Indian Subcontinent and South Asia, Afghanistan, Bangladesh, Bhutan, British Indian Ocean Territory, India, Maldives, Nepal, Pakistan, Sri Lanka
Bordered for the most part by high mountain ranges in the north, the area extends from steppes and desert in the west to monsoon and tropical rain forests in the east and south.
Anthropod Borne Diseases
Arthropod-borne diseases are endemic in all these countries. In some countries, malaria occurs in urban as well as rural areas. Filariasis is common in Bangladesh, India, and the southwestern coastal belt of Sri Lanka. Sand fly fever is on the increase. A sharp rise in the incidence of visceral leishmaniasis has been observed in Bangladesh, India, and Nepal. In Pakistan, it is mainly reported from the north (Baltisan). Cutaneous leishmaniasis occurs in Afghanistan, India (Rajasthan), and Pakistan. There is evidence that natural foci of plague exist in India; tickborne relapsing fever is reported from Afghanistan and India, and typhus occurs in Afghanistan and India. Outbreaks of dengue fever can occur in Bangladesh, India, Pakistan, and Sri Lanka, and the hemorrhagic form has been reported from eastern India and Sri Lanka. Japanese encephalitis has been reported from the eastern part of the area and Crimean-Congo hemorrhagic fever from the western part. Another tickborne hemorrhagic fever has been reported in forest areas of Karnataka State in India and in a rural area of Rawalpindi District in Pakistan.
Foodborne and Waterborne Diseases
Foodborne and waterborne diseases are common throughout the area, in particular cholera and other watery diarrheas, the dysenteries, typhoid fever, hepatitis A and E, and helminthic infections. Large epidemics of hepatitis E can occur. Giardiasis is common in the area. Brucellosis and echinococcosis (hydatid disease) are found in many countries in the area. Poliomyelitis eradication activities have begun in all countries in the area, but transmission is still occurring. However, surveillance data are incomplete, and poliovirus transmission should still be assumed to be a risk for travelers in most countries, especially in the Indian subcontinent. Wild poliovirus isolates were reported from Afghanistan, Pakistan, and India in 2002.
Hepatitis B is endemic. Outbreaks of meningococcal disease have been reported in Afghanistan, India, and Nepal. Trachoma is common in Afghanistan, in parts of India, Nepal, and Pakistan. Rabies is a significant problem throughout this region.
Snakes are hazards in most of the countries in the area.