Southeast Asia is a “hotspot” for emerging infectious diseases (EIDs) because several major outbreaks have started in this region, warn experts.

Now, with unprecedented levels of connection between animals and people through urbanization, and of people with other people through increased air travel, scientists say the threat level for new diseases is high. 

The current measles outbreak in Canada imported from the Philippines is a case in point, said the experts according to a report from the UN Office for the Coordination of Humanitarian Affairs out of Bangkok earlier this month.

A widespread outbreak in the Philippines that reportedly killed more than two dozen children last year is now slowly spreading to Canada.

Several health authorities including those in British Columbia, Saskatchewan and Ontario have surveillance alerts after an infected 1-year-old with his parents arrived at Vancouver International Airport on  Jan. 2 after a flight from the Philippines and subsequently departed Vancouver on Jan. 7 for Saskatchewan. 

The patient stayed with relatives and spent a night in a hotel while in the Vancouver area.

This case is the sixth imported case of measles to Canada from the Philippines this year.

In 2013, there were 17 cases of measles reported in BC; several of these were among travelers returning from Thailand, the Netherlands, Philippines, and even those whose only apparent exposure was transit through Vancouver international airport.

In addition to Canada, Australia, Taiwan and the United Kingdom have also reported that measles from the Philippines have spread to their countries.

In the Philippines, over 13 million children have been vaccinated by the Department of Health. Last year, over 1,700 measles cases were recorded, including 21 deaths.

According to the WHO, measles is one of the leading causes of death in children worldwide, even though a safe and cost-effective vaccine is available. More than 95 percent of measles deaths occur in low-income countries, where both health infrastructure and systems are often weak.

Measles is caused by a highly infectious virus.  The illness starts with a cough, runny nose and fever, and a rash that covers the face and body. Complications include pneumonia and encephalitis.

The measles spread from the Philippines, comes as the The US-based Centres for Disease Control and Prevention (CDC) noted that with visa-free travel on the horizon for the 10 countries in the Association of South East Asian Nations (ASEAN), and the proliferation of low-budget airlines, experts predict that a more rapid spread of diseases may soon follow. 

Rapid economic growth in the region - as high as 6 percent in the GDP of some countries over the past five years - has catalyzed new lifestyles and habits, including a gradual erosion of remoteness in some areas, which can affect public health. 

“[Economic growth] has created in the region a greater concentration and interconnection of animals, people, and products than is found almost anywhere else in the world,” said Chris Gregory, an epidemiologist with the Thailand International Emerging Infections Programme. 

He notes that this growth has created almost unparalleled “large-scale population movements and animal trade, changing patterns of land use - including increased agriculture and livestock development and deforestation - that alter ecosystems, and increase antibiotic resistance through the easy availability and heavy use of antimicrobials in both people and animals.” 

In 2012, East and Southeast Asia produced 60 percent of the world’s pigs (569 million animals) and 43 percent of the world’s poultry (9.2 billion birds), while nine out of 10 of the world’s ducks were farmed here, according to the UN Food and Agriculture Organization (FAO). 

Asia is expected to increase its urban population by 1.4 billion between 2011 and 2050 and while rapid urbanization can be seen as an indicator of people moving toward more prosperous lives and better healthcare services, city population booms are a double-edged sword. 

A 2013 paper looking into the risk of emerging infections in the Asian region 10 years after the outbreak of Severe Acute Respiratory Syndrome (SARS), which killed an estimated 774 people by July 2003, showed how cities can increase the speed of disease transmission, acting as “hubs” for spreading diseases nationally and internationally, or as “bridges between human and animal ecosystems”. 

Sewage and sanitation systems struggle to cope with demand in growing cities, said Kenrad Nelson, a professor of epidemiology and international health at the Johns Hopkins University Bloomberg School of Public Health. “The live [animal] markets in most [of the] larger cities are where cross-contamination with pathogens can occur,” he commented, echoing what others have called the “intensification of animal systems in cities”. 

The Centre for Aviation (CAPA), a global association, lists 25 low-cost carriers operating in Southeast Asia, five of which have joined the market since the end of 2011. CAPA predicted continued growth in budget airline fleets in 2013, potentially increasing flight traffic by as much as 30 percent. 

More people on the move to more places can take more than their luggage to their destinations. “Cross-national migration, mostly for economic reasons from lower-income to higher-income countries, is also significant and likely to further increase after the opening of ASEAN borders in 2015,” said an epidemiologist. 

“Lower airline fares and more flights mean it’s an opportunity for people with these diseases to travel more frequently and more quickly,” he told IRIN. 

“We have to remember that greater connectivity means information is more linked-up, too. Someone in Laos or Cambodia can look up a doctor in Bangkok or Singapore and get on a flight the next day to seek care for an illness that he or she thinks can’t be, or won’t be, adequately treated at home.”

 

 

Watch where you travel

 

Many countries of the world including the Philippines are experiencing a resurgence of measles, and anyone planning travel outside of the Americas should check their immunization record to ensure that they’re up to date on their measles vaccine. 

Measles is caused by a highly infectious virus.  The illness starts with a cough, runny nose and fever, and a rash that covers the face and body. Complications include pneumonia and encephalitis. 

In BC, the measles vaccine is free:

• it is recommended for children in a series of two doses given at 12 months and at 4-6 years of age.

• Infants as young as 6 months of age should receive a dose of MMR (measles, mumps and rubella) prior to travel to a measles endemic area. 

• The MMR vaccine should be administered in two doses for adults born on/after 1970. 

• Adults born prior to 1970 should be immunized with two doses if they are traveling to endemic parts of the world, or if they are health care workers, unless they have laboratory proof of measles immunity; otherwise most adults born prior to 1970 are assumed to be immune because of previous measles infection.