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.

The rabies epidemic on Flores Island, Indonesia (1998-2003).

Flores is an isolated previously rabies-free Indonesian island which has been experiencing a canine rabies outbreak which resulted in at least 113 human deaths. It started with the importation of three dogs from rabies endemic Sulawesi in September of 1997. Local authorities responded with massive killing of dogs starting in early 1998. Approximately 70% of the dogs, in the district where rabies had been introduced, were killed during that year, yet canine rabies still exists on Flores at this time (June 2004). Approximately 50 percent of dog bite cases and human deaths were in children under 15 years of age. Between 1998 and the end of 2002, 3,389 post-exposure rabies treatments were provided and none of the treated subjects died. Almost all patients were given the Thai Red Cross intradermal rabies postexposure treatment regimen using tissue culture rabies vaccine. A small but unknown number of patients with very severe exposures also received equine rabies immune globulin. This occurrence indicates that even massive culling of the dog population, without an intensive vaccination campaign of the survivors, will not arrest an outbreak even if it occurs on a small island.

The problem of Taeniasis and Cysticercosis in Irian Jaya, Indonesia.

The disease, caused by the adult and larva of Taenia solium, spread to the western part of Irian Jaya crossing the border of Indonesian to Papua New Guinea. Twenty local health centers reported 638 and 945 new cases with epileptic seizures in 1994 and 1995 respectively. Questionnaires were distributed to 31 respondents with results as follows: 83.9% were illiterate, 93.6% farmers and all of them sometimes ate not well-cooked pork; no other meat was consumed. In this area no healthy drinking water was available; also there was no sanitary facilities. Pigs were roaming around the houses, rarely the pigs were put behind fences. After international collaboration with several institutions, e.g with Asahikawa Medical College, Japan, 29 serum samples were examined by immunoblot with positive results for 67% of the cases suffering from epileptic seizures and 65% with subcutaneous nodules. Moving of people to other areas personal and environmental hygiene, the importance of pigs in the daily life of the community were important issues in maintaning the disease being caused by T.Solium in this area.