Pacific Center for Emerging Infectious Diseases Research
John A. Burns School of Medicine, University of Hawai'i at Manoa
Director: Dr. Richard Yanagihara

INTRODUCTION

A dramatic global resurgence of infectious diseases has occurred during the past 25 years, such that infectious diseases have regained their position as the leading cause of morbidity and mortality worldwide. Moreover, infectious diseases are among the most important public health and economic problems facing the Asia-Pacific region at the beginning of the new millennium. Unbridled population growth and widespread environmental upheaval throughout Asia and Oceania, along with the insidious breakdown of the public health infrastructure, have contributed to the resurgence of infectious diseases. Movements of people, animals and insect vectors via jet travel have also increased the likelihood that infectious agents can spread swiftly and widely. A recent example is the outbreak of dengue fever in Hawai'i in 2001, following the independent and simultaneous introduction of dengue virus to the islands of Maui, Kauai and O'ahu from Tahiti and Samoa. Thus, heightened capacity for infectious diseases surveillance is urgently needed.

Its strategic geographic location and strong ties to resource-poor developing countries in the Asia-Pacific region places the University of Hawai'i at Manoa in a unique position to monitor the emergence or introduction and spread of newly recognized infectious diseases, such as Nipah virus encephalitis and severe acute respiratory syndrome (SARS). Against this backdrop, the Pacific Center for Emerging Infectious Diseases Research is being developed through a $9.6-million grant from the Centers of Biomedical Research Excellence (COBRE) program, of the National Center for Research Resources of the National Institutes of Health.

Investigations will focus on the risk factors associated with acquisition of infection with human papillomaviruses (which cause cervical cancer in women) and group A streptococci (which cause acute rheumatic fever). In addition, the immune responses to dengue viruses will be studied, as part of studies aimed at developing vaccines. In addition, studies will focus on the development of improved rapid diagnostic tests for leptospirosis and murine typhus. Each of these infectious diseases is of local and regional importance and disproportionately affect under-served ethnic minorities and disadvantaged or marginalized communities in Hawai‘i and the Asia-Pacific region.

Emerging Infectious Diseases are those infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. These are human illnesses caused by microorganisms or their toxic byproducts and having the potential for occurring in epidemic numbers. The introduction of the agent into a new host (whether from the environment, another species or as a variant of an existing human infection) and the establishment and further dissemination within the new host population (or adoption) are all vital areas of research for controlling outbreaks. Various factors that can further be associated with emerging infectious diseases are:

• Ecological Changes (agriculture, reforestaion and deforestation, famine, global warming, flood/drought)
• Human Demographics and Behavior (population growth and migration, urbanization, war, sexual behavior, injection drugs, use of high-density facilities)
• International Travel and Commerce (air travel, worldwide movement of goods, people, and vectors)
• Technology and Industry (globalization of food supplies, organ transplantation, antibiotic misuse)
• Microbial Adaptation and Change (microbial evolution, response to selection pressures)
• Breakdown in Public Health Infrastructure (reduction in prevention programs including immunization, inadequate sanitation and vector control measures, lack of trained personnel)