South-East Asia Regional Conference on Epidemiology

Fig. 4: SARS epidemic curve, China, 2002-2003
<strong>South</strong>-<strong>East</strong> <strong>Asia</strong> <strong>Regional</strong> <strong>Conference</strong> on Epidemiology | 27
In the 2000 Eco-Challenge, 33 of the 312 participants returned to their home countries infected with
leptospirosis. Fortunately, leptospirosis does not transmit from human to human and there were no
outbreaks in the home countries. Many were diagnosed with difficulty by their physicians, and some
died. In a globalized world, humans carry diseases from one part of the world to another. Diseases
also get transferred in insects; for example “airport malaria”, where people who live near airports but
have not travelled become infected with malaria transmitted by mosquitoes travelling in an airplane
from a developing country to an industrialized country. The export of cattle, food and many other
products around the world is also responsible for the spread of infectious diseases. In the 1990s, the
United Kingdom had an outbreak in cattle called mad cow disease. The cattle and cattle bi-products,
however, continued to be traded because it was not known that this organism could infect humans. In
fact, it was only in 1995 that it was found that humans could be infected with this organism. Another
striking illustration of how diseases can travel in the modern world is the case of eagles smuggled into
Belgium in 2005 that were found to be infected with the H5N1 influenza virus. We live in a world
where globalization is rapidly moving infectious diseases that emerge in one place to other locations
across the world in humans, insects, food, animal products and animals.
Political issues can also hold pathogens hostage, as occurred over the bioterrorism worries with
the smallpox virus. Polio eradication offers another good example of how a pathogen can be held
hostage. In 1988, polio eradication began with approximately 1000 children being paralysed each day
in 125 countries because of inequitable access to polio vaccine —just as had occurred with smallpox.
However, by 2003, there were less than one thousand children infected in the whole year and only
six countries remained endemic, i.e. India, Pakistan, Afghanistan, Egypt, Israel and Nigeria. But in
2003, the Governor of one of the northern states in Nigeria had heard of rumours circulating on the
Internet that polio vaccine was being used to sterilize young girls in certain parts of the world to
limit population growth. He immediately stopped all vaccination activities in northern Nigeria. In no
time, 19 countries that had been polio free began to be re-infected from Nigeria, mainly through the
trade routes and Islamic religious groups all the way into Mecca, Saudi Arabia, and to Indonesia. The
Organization of Islamic <strong>Conference</strong>s took this very seriously and developed a series of resolutions and