human immunodeficiency virus infection and AIDS), existed long before the introduction of the Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS). In some ways DoD-GEIS represented a departure for AFRIMS, although in other ways DoD-GEIS is a natural extension of the field research that has been AFRIMS’s mainstay. For example, the DoD-GEIS malaria pillar complements ongoing surveillance for antimalarial drug resistance, whereas surveillance for acute febrile illness is a somewhat new area of involvement.

On July 4, 2005, AFRIMS was also designated a World Health Organization (WHO) Collaborating Center for Diagnostic Reference, Training, and Investigation of Emerging Infectious Diseases. The projects undertaken by AFRIMS using the fiscal year 2006 AI/PI supplemental funding included increasing the laboratory infrastructure and capabilities of AFRIMS laboratories in Bangkok, Thailand, as well as performing regional influenza surveillance, particularly for highly pathogenic avian influenza (see Figure 4-1).

A site visit team of the Institute of Medicine (IOM) Committee for the Assessment of DoD-GEIS Influenza Surveillance and Response Programs visited AFRIMS from March 12-17, 2007.1 The IOM site visit team spent two days in Bangkok and two and a half days in Kathmandu, Nepal, visiting the laboratories and reviewing surveillance projects supported by the DoD-GEIS supplemental funding. A list of the people with whom the site visit team met and the itinerary that was followed can be found at the end of this chapter.

INFLUENZA IN THAILAND

In January 2004, Thailand issued its first report of highly pathogenic avian influenza virus of the H5N1 subtype in poultry and humans (WHO, 2007a). Since that time Thailand has had a total of 25 human cases of avian influenza, 17 of which were fatal, but it has reported no human infections since September 2006 (although it did confirm H5N1 in poultry during routine intensive surveillance in January 2007) (WHO 2007a, WHO 2007b). In addition to its human and poultry infections, Thailand has also had a number of domestic cats, captive tigers, and leopards die of the H5N1 virus (Tiensin et al., 2005).

Other novel findings related to avian influenza in Thailand have been documented, dating back to July 2004, when a report described an atypical human H5N1 infection that lacked the usual respiratory symptoms

1

Prior to the committee’s AFRIMS visit, the laboratory staff provided the committee with detailed background information on AFRIMS and the pandemic/avian influenza activities it was supporting. These materials are available from the IOM in the Public Access File.



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