Emerging disease surveillance in Southeast Asia

The emergence of infectious disease causing agents/pathogens necessitates a rational surveillance approach leading to early detection and appropriate intervention. Surveillance activities with support from the US Naval Medical Research Unit No. 2 (NAMRU-2), targeting susceptible populations/areas in Southeast Asia, have been organised using a multi-design strategy: 1) systematic multi-size (usually hospital-based) study; 2) investigation of (suspected) outbreak events involving significant case populations (and associated fatalities); and 3) monitoring of unique "risk opportunities" that include pre- and post-screening of immunologically naïve (susceptible) persons (including military personnel and tourists) travelling in groups to areas of likely disease transmission/occurrence. Recognition of new (or old) disease agents or emerging antimicrobial resistance requires a standardised study effort with complementary advanced diagnostic capabilities. Collaborative research involving NAMRU-2 includes surveillance of 01 and non-01 Vibrio cholerae strains in epidemic and sporadic transmission, profiling regional patterns of antimicrobial resistance associated with Mycobacterium tuberculosis, describing the molecular epidemiology of HIV genotypic spread, and investigating foci of epidemic hepatitis E virus transmission. Focused surveillance efforts, as described, provide for recognition of emerging and/or re-emerging diseases, optimising the investment of generally scarce public health resources.