Globalization started from last century is having caused the rapid population growth, increased population movement and widening gaps between rich and poor.  The situation constitutes favorable condition for emerging and re-emerging diseases, including pandemic infections of HIV and HCV, and emerging of bovine spongiform encephalopathy (BSE).  The recent outbreak of severe acute respiratory syndrome (SARS) worldwide made us aware that the concept of disease surveillance would be the key to cope with infectious disease outbreaks from now on. 

Under WHO's leadership, the global surveillance networks for emerging and re-emerging diseases have been taking place in collaboration with various bilateral multilateral organizations and NGOs.  With globalization, strengthened communicable disease surveillance at the global level has become an essential public health tool. Global surveillance serves as an early warning system for epidemics and provides the rationale for public health intervention. (Figure: Situation of Current Global Surveillance Networks)

Ministry of Health and Welfare Japan has started undertaking "Research Project on Emerging and Re-emerging Diseases" in 1997. Agency for Cooperation in International Health (ACIH) is collaborating with this project, and has set up a study group for examining on how we can contribute to the development of global surveillance network for emerging and re-emerging diseases.

The surveillance system, AGSnet, was built based on the relationship with the scientists who participated in JICA training course in past years in Kumamoto.  As of June 2003, 61 sentinels in 29 countries are collaborating as sentinel, reporting quarterly on target diseases. 

The study is now in 3rd phase, and aiming to consolidate the system by following activities:

1. Routine report on target diseases from sentinels and feedback
2. Consider usefulness of sentinel reports for global surveillance on target diseases, including of the geographical distribution of sentinels.
3. Compare sentinel reports with information of other surveillance networks from the view point of rapidness, effectiveness and the discrepancy.
4. Conduct effective feedback from ACIH to sentinels.
5. Promote the collaborating studies with sentinels.
6. On-site discussion with sentinel by Advisory Group

The recent outbreak of severe acute respiratory syndrome (SARS) worldwide made us aware that the concept of disease surveillance would be the key to cope with infectious disease outbreaks now and in future.  The sovereignty of a country becomes weaker, it is difficult to maintain the sensitivity of surveillance, and participation of an additional system like AGSnet is indispensable. 

The detailed information is in the study plan for third phase.

African Multicenter Epidemiological Study for Blood-borne Diseases

The study for "African Multicenter Epidemiological Study for HIV, HBV, HCV, HTLV-1 and Syphilis" is the collaborating research with ICCI, Suez Canal University, Egypt, to consolidate the surveillance system in African region.

In short, the idea of the study was developed from the study activity the phase I, which was a follow up activity of the Third Country Training Program of JICA: The International Training Course for Clinical Immunology of Infectious Diseases and Introduction to Molecular Biology, which is held annually for 4 weeks at Suez Canal University, Ismailia-Egypt and supported by Kumamoto National Hospital and Clinical Research Institute. The phase II is designed to: screen 5 pathogens (HCV, HBV, HIV, HTLV-1 and syphilis) among 500 volunteer blood donors in eight different African Countries.

It would be expected that the study will help:

• Building up a networking of African scientists working in the fields of communicable diseases together along with the Japanese Experts in the same field;
• To provide the data of the research to the local health authorities in each of the participating country to take the necessary preventable measures accordingly;
• To provide important epidemiological data about the prevalence of the screened diseases in different parts of Africa;
• To explore the potentiality for a higher research activities within Africa.

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