OBJECTIVES: To review the socio-economic impact of avian influenza in South-East Asian nations and neighbouring high risk countries. METHODS: The information was retrieved from the websites of World Bank, United Nations, clinicaltrials.gov, Medline and relevant grey literature from 1995 to 2008. Only English language articles and those covering South East Asia and neighbouring nations were analysed. Number of cases of avian influenza diagnosed, deaths in humans and poultry and associated socioeconomic impact were the outcomes of interest.  RESULTS: Of the 1973 citations, 134 met the inclusion criteria. As per World Organisation for Animal Health, 6435 outbreaks of avian influenza in poultry (4470 from South East Asia) have been reported in 48 countries till June 2008. Fourteen countries have confirmed 383 human cases with a fatality rate of 63% (241/383) as per WHO May 2008 data. The major share is from three South East Asian (SEA) countries - Vietnam, Thailand and Indonesia, which together accounted to 177 deaths from 264 cases. Poultry sector contributes 1.2-2.4% of GDP in East Asian and pacific countries. Bird flu has encroached poultry trade in South East Asia killing more than 120 million birds with a gross economic loss of US$10 billion compared to 300 million birds killed globally with economic loss of US$20 billion  (0.5-1% fall in GDP) since 2003. The impact extends not only to poultry farmers but also to upstream and downstream sectors (poultry trade, breeding farms, tourism etc.). A recent analysis has projected that a future pandemic could kill 5-150 million people leading to a 3.1-5.1% loss of world GDP (US$1.2-2 trillion). CONCLUSIONS: Health and economic losses have posed a major challenge to South East Asia. Appropriate and timely measures are required to prevent a future pandemic which could be devastating to Asia and rest of the world.