Emerging infectious diseases in an island ecosystem: The New Zealand perspective

Several unique features characterize infectious disease epidemiology in New Zealand. Historically, well-organized, government-run control programs hav e eliminated several zoonoses. More recently, however, communicable disease control has been mixed. Rates of rheumatic fever, tuberculosis, and enteri c infections are high, and rates of meningococcal disease are increasing. T hese diseases are overrepresented in New Zealanders of Polynesian descent, who generally live in more deprived and overcrowded conditions than do thos e of European descent. Measles and pertussis epidemics are recurring becaus e of inadequate vaccine coverage, despite a well-developed childhood immuni zation program. A progressive response to the HIV epidemic has resulted in relatively low rates of infection, particularly among injecting drug users; however, the response to other sexually transmitted infections has been po or. A key challenge for the future is to build on successful strategies and apply them to persisting and emerging infectious disease threats in a smal l, geographically isolated country with limited economic resources.