had reached 39 percent, along with the emergence of multidrug-resistant (clones 23F and 14B). Furthermore, 42.4 percent of the DSP population studied was found to be multidrug resistant. The Colombian response has been to continue the national surveillance program with the Colombian Pneumococcal Study Group and public health programs to detect changes in the susceptibility pattern.

The annual parasitic index (API which is the number of parasitologically confirmed cases per 1,000 population per year) for malaria has continuously increased in Colombia from 1970 (API = 1) through the end of the 1990s (API = 6). This increase is due to a variety of factors, including resistance to antimalarials (resistance to chloroquine in Plasmodium falciparum was first reported in 1961), vector resistance to pesticides, and the breakdown of public health measures. There has been major support for the development and improvement of a synthetic antimalarial vaccine (SPf66), primarily by Manuel E. Patarroyo at the Instituto de Immunologia, Universidad Nacional de Colombia. Furthermore, multicenter studies have been conducted in areas of malaria endemicity to develop community-based programs for vector control.

Despite the elimination of poliomyelitis in the Americas, there is a risk of the reemergence of this disease through importation, decreasing levels of vaccine coverage, and breakdown of intensified surveillance, as currently seen in Haiti and the Dominican Republic. Although the last confirmed case of wild-type derived poliomyelitis on the North American continent was reported in June 1991, the risk of importation and spread of wild-type poliovirus strains into the Americas has been documented on two occasions in Canada (1992 and 1996). This type of episode is especially problematic because of breakdowns in active surveillance and decreased vaccine coverage.

Colombia and the rest of Latin America are in the final phases of measles eradication. After measles was on the verge of control in 1996, outbreaks in Brazil, Argentina, and Bolivia are reminders of the reality of the reestablishment of transmission. Decentralization of health services in the process of health reform requires that national surveillance and control be conducted through INS, a step being implemented by the Colombia Ministry of Health.

Public health authorities are very much aware of potential disease outbreaks after natural disasters. Active surveillance after the earthquakes in Armenia and the coffee-growing region of Colombia brought attention to the fact that an apparent outbreak of hepatitis A had been endemic and undiscovered for more than 3 months before the disaster. In addition, an urban malaria outbreak was diagnosed for the first time in more than 30 years.

Front Matter (R1-R16)

Summary and Assessment (1-28)

Introduction (29-34)

Emerging Infections in Latin America (35-51)

Emerging Infections in Africa (52-61)

Emerging Infections in Asia and the Pacific (62-71)

Emerging Infections in Europe (72-84)

References (85-86)

Appendix A: Glossary and Acronyms (87-94)

Appendix B: Workshop Agenda (95-99)

Appendix C: Workshop Participants (100-106)

Appendix D: Forum Member and Staff Biographies (107-118)