Health in southeast Asia

Abstract

The Series paper on emerging infectious diseases in southeast Asia by Richard Coker and colleagues (Feb 12, p 599)1Coker RJ Hunter BM Rudge JW Liverani M Hanvoravongchai P Emerging infectious diseases in southeast Asia: regional challenges to control.Lancet. 2011; 377: 599-609Summary Full Text Full Text PDF PubMed Scopus (268) Google Scholar focuses attention on high-profile and undoubtedly significant disorders such as influenza, zoonoses, and vector-borne diseases. Other common, important, but less newsworthy infectious diseases including those less conventionally “tropical”, are of at least equal weight locally and also have global relevance.2Harris SR Feil EJ Holden MTG et al.Evolution of MRSA during hospital transmission and intercontinental spread.Science. 2010; 327: 469-474Crossref PubMed Scopus (841) Google Scholar, 3Croucher NJ Harris SR Fraser C et al.Rapid pneumococcal evolution in response to clinical interventions.Science. 2011; 331: 430-434Crossref PubMed Scopus (653) Google Scholar Bacteria resistant to antimicrobial agents are now commonplace in southeast Asia. Such organisms include meticillin-resistant Staphylococcusaureus,4Chheng K Tarquinio S Wuthiekanun V et al.Emergence of community-associated methicillin resistant Staphylococcus aureus associated with pediatric infection in Cambodia.PLoS One. 2009; 4: e6630Crossref PubMed Scopus (38) Google Scholar penicillin-resistant pneumococci,3Croucher NJ Harris SR Fraser C et al.Rapid pneumococcal evolution in response to clinical interventions.Science. 2011; 331: 430-434Crossref PubMed Scopus (653) Google Scholar multidrug-resistant Salmonella typhi, and extended-spectrum β-lactamase-producing Gram-negativebacteria including Shigella spp, Escherichia coli, and Klebsiella pneumoniae.5Nguyen NT Ha V Tran NV et al.The sudden dominance of blaCTX-M harbouring plasmids in Shigella spp. circulating in southern Vietnam.PLoS Neglected Trop Dis. 2010; 4: e702Crossref PubMed Scopus (43) Google Scholar In Angkor Hospital for Children, a provincial children's hospital in northwest Cambodia, all of these pathogens are regularly isolated from children in hospital and also, alarmingly, from the community. These infections cause morbidity and mortality in children in a region where access to appropriate treatment with expensive antimicrobials for resistant microorganisms is limited. Unfortunately, without intervention, this burden is likely to increase. Many of the factors discussed by Coker and colleagues that encourage the emergence of other infectious diseases also lead to increased antimicrobial resistance. The widespread use of empiric antimicrobials based on the clinical syndrome in health-care settings (owing to scarce diagnostic facilities) is likely to be one contributing factor. The use of injected extended-spectrum cephalosporins and other antimicrobials in the community often at subtherapeutic doses is also a concern. The key issue for this region, and indeed many other developing areas, is the scarcity of surveillance infrastructure and diagnostic microbiology facilities, without which coherent assessment, ongoing monitoring, and ultimately clinical management are extremely limited. Funding was provided by Oxford University Li Ka Shing Global Health Programme and the Wellcome Trust. We declare that we have no conflicts of interest.