Armed Forces Research Institute of Medical Sciences (AFRIMS)   Bangkok, Thailand

AFRIMS continues to conduct antimicrobial resistance

surveillance in six sentinel populations in Thailand,

Vietnam, and Nepal.  Generally these are young

children, tourists, or U.S. military personnel deployed

to Operation Cobra Gold.  This year AFRIMS reported

enteric surveillance data from 744 cases and 539 non 

cases. Campylobacter was the most common pathogen

identified in the non immunes with diarrhea (Cobra

Gold, and travelers in Nepal and Bumrungrad Hospital,

Bangkok) ranging from 14% to 36% but not frequently

isolated from indigenous populations (Vietnamese

children and Thai adults).  Shigella prevalence is low

in Thailand (Cobra Gold and Bumrungrad) but more

common in Nepal (17%) and Vietnam (8%).

Salmonella was detected in cases as well as healthy

non cases among foreigners and Thais seen at

Bumrungrad Hospital (about 15%).  ETEC is one of

In their evaluation of the DoD GEIS program, the

the common pathogens in Nepal, isolated from 12%

Institute of Medicine committee described AFRIMS,

of cases.  ETEC was found in 7% of foreigners and

the Army's largest overseas medical research unit, as

Thais with diarrhea.  Ciprofloxacin resistance

 probably the most sophisticated diagnostic and

Campylobacter is common in Thailand:  96% in

research laboratory in all of Southeast Asia. 

Cobra Gold cases and 82% in cases at Bumrungrad

Hospital.  In Nepal ciprofloxacin resistance in

Building upon this reputation AFRIMS endeavors to

Campylobacter was lower (50%), and it was 0%

strengthen its epidemiologic capabilities while still

among children in Vietnam.  Macrolides are still

capitalizing on its reputation as a  center of excellence 

effective for Campylobacter at every site.  High

in the area of diagnostics for flaviviruses, hepatitis,

resistance to nalidixic acid (96%) occurred among

HIV, malaria, and enteric pathogens.  In this capacity,

isolates from troops affected by Campylobacter during

AFRIMS has positioned itself as an important provider

Cobra Gold.  Ciprofloxacin is very effective for

of laboratory training and capacity building support

Shigella isolates, and it usually also covers salmonella

in the region.  One notable contribution in this area

and ETEC well.  AFRIMS has started to participate in

was AFRIMS' collaboration with several Thai govern 

the WHO Global Salmonella Surveillance Program

ment departments and universities in the sponsorship

(Global Salm Surv) by sending in isolates and partici 

of a major conference on leptospirosis diagnosis.

pating in external quality assurance protocols.

AFRIMS is supporting the printing of a post conference

handbook entitled  The Handbook of Laboratory

AFRIMS also continues to support critical regional

Methods for Leptospirosis Diagnosis.   With the

anti malaria drug resistance studies.  During FY

DoD GEIS program, it has increasingly developed a

2001, 217 P. falciparium isolates from Vietnam,

public health role to complement its reputation as a

Myanmar (Shan State), Thailand (Sankhlaburi), and

leading research institution.  This has included

Nepal (Terai Region) were collected.  AFRIMS in

assisting the Royal Thai Army in developing its sur 

vitro data indicate no improvement in mefloquine

veillance and preventive medicine capabilities.  

resistance on the Thai Myanmar border in recent

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