Influenza in the Pacific

Influenza A and B viruses cause significant human disease worldwide through regular outbreaks and epidemics of seasonal influenza, and occasional pandemics when a novel influenza A virus emerges. Whereas Australia and New Zealand have well-established systems for community and laboratory-based surveillance of influenza, most other countries of the Pacific are only beginning to develop such systems with the support of various global and regional agencies and networks. Here we describe the role of the World Health Organization Global Influenza Surveillance Network and other organizations in laboratory-based influenza surveillance in the region and review some of the available data on seasonal and pandemic influenza in the developed and developing countries of the Pacific. The particular features of the Pacific Island countries and territories as small dispersed island communities, together with the greater susceptibility of indigenous people to the severe effects of influenza, highlight the importance of developing local laboratory-based surveillance systems. Such systems will improve the understanding, detection and control of seasonal influenza while also providing early warning of the emergence of potential pandemic viruses.

Taeniasis and cysticercosis in Asia and the Pacific: present state of knowledge and perspectives.

Several topics on taeniasis and cysticercosis in Asia and the Pacific are overviewed. In Asia and the Pacific, three human taeniid species have been recognized: Taenia solium, Taenia saginata and Taenia asiatica. The first topic is on evolution of T. solium. Mitochondrial DNA polymorphisms of T. solium worldwide are discussed with emphasis of two specific genotypes: American-African and Asian. The second topic is recent major advances in sero- and molecular-diagnosis of T. solium cysticercosis in humans, pigs and dogs. The third is the present situation of T. solium taeniasis/cysticercosis in Papua (Irian Jaya), Indonesia. The forth is the present situation of T. solium cysticercosis and T. saginata taeniasis in Bali, Indonesia. The fifth is the present situation of T. asiatica taeniasis in Asia and the Pacific and in North Sumatra, Indonesia. The sixth is on the debate of the exact definition of T. asiatica. Because T. asiatica can not be differentiated from T. saginata morphologically, it is time to re-evaluate T. saginata in Asia and the Pacific. New and broad-based surveys across this region are necessary from epidemiological and public health perspectives, based on evidence.

Cervical cancer in the asian pacific-epidemiology, screening and treatment.

Squamous cell carcinoma (SCC) of the cervix continues to be a major problem in many areas of the Asian-Pacific, particularly in the Indian subcontinent and Papua New Guinea, and to a lesser extent in South-East Asia, Korea and Mongolia. In contrast, levels in the developed countries of the region are low, as is also the case for the Muslim countries of Western Asia, and mainland China. Incidence generally mirrora associated mortality, although with some exceptions reflecting facilities and infrastructure for early detection. Over the last 25 years there has been a marked decrease in incidence rates across most of the Asian Pacific, although less pronounced in India than elsewhere, and there are exceptions where the incidence is on the increase. The predominant risk factor is well established to be persistent infection with a high risk 'oncogenic' type of human papilloma virus (HPV), along with multiple partners, other sexually transmitted diseases and smoking. Consumption of vegetables, in contrast, appears to be protective. Hormonal factors may also play some role. Modifying factors may either impact on neoplasia by directly influencing the processes underlying carcinogenesis, or indirectly by affecting persistence of viral infections. For primary prevention, avoidance of repeated infections and smoking, as well as a high antioxidant intake may be beneficial. Vaccines against HPV also have promise for the future, but a better understanding of the mechanisms underlying spontaneous clearance of both infection and cervical intraepithelial neoplasia (CIN) of different grades is also essential for optimal intervention. For screening, the choice of whether the PAP smear, HPV testing or some form of visual inspection are utilized depends on the resources which are available, all approaches having their own advantages and disadvantages, but with similar sensitivity and specificity. One complication is the increase in adenocarcinoma of the cervix which has been reported in some countries, for which risk factors and most effective screening may differ from the SCC case. A focus on high risk groups like sex workers might be warranted where financial and technical support are limited. If cervical intraepithelial neoplasias are detected then cryotherapy or the loop electrosurgical excision procedure (LEEP) are effective for their removal. Control of cancer of the cervix, however, demands that a comprehensive approach to screening and management is adopted, necessitating major training of personnel and provision of appropriate resources.

Cancer burden and trends in the Asian Pacific Rim region.

This paper describes the current cancer burden and time trends, discusses dominant risk factors and prevention and control strategies, and makes future projections for the top eight cancers (stomach, lung, liver, colon/rectum, esophagus, breast, cervix, and leukemia) in the Asian Pacific Rim region. The future cancer trends through to the year 2050 are projected based on population dynamics, including population growth and ageing. In 2000, the Asian Pacific Rim had over 3 million new cancer cases, over 2 million cancer deaths, and 5.4 million people living with cancer. In 2050, 7.8 million new cancer cases and 5.7 million deaths from cancer are projected. The current cancer burden and the future projection provide facts that cancer is and will be a very serious public health problem in the Asian Pacific Rim region and will assist public health officers and cancer researchers in the design and establishment of public health policies, prioritization of future research, and application of current knowledge in the prevention and control of cancer.

Universal neonatal hearing screening: applications for a developing country in the Asia-Pacific region.

Various centers around the world have implemented and evaluated universal hearing screening programs as a response to the US National Institute of Health policy statement on early identification of hearing loss. Several well conducted clinical trials have been devised to examine and evaluate various factors relevant to establishing a UNHS program. This paper aims to describe some of these factors and analyze their applications and implications for a UNHS program for a developing country in the Asia-Pacific Region. Specifically, three main issues will be discussed: hospital vs community based programs, choice of technology, and choice of screening protocol.