Approximately 200 participants gathered in Bangkok, Thailand, March 6-8, 1997, to discuss issues related to emerging infectious diseases in the Pacific Rim. The meeting was organized under the auspices of the U.S.-Japan Cooperative Medical Science Program. Scientists from the United States, Japan, the host country, and 15 other nations of the region, as well as from the World Health Organization (WHO) attended. The meeting focused on research topics relevant to emerging diseases and discussed surveillance and disease prevention. Formal presentations focused on themes of special interest to the region: enterohemorrhagic Escherichia coli (EHEC), dengue and dengue hemorrhagic fever (DHF), and the growing problem of antimicrobial resistance. Summaries of the WHO global and regional plans to address emerging infectious diseases were presented along with summaries from participating countries of their national plans and problems relevant to these diseases.

The session on EHEC included presentations on the status of this important pathogen in the United States, Japan, Australia, and Thailand, as well as a summary of recent efforts to develop better strategies to detect, treat, and prevent EHEC illness. Presentations on dengue included a discussion of atypical infections and brief mention of new results regarding the stability of dried whole blood samples for serologic examination and the use of insecticide-impregnated screens to control vector mosquitoes; the prospective clinical study of DHF under way in Bangkok, carried out as a multicenter collaborative study involving Thai, United States, and Japanese scientists, was described. Presentations on nosocomial and community-acquired resistant infections, acute respiratory infections, and tuberculosis underlined the growing problem of antimicrobial resistance.

Several themes emerged from country reports: the growing importance of dengue fever/DHF and Japanese encephalitis in many countries of the region; increasing problems with diarrheal diseases and other food or waterborne diseases, including cholera; antimicrobial resistance and the need for assistance in laboratory culturing and sensitivity testing; the need for regional surveillance to better define the current patterns of antimicrobial resistance and for the establishment of regional quality control and proficiency testing as one aspect of the regional response; frustration with existing surveillance systems and need for assistance in developing improved surveillance tools and easier information sharing; the need for improved laboratory support, especially the regional availability of high quality diagnostic reagents and development of regional reference facilities; and the desire for a regional approach to addressing emerging infectious diseases.

The meeting concluded with recognition of the need for both greater research in the areas of the epidemiology, diagnosis, treatment, and prevention of EHEC and other Shiga-toxin producing organisms; further studies on DHF, including pathogenesis, clinical intervention, viral genetic variability, and genomic analysis; vaccine development; and improved vector control and fundamental strengthening of public health practices to address emerging infectious diseases including improved laboratory capacity, better surveillance programs, easier and more open communications and information sharing, and assistance in outbreak responses. Participants highlighted the need for greater training opportunities for scientists of the region and for development of regional reference facilities and centers of excellence. The meeting did not cover human immunodeficiency virus and AIDS, although there was clear recognition of its importance within the region.

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