Emerging infectious diseases among indigenous peoples.

554 Many indigenous peoples are at higher risk for emerging infectious diseases compared to other populations. This conference panel focused on diseases of particular concern to Native Americans (American Indians and Alaska Natives), Australian aboriginal peoples, and the Maori of New Zealand. Important emerging diseases among these groups include respiratory tract infections, infections with antimicrobial-resistant organisms, zoonotic diseases, viral hepatitis, Helicobacter pylori and respiratory syncytial virus infections, diseases caused by Group A and B streptococcus, tuberculosis, and bacteremia and meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis. Although the populations discussed are diverse, they have many things in common, including a high risk for many emerging infectious diseases, the requirement for culturally appropriate prevention and control strategies, and the need for increased leadership within communities of indigenous peoples. Native Americans comprise over 500 American Indian and Alaska Native tribes of unique ethnic and anthropologic origin. Although Native Americans account for only about 1% of the total U.S. population, American Indians account for a larger percentage of the population in western states, and Alaska Natives make up 17% of persons living in Alaska. Hospitalization rates among American Indians are 20 to 40 times greater than rates in the general U.S. population for a number of zoonotic and vectorborne diseases, such as hantavirus pulmonary syndrome, plague, and Rocky Mountain spotted fever. Multiple factors may contribute to higher risks for American Indians, but a likely explanation is that they live in rural areas or do some type of agricultural work, both of which increase their chance of contact with small mammals and arthropods capable of transmitting these diseases. Greater understanding of the transmission of these diseases will help in the development of prevention strategies that also preserve traditional practices. As with hantavirus pulmonary syndrome, methicillin-resistant Staphylococcus aureus (MRSA) infection acquired outside of healthcare settings is an emerging infectious disease first recognized among Native Americans. At some rural clinics serving Natives, over 60% of S. aureus isolates are methicillin-resistant. In one rural American Indian community, 74% of MRSA infections could not be linked to any of the known risk factors for MRSA such as hospitalization within the prior year, residence in a long-term care facility, hemodialysis, or injecting drug use. Tuberculosis is an example of a disease that recently reemerged, is now in decline, but continues to disproportionately affect Native Americans, both in number of cases and severity of disease. …