Although most cases of Lyme disease in the United States were initially reported by New York, Pennsylvania and Connecticut, disease incidence in these states has not paralled a steady increase in national rates since the 1990′s (see graph). [1-3]

References:
1. Berger SA. Infectious Diseases of the United States, 2012. 1089 pp, 467 graphs, 9760 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Berger SA. Lyme Disease: Global Status, 2012. 73 pp, 65 graphs, 593 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/lyme-disease-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

For over 20 years, the highest incidence of Ross River disease has been reported in Queensland and New South Wales (highest disease rates per 100,000 in Northern Territory). [1,2] In 2011, Victoria reported more cases than any other state. See graph [3] The blue line (arrow) represents incidence in Victoria.

References:
1. Berger SA. Infectious Diseases of Australia, 2012. 519 pp, 161 graphs, 2950 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-australia/
2. Berger SA. Australo-Pacific Arboviruses: Global Status, 2012. 30 pp, 19 graphs, 280 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/australo-pacific-arboviruses-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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In analyzing a recent case in Canada ex Dominican Republic, it is interesting to compare the background of rabies in these two countries. [1-4] While human rabies is clearly more common in the Dominican Republic (graph 1), the incidence of animal rabies is higher in Canada (graph 2).

Skunks and foxes account for over 50% of aminal rabies in Canada, while dogs, mongoose and ruminants account for most cases in the Dominican republic. The number of rabid dogs reported by the two countries has been strikingly similar through much of the past four decades (graph 3).

References:

References:
1. Berger SA. Infectious Diseases of Canada, 2012. 496 pp, 107 graphs, 3130 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-canada/
2. Berger SA. Infectious Diseases of the Dominican Republic, 2012. 339 pp, 53 graphs, 1314 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-dominican-republic/
3. Berger SA. Rabies: Global Status, 2012. 376 pp, 546 graphs, 1375 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/rabies-global-status/
4. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

The following background data on rubella in Spain are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2] (Primary references available on request)

Vaccination of 11-year-old girls with monovalent Rubella vaccine was introduced in 1979.
- Routine MMR immunization was introduced in 1981.
- The second dose was advanced to age 3 to 6 years in 1999.

The following graph contrasts Rubella (MMR) vaccine uptake with rubella incidence in Spain [3]:

Graph Notes:
1. 658,767 cases of rubella were reported during 1982 to 1989.
2. Six fatal cases were reported during 1980 to 1994.
3. 267 hospitalizations for rubella (0.065 per 100,000) were reported during 1997 to 2006 – including 144 for intrpartum infection.
4. Eighteen cases of congenital rubella syndrome were reported during 1997 through 2011.

Seroprevalence surveys:
95% of the general population of Madrid (98.6% of women of childbearing age) (2000 survey)
96.4% of persons ages 17 to 36 (Barcelona, 1992 to 1993)
91.2% of women of childbearing age (Aragon, 2003 to 2007)
99.95% of pregnant women in Salamanca (2001)
93.4% of pregnant women (94.9% of indigenous women, 89% of immigrants) at the time of delivery (Catalonia, 2007 publication)
92% of pregnant immigrant women and 97.7% of native pregnant women (2006 to 2010)
95% of native-born pregnant women (2007 to 2008)
97.3% of pregnant women in Grenada (2007 to 2008)
88.3% of immigrant women in Catalonia (2009 publication)
95.7% of children ages 1 to 5 years, and 90.5% ages 5 to 14 in Castilla de Leon (2001 to 2002)
98.1% in Catalonia (1996)

Notable outbreaks:
1991 – An outbreak (175 cases) was reported in Cadiz.
2002 to 2003 – An outbreak was reported in Madrid – 19 cases (11 of whom were from Ecuador).
2004 to 2005 – An outbreak (460 suspect cases) was reported in Madrid region.
2005 – An outbreak (8 cases) was reported in Barcelona, among expatriates from Brazil.

References:
1. Berger SA. Infectious Diseases of Spain, 2012. 557 pp, 194 graphs, 2850 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/
2. Berger SA. Rubella: Global Status, 2012. 314 pp, 447 graphs, 611 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/rubella-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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Nine tick-borne infections affect humans in the United States. Data on a national level are available for Lyme disease, Powassan encephalitis, Rocky Mountain spotted fever, Tularemia, Granulocytic ehrlichiosis (Anaplasmosis) and Human monocytic ehrlichiosis. Statistics for three diseases (Babesiosis, Relapsing fever and Colorado tick fever) are not published. The following graph compares reporting trends for tick-borne infections (Lyme disease displayed as cases/100,000 for fit). [1,2]

Note an apparent parallel increase for some diseases during 2000 to 2008, followed by a dip during 2009 to 2010. Assuming a statistical association between these data, explanations might include changes in tick populations as a whole, or trends in human-tick contact over time.

References:
1. Berger SA. Infectious Diseases of the United States, 2012. 1089 pp, 467 graphs, 9760 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-states/
2. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

The following background data on Filariasis in Indonesia are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1-3] (Primary references are available on request).

Three nematode species are responsible for human filariasis in Indonesia: Wucherichia bancrofti, Brugia malayi and Brugia timori. A fourth zoonotic species, Brugia pahangi, is occasionally reported. Populations at risk have increased in recent years, in parallel with use of mass chemotherapy – see graph [4]:

Wucherichia bancrofti:
Time and Place:
- Bancroftian filariasis is found in the forests of Sumatra, Kalimantan and Sulawesi
- Cases have also been reported in Jakarta and Semarang.
- Microfilaremia in Indonesia is nocturnally periodic.

Prevalence surveys:
0.3% in West Kalimantan (1976 publication)
4% in Irian Jaya (1972)

Vectors:
- The local vectors are Anopheles aconitus, An. balabacensis, An. subpictus, An. vagus, Culex annulirostris, Cu. bitaeniorhynchus and Mansonia uniformis.
- Cu. sitiens, Cu. annulirostris, Cu. bitaeniorhynchus and Mansonia uniformis are active in West Irian.

Brugia malayi:
Time and Place:
- Brugian filariasis is endemic to the Lesser Sunda islands – Ceram, Kalimantan, Sulawesi, Timor and Sumatra.
- The disease pattern is nocturnally-periodic in Indonesia

Prevalence surveys:
3.6% of the population of West Kalimantan (1976 publication).
15% of the population of south Sulawesi (1978 publication).

Vectors:
- The local vectors are Anopheles barbirostris, Mansonia bonneae, Ma. annulata, Ma. annulifera and Ma. uniformis and Ma. dives.
- Ma. dives is associated with a nocturnally subperiodic pattern on Sumatra.

Brugia pahangi:
- Evidence for Brugia pahangi infection has been documented among humans, domestic cats (Felis domesticus), and silvered leaf monkeys (Presbytis cristatus) from South Kalimantan (Borneo).
- Additional reservoirs include Macaca monkeys, wild cats (eg, civets) and pangolins (Manis sp.).

Brugia timori:
Time and Place:
- Brugia timori infection is limited to Timor and islands of the Lesser Sunda Archipelago: Flores, Alor, Sumba, Roti and Savu.
– The total number of persons infected is estimated at <800,000.
– Clinical disease on Flores occurs in coastal (but not highland) areas, and is more common among males than females.
- Disease rates on the island double between the first and second decades of life.

Prevalence surveys:
25% of the highland population of Alor Island are microfilaremic and 13% have lymphedema (2001)

Vectors:
- The local vectors are Anopheles barbirostris and Aedes oceanicus.

References:
1. Berger SA. Infectious Diseases of Indonesia, 2012. 412 pp, 67 graphs, 1992 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-indonesia/
2. Berger SA. Bancroftian Filariasis: Global Status, 2012. 102 pp, 111 graphs, 606 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/bancroftian-filariasis-global-status/
3. Berger SA. Miscellaneous Filaria: Global Status, 2012. 47 pp, 18 graphs, 535 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/miscellaneous-filaria-global-status/
4. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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The following background data on Leishmaniasis in Panana are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2]

Time and Place:
- Most cases are reported from western Panama – Bocas del Toro, Cocle, Colon, Chiriqui and Panama Provinces.
- Children and new settlers to forest areas are at highest risk.

Infecting species:
- Leishmania mexicana amazonensis and L. braziliensis panamanensis are implicated.
- L. colombiensis is also encountered.
- L. naiffi has been identified in sand flies the region of the Canal Zone.

Reservoirs:
- Leishmania braziliensis has been identified in the two-toed sloth (Choloepus hoffmanni) and three-toed sloth (Bradypus infuscatus.
- The two-toed sloth has also been identified as a reservoir for Leishmania panamensis and L. colombiensis.
- Parasites have also been demonstrated in the night monkey (Aotus trivirgatus).
- Dogs may also act as natural reservoirs in this country. 3% of dogs in forest settlements are infected (1968 to 1973).

Vectors:
- The principal local vector for L. panamensis is Lutzomyia (Nyssomyia) trapidoi.
- Additional species of anthropophilic sandflies have been implicated, including Lu. (N.) ylephiletor, Lu. (Ps.) panamensis, Lu. ovallesi, Lu. (Ps.) shannoni, and Lu. gomezi.
- The predominant vectors in Gamboa (central Panama) are Lu. (Ps.) panamensis and Lu. gomezi.

Notable outbreaks:
1984 – An outbreak (15 cases) was reported among Puerto Rican National Guard personnel conducting exercises in Panama.

References:
1. Berger SA. Infectious Disases of Panama, 2012. 378 pp, 79 graphs, 1290 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-panama/
2. Berger SA. Cutaneous and Mucosal Leishmaniasis: Global Status, 2012. 106 pp, 92 graphs, 837 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/cutaneous-and-mucosal-leishmaniasis-global-status/

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Note that among the major English-speaking countries, rates of legionellosis are highest in Australia and New Zealand [1-3] – see graph:

References:
1. Berger SA. Infectious Diseases of New Zealand, 2012. 413 pp, 136 graphs, 1534 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-new-zealand/
2. Berger SA. Legionellosis: Global Status, 2012. 94 pp, 110 graphs, 840 references. http://www.gideononline.com/ebooks/disease/legionellosis-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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Although the incidence of pertussis in South America has remained low in recent years, disease rates in Chile remain slightly higher than those of neigboring countries [1-3] – see graph

Surprisingly, DPT vaccination uptake in Chile has continued to be relatively high for over two decades – see graph.

References:
1. Berger SA. Infectious Diseases of Chile, 2012. 383 pp, 90 graphs, 1546 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-chile/
2. Berger SA. Pertussis: Global Status, 2012. 40 pp, 506 graphs, 401 references. Gideon e-books, http://www.gideononline.com/ebooks/disease/pertussis-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps

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The experience of Spain with vaccine-preventable disease is a paradigm for the success of immunization. Rates of measles, mumps and rubella in Spain declined dramatically following the introduction of routine MMR in 1981 [1,2] – see graph [3]:

Mumps rates for the entire region have remained low since 2000 – see graph:

Seroprevalence surveys:
91.1% in Catalonia (1996)
92.1% of persons ages 17 to 36 in Barcelona (1992 to 1993)

Notable outbreaks:
1987 – An outbreak (104 cases) was reported among school children in Castellon.
1992 (publication year) – An outbreak (52 cases) was reported in Zaragoza.
1993 to 1994 – Outbreaks (216 cases total in 19 outbreaks) were reported in Toledo.
1995 to 1996 – An outbreak was reported in Leon.
1997 – An outbreak (283 cases) was reported in an urban area in Andalucia.
1999 to 2000 – An outbreak (33 cases) was reported at a school in Huesca.
2000 – An outbreak (35 cases) was reported among three-to-four year old children in San Sebastian.
2005 – An outbreak (145 cases) was reported in Almeria.
2006 – An outbreak (63 cases) was reported at a school in Bizkaia.
2006 to 2007 – An outbreak (1,397 cases) was associated with a festival in the Navarre region.
2008 – An outbreak (116 cases) was reported in Jerez de la Frontera.

References:
1. Berger SA. Infectious Diseases of Spain, 2012. 557 pp, 194 graphs, 2850 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-spain/
2. Berger SA. Mumps: Global Status, 2012. 167 pp, 191 graphs, 433 references. Gideon e-books, http://www.http://www.gideononline.com/ebooks/disease/mumps-global-status/
3. Gideon graph tool at http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps
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