East Asia (China, the Democratic People's Republic of Korea, Hong Kong, Japan, Macao, Mongolia, and the Republic of Korea). The area includes the high mountain complexes, the desert and the steppes of the west, the various forest zones of the east, down to the subtropical forests of the southeast.

Among the arthropod-borne diseases, malaria now occurs only in China. Although reduced in distribution and prevalence, bancroftian and brugian filariasis are still reported in southern China. A resurgence of visceral leishmaniasis is occurring in China and plague may be found in China and Mongolia. Cutaneous leishmaniasis has been recently reported from Xinjiang, Uygur Autonomous Region. Hemorrhagic fever with renal syndrome—rodent-borne, Korean hemorrhagic fever—is endemic except in Mon-golia, and epidemics of dengue fever and Japanese encephalitis may occur in this area.

Mite-borne or scrub typhus may be found in scrub areas in southern China, certain river valleys in Japan, and in the Republic of Korea.

Foodborne and waterborne diseases such as diarrheal diseases and hepatitis A are common in most countries. Hepatitis E is prevalent in northwestern and northeastern China. The present endemic area of schistosomiasis (bilharziasis) is in the central Chang Jiang (Yangtze) river basin; active foci no longer occur in Japan. Clonorchiasis (oriental liver fluke) and paragonimiasis (oriental lung fluke) are reported in China, Japan, Macao and the Republic of Korea, and fasciolopsiasis (giant intestinal fluke) in China. Brucel-losis occurs in China.

Other diseases. Hepatitis B is highly endemic. Low levels of poliomyelitis morbidity are reported from China and Mongolia. Trachoma, and leptospirosis occur in China. Out-breaks of meningococcal meningitis occur in Mongolia. [Rabies is endemic in China and Korea.]*

Eastern South Asia (Brunei Darussalam, Cambodia, Indonesia, Lao People's Demo-cratic Republic, Malaysia, Myanmar (formerly Burma), the Philippines, Singapore, Thailand, and Viet Nam). From the tropical rain and monsoon forests of the north-west, the area extends through the savanna and the dry tropical forests of the Indochina peninsula, returning to the tropical rain and monsoon forests of the islands bordering the South China Sea.

The arthropod-borne diseases are an important cause of morbidity throughout the area. Malaria and filariasis are endemic in many parts of the rural areas of all the countries or areas-except for malaria in Brunei Darussalam, and Singapore, where normally only imported cases occur. Foci of plague exist in Myanmar. Plague also occurs in Viet Nam. Japanese encephalitis, dengue and dengue hemorrhagic fever can occur in epidemics in both urban and rural areas. Mite-borne typhus has been reported in deforested areas in most countries.

Foodborne and waterborne diseases are common. Cholera and other watery diarrheas, amebic and bacillary dysentery, typhoid fever, and hepatitis A and E may occur in all countries in the area. Schistosomiasis (bilharziasis) is endemic in the Southern Philip-pines and in central Sulawesi (Indonesia) and occurs in small foci in the Mekong delta. Among helminthic infections, fasciolopsiasis (giant intestinal fluke) may be acquired in most countries in the area; clonorchiasis (oriental liver fluke) in the Indochina peninsula; opisthorchiasis (cat liver fluke) in the Indochina peninsula, the Philippines, and Thai-land; and paragonimiasis in most countries. Melioidosis can occur sporadically through-out the area.

Other diseases. Hepatitis B is highly endemic. Cases of poliomyelitis (also a food-borne and water-borne disease) continue to be reported from Cambodia, Indonesia, the Lao’s Democratic Republic, Myanmar, and Vietnam. The incidence of poliomyelitis is low in Malaysia, the Philippines, and Thailand. Trachoma exists in Indonesia, Myanmar, Thailand, and Viet Nam.

Other hazards include rabies, snake bites, and leeches.

Middle South Asia (Afghanistan, Armenia, Azerbaijan, Bangladesh, Bhutan, India, Islamic Republic of Iran, Kazakstan, Kyrgyzstan, Maldives, Nepal, Pakistan, and Sri Lanka, Tajikistan, Turkmenistan and Uzbekistan). 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.

Arthropod-borne diseases are endemic in all these countries except for malaria in Georgia, Kazakstan, Krygyzstan, Turkmenistan and Ubekistan. There are small foci of malaria in Azerbaijan, Tajikistan and for Turkmenistan. In some of the other 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), the Islamic Republic of Iran, and Pakistan. There are very small foci of cutaneous and visceral leishmaniasis in Azerbaijan and Tajikistan. There is evidence that natural foci of plague exist in India and Kazakstan. An outbreak of plague occurred in India in 1994. Tick-borne relapsing fever is reported from Afghanistan, India, and the Islamic Republic of Iran, and typhus occurs in Afghanistan and India. Outbreaks of dengue fever may 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 tick-borne 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 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. A very limited focus of urinary schistosomiasis (bilharziasis) persists in the southwest of the Islamic Republic of Iran. Foci of dracunculiasis (guinea worm) infection occur in India. Brucellosis and echinococcosis (hydatid disease) are found in many countries in the area.

Other diseases. Hepatitis B is endemic. Outbreaks of meningococcal meningitis have been reported in India and Nepal. Poliomyelitis (also a food-borne and water-borne disease) is widespread except in Bhutan and the Maldives. Diphtheria outbreaks are reported from Azerbaijan, Georgia, Kazakstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Trachoma is common in Afghanistan, in parts of India, the Islamic Republic of Iran, Nepal, and Pakistan. Snakes and the presence of rabies in animals are hazards in most of the countries in the area.

Western South Asia—Bahrain, Cyprus, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, the United Arab Emirates, and Yemen). The area ranges from the mountains and steppes of the north-west to the large deserts and dry tropical scrub of the south.

The arthropod-borne diseases, except for malaria in certain areas, are not a major hazard for the traveler. Malaria does not exist in Kuwait and no longer occurs in Bahrain, Cyprus, Israel, Jordan, Lebanon, or Qatar. Its incidence in the Syrian Arab Republic is low, but elsewhere is endemic in certain rural areas. Cutaneous leishmaniasis is reported throughout the area; visceral leishmaniasis, although rare throughout most of the area, is common in central Iraq, in the southwest of Saudi Arabia, in the northwest of the Syrian Arab Republic, in Turkey (southeast Anatolia only) and in the west of Yemen. Murine and tick-borne typhus can occur in most countries. Tick-borne relapsing fever may occur. Crimean-Congo hemorrhagic fever has been reported from Iraq. Limited foci of onchoceriasis are reported in Yemen.

The foodborne and waterborne diseases are a major hazard in most countries. The typhoid fevers and hepatitis A exist in all countries. Schistosomiasis (bilharziasis) occurs in Iraq, Saudi Arabia, the Syrian Arab Republic, and Yemen. Dracunculiasis (guinea worm) infection is found in some of these countries. Taeniasis (tapeworm) is reported from many of the countries. Brucellosis is widespread and there are foci of echinococcosis (hydatid disease).

Other diseases. Hepatitis B is endemic. The incidence of poliomyelitis (also a food-borne and water-borne disease) is low in most countries of the area, with the exception of Turkey and Yemen. Trachoma and animal rabies are found in many countries in the area.

The greatest hazards to pilgrims to Mecca and Medina are heat and water depletion if the period of the Hajj coincides with the hot season.

* Editor’s note: CDC addition.