Current outlook of infectious diseases in Taiwan.

The "emerging" infectious diseases have received global attention. Taiwan is a country which is going through the process of becoming "developed" from being "developing". If we compare five leading causes of death in 1952 and in 1993, three were infectious diseases in 1952 and there was none in 1993. And yet today, infectious diseases remain a major problem in this country as well in every country in the world, whether developing or developed. Some of the problems Taiwan faces are old problems with old faces. They have never been adequately solved because the societal and environmental sanitary infrastructure does not ensure proper sewage disposal, safe potable water and freedom from dangerous vectors. Examples are the diarrheal diseases, parasitic diseases, scrub typhus and Japanese encephalitis. Some of the Taiwan's problems are caused by old agents which present a new face. Mortality from tuberculosis took a dramatic and gratifying plunge in the last fifty years. Yet tuberculosis is ever present and a constant public health threat. Dengue has become a problem again because of a world breakdown in the control of the mosquito, Aedes egypti, and it is partly contributed to by increased urbanization and world travel. The problem of antibiotic resistant bacteria causing hospital acquired and community acquired infections is probably the most serious "new" problem. The most important cause is excessive and indiscriminate use of antibiotics in the community and in hospitals. We propose the establishment of "Bacterial Infections Reference Laboratory" at the National Health Research Institutes to be a national facility to study the epidemiology and control of antibiotic resistance. All infectious diseases require a rigorous system of surveillance, and precise etiological diagnosis before they can be treated or prevented. This should be kept clearly in mind when one considers the changing role of the infectious disease physician in Taiwan in the face of unsolved disease problems and a new health care system. There is inadequate attention to precise microbiological definition of most infectious diseases in Taiwan. The community of infectious disease specialists may well redirect its attention to improving the competence and utilization of microbiological laboratory diagnosis.