Contaminated drinking water is the primary route of transmission for the hepatitis E virus (HEV). HEV is the leading cause of hospitalization due to severe hepatitis in Nepal and other parts of Asia and Africa. HEV infection in pregnant women has a particular devastating effect on both mother and child. To study this disease, AFRIMS has established a field station in Kathmandu, Nepal known as the Walter Reed/AFRIMS Research Unit, Nepal (WARUN). AFRIMS has played a leading role in describing HEV disease, obtaining virus strains for genetic characterization and in developing and evaluating diagnostic tests to detect infection. Current efforts focus on describing the ecology and risk factors for disease in different population groups in South and Southeast Asia. A vaccine trial against HEV is currently underway.

A hepatitis E vaccine study, Nepal.

          The AFRIMS Global Emerging Infections Surveillance and Response System (GEIS) is part of a larger DoD-GEIS mission. The program was developed, via a Presidential Decision Directive in 1996, to address the growing concerns of bioterrorism and emerging or re-emerging infectious diseases. This directive expanded the DoD mission to support global surveillance, research and development, training, and outbreak response to emerging infectious diseases that threaten military readiness and the American people. The AFRIMS has established surveillance systems throughout Southeast Asia to monitor for a number of infectious diseases, including drug-resistant enteric organisms, influenza, scrub typhus, and febrile illnesses. AFRIMS has been instrumental in obtaining influenza isolates in Nepal and Thailand. Analysis of these isolates then contributes towards determining the composition of each year’s flu vaccine. Through technology transfer and training, the AFRIMS is working with regional health officials to establish sustainable, diagnostic capabilities, which will allow for rapid diagnosis of disease at the local level, improved patient care, and real-time surveillance for infectious diseases.