diabetes, which helps explain why the disease is spreading in places where people are, on average, quite thin. [Ibid] In Sweden, an increase in number of cases of tick-borne encephalitis has been blamed on global warming.

Malaria in Asia

Malaria is common in some parts of Southeast Asia. Of the 1.1 million people who died of malaria in 1998, 73,000 died in Southeast Asia. On the border of Thailand and Cambodia about 80 percent of the malaria is mefloquine resistant (1994). Preventive measures have lowered the rate among men but the virus is still spreading among women and children. About 6,400 children are infected annually.

Malaria is found in rural areas, but there is generally not much of a risk if you stay close to the cities and the beach resorts. Dangerous chloroquine- and Fansidar-resistant strains of malaria are common, especially near the borders of Thailand, Cambodia and Myanmar . Mefloquine-resistant strains have also been reported. Chloroquine, Fansidar and Mefloquine are the preventative anti-malaria medicines people usually take in malaria areas. Be especially careful in swampy areas and during the monsoon season. Malaria has been “practically eliminated” from coastal areas of Thailand (it is still found on some islands near Cambodia).

The most virulent and drug resistant from of malaria (Falciparum malaria) is found along the Thai-Myanmar border. Untreated the disease is often fatal. The disease has largely been kept under control thanks to doctors, using modern diagnostic method and he Chinese herbal "wonder drug" artesunate in refugee camps in Thailand near the Burmese border. The malaria rate in the camps is 1 to 5 percent compared to 25 percent in border regions in Burma. Unfortunately some doctors have been attacked by Karen guerrillas.

Malaria medication is harmful if it is taken more than several months, consequently local people usually take precautions against being bitten by mosquitos---primarily mosquito netting over their beds and mosquito coils lit in the evenings. Many of the antimalarial medicines sold in Southeast Asia are fake. A study by Lancet in 2001, found that a third of antimalarial drugs sold in Cambodia, Thailand, Vietnam, Laos and Burma contained no active ingredient. Low cost alternatives methods of combating malaria include breeding fish in ponds where mosquito larvae live, filling pits that collect standing water and planting eucalyptus trees in marshy areas.

Urban areas is Asia were one thought to be fairly safe from malaria. But that is no longer always the case. The disease is particularly prevalent around cities in India. Malaria was nearly eradicated in India. The Indian government runs the world's largest anti-malaria campaign. In the 1950s there wee an estimated 75 million cases of malaria a year, with 800,000 fatalities. By 1965, there were only 100,000 cases and considerably less fatalities. Much of the success was due to the use of DDT.

Drug-Resistant Malaria in Southeast Asia

In the monsoon jungles of northern Thailand and forest along the Thai-Cambodia border, malaria has managed to mutate so quickly that every known preventative medicine is either ineffective or partially effective for reasons that are still unknown. Nearly all the people in the stricken area on the Thai-Cambodia border, mostly gems miners, farmers and refugees who fled the Khmer Rogue, came down with malaria in the early 2000s. Many got very sick and more died of the disease than in other places. In Thailand, 15 percent of the deaths at Karen refugee camps in the region are caused by malaria.

Drug-resistant malaria was found on the Thailand-Cambodia border in 2004, and later was discovered along the Thailand-Myanmar border. The story of malaria resistence ges back much futher in Asia. Claire Panosian Dunavan wrote in Discover magazine, “The earliest sightings of chloroquine-resistant parasites date as far back as the late 1950s and early 1960s. Clinical failures first surfaced along the Thailand-Cambodia border, in Colombia’s Magdalena Valley... In the early phases of the Vietnam War, nearly 10 percent of American soldiers came down with malaria; many cases were due to drug-resistant parasites. With their first-line treatment failing, U.S. military doctors quickly moved to mefloquine, a potent replacement. Across the battle lines, Ho Chi Minh, faced with the same problem, appealed for help to then Chinese leader Chou En-lai. His timing couldn’t have been better because it coincided with China’s campaign to reassess plants once used in traditional medicine. That effort turned up the ancient Chinese herb qinghao (artemisinin). [Source: Claire Panosian Dunavan, Discover magazine, August 2005]

“By the late 1980s, some Asian strains were impervious not only to chloroquine but also to sulfadoxine-pyrimethamine, a low-cost alternative to chloroquine, mefloquine, and quinine. Malaria deaths were on the rise. In Vietnam, for example, malaria mortality increased 300 percent between 1987 and 1990. Vietnamese health officials responded with bed nets, community health care, and annual malaria surveys. But their most potent weapon was artesunate. In one southern village, artesunate treatments lowered the proportion of residents with blood parasites from 42 to 4 percent in just five years. And on the Thailand-Myanmar border, using artesunate plus mefloquine stemmed the high rate of malaria infections and restored mefloquine to its previous efficacy. [Ibid]

Drug-Resistant Malaria Spreads Rapidly to Thai-Myanmar Border

In April 2012, AFP reported: “Deadly malaria that is resistant to drug treatment has spread rapidly from Cambodia to the border between Thailand and Myanmar, raising concerns of an uncontrollable epidemic, scientists said. A pair of studies published in The Lancet and the journal Science showed how the disease is moving fast into new territory and identified a region of the parasite's genome that may be responsible for mutating in order to survive. [Source: AFP, April 5, 2012 **]

“Malaria that was resistant to treatment with the current standard therapy, artemisinin, was confirmed in Cambodia in 2006 and has since surged 800 kilometers (500 miles) westward to the Thailand-Myanmar border, the researchers said. By studying 3,202 patients along the northwestern border of Thailand near Myanmar from 2001 and 2010 and measuring the time it took them to clear malaria infections from their blood after treatment, scientists were able to show a steady increase in drug resistance. **

“The number of slow-clearing infections rose from 0.6 percent of cases treated in 2001 to 20 percent in 2010. In western Cambodia, 42 percent of malaria cases were resistant between 2007 and 2010, indicating that the Thailand-Myanmar region was swiftly catching up to Cambodia's rates. "Genetically determined artemisinin resistance in P. falciparum emerged along the Thailand-Myanmar border at least eight years ago and has since increased substantially," said The Lancet study. "At this rate of increase, resistance will reach rates reported in western Cambodia in two to six years." **

“The research in the journal Science focused on what was making these parasites different, and found that a region on chromosome 13 of the parasite was strongly associated with slow clearance of infection. They sequenced the genomes of 91 P. falciparum parasites from Cambodia and western Thailand and compared them to parasites from Laos, where resistance to the latest artemisinin-based drugs has not yet emerged. They found seven genes that may be responsible for making the parasite resistant to drugs, and which may explain up to 35 percent of the growing resistance in southeast Asia. **

"We have now seen the emergence of malaria resistant to our best drugs, and these resistant parasites are not confined to western Cambodia," said leader of the study Francois Nosten, director of the Shoklo Malaria Research Unit that studies and treats malaria in the Thai-Myanmar region. "This is very worrying indeed and suggests that we are in a race against time to control malaria in these regions before drug resistance worsens and develops and spreads further." **

Artemisinin-Resistant Malaria in Southeast Asia

The World Health Organization said in September 2012 that governments in the Mekong region must act “urgently” to stop the spread of drug-resistant malaria which has emerged in parts of Vietnam and Myanmar. [Source: Agence France-Presse, September 27, 2012]

There is growing evidence that the malaria parasite is becoming resistant to a frontline treatment, the anti-malarial drug artemisinin, in southern and central Vietnam and in southeastern Myanmar, the WHO said. Drug-resistant malaria in Vietnam is mainly concentrated in three central and southern provinces, say health officials, adding that there are a number of key factors which make tackling the problem difficult in the communist country. Resistance to artemisinin does not prevent patients being cured, thanks to other partner drugs, but treatment typically takes a few days instead of 24 hours.

WHO regional director, Shin Young-soo, said countries must “urgently address this issue before we put at risk not only the fragile gains we have made in malaria control but also our goal of a malaria-free Western Pacific Region.” Countries in the Mekong region must “intensify and expand” operations to contain and eliminate artemisinin-resistant malaria, Shin said at a WHO regional meeting in Hanoi.

The population in the affected provinces are very poor, highly mobile, and have not widely embraced DEET-treated mosquito nets which could reduce malaria infections, according to media reports of a government conference in July. People in the affected provinces often received outpatient treatment and frequently fail to complete a full course of anti-malarial treatment.

Japanese Encephalitis

Japanese encephalitis is a mosquito-born viral disease that usually infects people in rural areas in the summer and autumn in temperate regions and northern tropical zones of Bangladesh, China, India, Cambodia, Korea, Laos, Myanmar, Nepal, Thailand, Vietnam and eastern Russia. It is sometimes present in the wet season in the tropical zones of south India, Indonesia, Malaysia, the Philippines, Singapore, Sri Lanka. Taiwan and south Thailand.

Japanese encephalitis is transmitted chiefly by the Culex vishui and Culex tritaeniorhyncus mosquitos, which bite mainly in the afternoon and evening and develop from larvae found mainly in cultivated rice fields and marshes. People traveling in rural areas have a stronger likelihood of contacting the disease than those who stay in urban areas.

Most people who are infected display no symptoms, but the fatality rate is as high as 30 percent among victims who are hospitalized. Severe swelling in the head and central nervous system are manifestations of severe cases of the disease.

There is a vaccine that is given in a series of two or three injections one or two weeks apart. There is no medical cure but most victims recover on their own with rest and hospital care.

Encephalitis is a tick-bourne disease that often produces fatal swelling of the brain. Symptoms include fever, headache vomiting, neck stiffness, pain in the eyes when looking at light, alterations in consciousness, seizures, paralysis or muscle weakness. Correct diagnosis requires hospitalization. There are vaccines for encephalitis and specific tick-borne encephalitis immune globulin. Encephalitis prevention includes avoiding places with ticks such as high grass, edges of forests, clearings.

Rabies in Asia

Asia is experiencing a resurgence of rabies. Each year, about 55,000 people around the world die from rabies, more than 80 percent of them in Asia, according to the World Health Organization (WHO). In China, more than 2,400 people die of rabies each year, a sharp climb from less than 200 in 1996. By some estimated there are 17,000 rabies deaths in India each year. Making the virus more tragic is that the victims tend be very young and very poor. Half of all human rabies deaths occur in children under the age of 15, says WHO, and more than 90 percent of human rabies victims in China are low-income farmers living in poor provinces, according to a study published in 2006 in the Chinese Journal of Epidemiology. [Source: Geoffrey Cain, Time, October 12, 2010]

Geoffrey Cain wrote in Time: Dogs, bats, foxes and other warm-blooded mammals carry the virus in their saliva and spread it through bites, scratches or licks on open wounds. People who've been exposed can expect a hellish demise---unless they immediately clean their wounds and seek a post-exposure treatment. Typically between 10 days and a year after exposure, patients can experience headaches, irritation, a fever, insomnia and feel pain or twitching at the location of their bite wound. Two to 10 days after those first signs appear, patients hallucinate, convulse, become paranoid at the sight of water and experience seizures and paralysis before they die typically from respiratory failure. Rabies has the highest fatality rate of any infectious disease, according to Dr. Deborah Briggs, head of the Global Alliance for Rabies Control, a Kansas-based non-profit organization. She says, "Basically when you get it, you die."

Health officials point to a variety of reasons for the surge in rabies. In remote provinces in countries such as China, India and Bangladesh, many rabies infections go undocumented, making it difficult to swiftly pinpoint outbreaks and deliver the necessary post-exposure treatments. Meanwhile, over the past decade public health experts have been fighting urgent outbreaks such as swine flu, bird flu and SARS, overshadowing the gradual rise in the human rabies cases. The fact that poor people are most susceptible to rabies puts initiatives against the virus even further under the radar, says Dr. François-Xavier Meslin, the Geneva-based team leader for neglected zoonotic diseases at the WHO.

Others blame governments for not following through effectively. In the 1990s, some Asian governments blithely assumed they were close to eradicating rabies, leading them to prematurely cut down on much needed prevention and surveillance programs. In China, for example, the number of human rabies cases dropped from about 3,500 in 1990 to 159 six years later, thanks to the government's strict enforcement of domestic dog vaccination and the culling of stray ones. But after the government disbanded most of the country's rabies teams in the mid-1990s, the number of rabies cases predictably shot back up to over 2,000. It's a stark reminder of what can happen when a country doesn't stay on top of disease prevention, even if an epidemic appears to be withering.

The abundance of rabies vaccines for dogs and humans make these deaths completely preventable, Briggs says. Even after someone is bitten, health care workers can quickly inject around the wound a combination of a booster vaccine and rabies immunoglobulin, or antibody. After that, they typically follow up with four more injections every few days for the next month. For the world's poorest people, however, obtaining the vaccine can be prohibitively expensive, and Meslin argues that requires stronger government subsidies in countries such as China and Laos.

Few public health officials advocate the killing of animals unless absolutely necessary, and many Asians are Buddhists or Hindus, which oppose killing animals. With enough support and funding, “locations with a growing rabies problem can hope to repeat the success of Bohol, an island of 1.4 million people in the central Philippines that has witnessed the complete eradication of dog and human rabies. Prior to 2007, the island had one of the highest human rabies death rates in the country, but the government and health care organizations aggressively promoted education and surveillance and vaccinated over 70 percent of dogs according to WHO's guidelines. It shows that governments can curb Asia's growing rabies problem while saving its animals. Says Girardi of BAWA, "We now have a humane alternative for protecting our people and our animals."

Raw Fish Linked to Liver Cancer in Southeast Asia

In 2007, Reuters reported: “Thai researchers have urged people in Southeast Asia to stop eating raw freshwater fish because they risk becoming infected with a parasitic worm that may predispose them to developing liver cancer. At issue are parasitic worms, commonly known as fluke, which infest rivers in rural parts of Thailand, Vietnam, Laos, Cambodia, Korea and China. The worms find their way into freshwater fish, and into humans when the fish is consumed raw. [Source: Reuters, July 9, 2007]

Writing in the latest issue of the Public Library of Science journal PLoS Medicine, the researchers said most people infected with fluke showed no symptoms but some went on to develop liver cancer years later. "Less than 1 percent who are infected with fluke will get liver cancer, but those who get infected are in the millions in Thailand, Cambodia and Vietnam. There are 6 million (infected with fluke) in Thailand," said Banchob Sripa of the pathology department in Thailand's northern Khon Kaen University.

Banchob has studied the link between fluke infection and liver cancer, particularly in the bile duct, for more than 20 years. He and his colleagues found fluke infection to be especially serious in the north and northeastern provinces of Thailand, where a raw fish dish, called Koi-Pla, is popular. "Stop eating this, it's the easiest thing to do," Banchob said. He said fluke attack the human bile duct and the incursion triggers a "cytokine storm"---an immune response so intense that it destroys not only the parasites, but the person's surrounding tissues as well.

"There are two mechanisms. The fluke has two suckers. It can bite the surface epithelium of the bile duct and cause ulcers. The second is the inflammation," Banchob said. "The ones with more inflammatory cytokines may have more inflammation ... and these may develop cancer later on." Liver cancer is usually diagnosed when it is far advanced because symptoms surface late. "Most who are diagnosed have advanced cancers, like stage 4, so they only get palliative care. It is very difficult to detect early lesions because there are no symptoms," he said. Most deaths occur within six months to a year of diagnosis. "There would be zero survivors after five years," he said.

Swine Flu in Asia in 2009

In April 2009, Reuters reported: “Across Asia, people are closely following the global spread of swine flu from Mexico and preparing for the worst after the World Health Organisation raised its alert level for the outbreak. Authorities in the region have boosted surveillance at airports and hospitals, stockpiled anti-viral drugs and other supplies to fight any outbreaks. Face masks and anti-viral drugs like Relenza and Tamiflu flew off the shelves from pharmacies in some cities.

"It's really apparent, people have been buying face masks all day," said Cyrus Chan, the boss of a dispensary in Hong Kong's Wanchai bar district who had sold out his entire stock of 10,000 adult face-masks and only had child sizes left. "Since SARS, this is the second time there's been such a great demand," Chan added, as a steady stream of customers asking for masks were told there wouldn't be any new stocks of adult masks till later. Still, the mood on the streets appeared largely calm, with the world's most populous region, used to outbreaks of SARS and the H5N1 avian flu, not having yet reported any confirmed cases. [Source: Reuters, April 28, 2009]

“In South Korea, health authorities are testing a 51-year-old woman for suspected swine flu after a trip to Mexico. "There hasn't been much of a reaction yet. I've just had a few calls asking if we have anti-viral drugs or special masks" said a pharmacist in downtown Seoul. "I guess South Koreans have grown accustomed to these breakouts over the past 10 years. But I will be bringing in more Tamiflu to the shelves." [Ibid]

“Asia's patchy medical infrastructure, poverty and vast populations in countries like China and India make it particularly vulnerable should the virus take hold and propagate. China has vowed to disclose any human cases of swine fever promptly, while state-run newspapers on Tuesday urged officials to be open and avoid the kind of cover-ups that brought panic during the SARS epidemic. [Ibid]

“In Singapore, stocks of high-end N95 masks were being depleted in stores, with a sales attendant at Changi Airport saying new stocks wouldn't arrive till next week at the earliest. "We've run out of the masks as people going to Europe or the U.S. are trying to resort to some protection from the flu." In Vietnam, there appeared to be a degree of confusion towards swine flu which is not in fact linked to pigs alone -- but an assortment of swine, human and avian viruses. "Death is everyone's destiny but this will be my last pig blood pudding for a while until the flu warning is over," said truck driver Nguyen Huu Luong, as he finished a bright red bowl of fresh pig blood and herbs in downtown Hanoi. [Ibid]

As a whole the nations of Asia were given credit for coming to together quickly to contain the swine flu threat. Health ministers form east Asian countries held meetings after the disease began taking told in Asia. Information was shared. Procedures were transparent. The region seems to have learned lessons after the SARS and bird flu outbreaks. Asian people took matters into their own hands. "I just want to be safe," a Hong Kong man surnamed Cheng told Reuters as he bought 100 child face-masks for his nine-year-old daughter from the Wanchai pharmacy."SARS was like a rehearsal for us," said Wong Pak-keung, a taxi driver who recalled those dark days when streets emptied and few of the city's 7 million people left home without a face mask. "After SARS, people are more prepared and know what to do." [Ibid]

See China, Japan

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© 2008 Jeffrey Hays

Last updated November 2012

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