Middle South Asia This section includes general information about health hazards as reported by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The region includes Afghanistan, Armenia, Azerbaijan, Bangladesh, Bhutan, Georgia, India, Islamic Repubic of Iran, Kazakhstan, Kyrgyzstan, Maldives, Nepal, Pakistan, 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, the Maldives, Turkmenistan, and Ubekistan. There are small foci of malaria in Armenia, Azerbaijan, and Tajikistan. 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 Kazakhstan. 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. Hepatitis B is endemic. Outbreaks of Poliomyelitis transmission is still a risk in most countries. Diphtheria outbreaks are reported from Azerbaijan, Georgia, Kazakhstan, 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.