INFLUENZA Worldwide
Feb. '19 – According to the CDC, annual vaccination against seasonal influenza is recommended for all people 6-months of age and older. Globally, influenza activity is low in most regions. In North America, influenza activity continues to decrease. In Europe, influenza activity continues to decrease in most countries. In northern Africa and the Middle East, influenza activity continues to decrease or reNov.ned low in most countries; however activity reNov.ned high in Jordan and Turkey. In the temperate countries of Asia, influenza activity continued to decrease, but continues to reNov.n high in the Republic of Korea. In tropical countries of the Americas, influenza activity reNov.ns low in most countries. In tropical Asia, influenza activity began to decline in India but continued to decrease in southern China and Hong Kong SAR. In tropical Africa, influenza activity increased in western Africa, however Madagascar reported declining influenza activity. Lastly, in the southern hemisphere influenza activity reNov.ns at inter-seasonal levels.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
YELLOW FEVER in Argentina, Brazil, Congo, Republic of the, Nigeria, Peru, Suriname, Uganda
Feb. '19 - Case numbers for yellow fever are thought to be greatly under-reported; the World Health Organization (WHO) estimates that there are approximately 200,000 cases of yellow fever worldwide per year, with 30,000 deaths; 90% of these cases occur in Africa. According to WHO, yellow fever is endemic in tropical areas of Africa and Latin America. WHO also notes, the number of yellow fever cases has increased over the past two decades due to declining population immunity to infection, deforestation, urbanization, population movements and climate change.
In early 2017, the Brazilian Ministry of Health reported outbreaks of yellow fever in several eastern states, including areas where yellow fever was not traditionally considered to be a risk. Although virus spread decreased by mid-2017, yellow fever cases have reappeared in several states since the end of 2017, especially in São Paulo State, including areas close to the city of São Paulo. In early 2018, the GeoSentinel Surveillance System reported a case of yellow fever in an unvaccinated Dutch traveler who had stayed near the São Paulo metropolitan region.
In Nigeria, the local Centre for Disease Control has reported an ongoing outbreak of yellow fever that began in September 2017. Laboratory-confirmed yellow fever cases have been reported in at least seven states, and a number of people have died.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
MALARIA in Brazil, Cape Verde, Costa Rica, South Africa
Feb. '19 - Malaria is a potentially deadly mosquito-borne disease found in many countries throughout the the world.
Cases of malaria have been reported in parts of South Africa, Costa Rica and Brazil.
Public health officials in Brazil have reported an outbreak of locally transmitted malaria in the town of Wenceslau Guimarães in Bahia State. Local transmission means that mosquitoes in the area may be infected with malaria and spreading it to people. Although mosquitoes that spread malaria are present in Bahia State, malaria is not usually found there; this outbreak is believed to have started with an infected person who traveled from Pará State, where malaria is known to spread.
In South Africa, as of March 2018, multiple cases have been reported in travelers to Limpopo Province.
CDC now recommends that travelers to the western Waterberg district of Limpopo Province take prescription medicine to help prevent malaria. CDC previously recommended these medicines only for people traveling to Vembe or Mopane cities in Limpopo province.
A malaria epidemic has been declared by the Burundi Ministry of Health. All of the country’s 18 provinces are reporting higher numbers of malaria cases than expected and nine provinces—Gitega, Kirundo, Muyinga, Karusi, Kayanza, Ngosi, Ruyigi, Cankuzo and Cibitoko—have been especially hard-hit.
CDC continues to recommend that travelers to Burundi take prescription medicine to prevent malaria.
Sources Include: Center for Disease Control and Prevention
EBOLA in Democratic Republic of Congo
Feb. '19 - Cases of Ebola have been reported in the North Kivu and Ituri provinces of the Democratic Republic of the Congo.
The North Kivu and Ituri provinces are among the most populated in DRC. These provinces share borders with other countries (Rwanda and Uganda) with frequent cross-border movement for trade activities. The provinces have been experiencing a prolonged humanitarian crisis and deteriorating security situation, which are expected to limit public health efforts to respond to this outbreak.
According to the CDC, travelers headed to an area affected by Ebola should do the following for prevention:
- practice careful hygiene
- do not handle items that could have come into contact with an infected person's blood or body fluids
- avoid burial rituals that require handling the body of someone who has died from Ebola
- avoid contact with bats and non-human primates, including blood, fluids, and raw meat prepared from these animals
- avoid hospitals where Ebola patients are being treated
- after returning, monitor health for 21 days and seek medical care promptly if you experience Ebola symptoms:
- fever
- headache
- muscle pain
- weakness
- diarrhea
- vomiting
- abdominal pain
- unexplained bleeding or bruising
CHOLERA in Cameroon, Chad, Cote d'Ivoire, Cuba, Democratic Republic of Congo, Dominican Republic, Ghana, Haiti, India, Iraq, Kenya, Malawi, Mozambique, Namibia, Nigeria, Somalia, Syria, Tanzania, Uganda, Yemen, Zambia, Zimbabwe
Feb. '19 – Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Although cholera is preventable, an estimated 3 to 5 million cases and over 100,000 deaths occur each year around the world. Cholera is common in many Sub-Saharan African countries. Passport Health offers products for water purification and electrolyte replacement; precautions for food and water are covered in the travel consultation.
Recently, the following places have reported cases and/or deaths due to cholera:
In Africa: Cameroon Cote d'Ivoire, Democratic Republic of Congo, Ghana, Kenya, Malawi, Mozambique, Nigeria, Tanzania, and Uganda. Tanzania alone has seen 4,835 cases, including 68 deaths in its most recent outbreak.
In Asia: India, Syria and Yemen.
In the Americas: The last confirmed cholera case in Cuba was reported in a Canadian Traveler returning from Cuba in January 2015. In the Dominican Republic, since the beginning of the epidemic (November 2010), more than 32,200 suspected cholera cases have been reported, including more than 480 deaths. Since the beginning of 2015, more than 180 suspected cases, including 9 deaths, have been reported; this is an increase of cases compared to the same period last year. In Haiti, since the beginning of the epidemic (November 2010), more than 734,000 cholera cases have been reported, of which more than 50% were hospitalized and more than 8,700 have died. Since the beginning of 2015, there have been more than 10,300 cases, including 106 fatalities; the number of cases and deaths reported in 2015 are already higher than those reported during the same period last year.
Sources Include: International Society for Infectious Diseases, Center for Disease Control, Pan American Health Organization and World Health Organization.
DENGUE FEVER in Argentina, Australia, Belize, Bolivia, Brazil, British Virgin Islands, Brunei, Cambodia, Cayman Islands, Chile, China, Colombia, Cook Islands, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Egypt, El Salvador, Ethiopia, Fiji Islands, France, French Guiana, French Polynesia, Guadeloupe, Guatemala, Honduras, India, Indonesia, Jamaica, Japan, Kenya, Malaysia, Martinique, Mauritius, Mayotte, Mexico, Mozambique, Myanmar (Burma), Nauru, Nepal, New Caledonia, Nicaragua, Pakistan, Panama, Paraguay, Peru, Philippines, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Samoa (USA), Saudi Arabia, Senegal, Singapore, Solomon Islands, Sri Lanka, St. Martin, Sudan, Taiwan, Tanzania, Thailand, Tonga, Turks & Caicos Islands, Tuvalu, U.S. Virgin Islands, USA, Vanuatu, Venezuela, Vietnam
Feb. '19 - Dengue Fever cases have been on the rise worldwide. According to WHO, incidence of dengue has increased 30 fold in the past 50 years. WHO estimates over 2.5 billion people are now at risk of dengue and there are about 50-100 million dengue infections worldwide every year. According to the CDC, dengue fever is the most common cause of fever in travelers who return from South Central Asia, Central America and the Caribbean.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
MEASLES Worldwide
Feb. '19 - Health officials in various countries throughout the globe have reported an outbreak of measles. Popular destinations include the United Kingdom, Brazil, Israel, the Philippines and Madagascar.
You can get measles primarily by breathing in airborne particles that contain the virus. Symptoms of measles are rash, high fever, cough, runny nose, and red, watery eyes.
The best protection against measles is vaccination.
SOURCES: CDC
LASSA FEVER in Nigeria
Févr. '19 - According to the CDC, the Nigerian and Benin health officials have reported 302 cases and 134 deaths form the virus.
According to the International Society for Infectious Diseases, Lassa fever is known to be endemic in Guinea (Conakry), Liberia, Sierra Leone, and parts of Nigeria, but probably exists in other West African countries as well. The number of Lassa virus infections per year in West Africa is estimated at 100,000 to 300,000, with about 5,000 deaths.
Lassa fever is a viral illness that is spread through direct contact with rat droppings or urine and through touching objects or eating food contaminated with rat droppings or urine. Lassa fever may also spread though person-to-person contact. Symptoms include, fever, headache, sore throat, a cough, nausea, vomiting, diarrhea, and muscle pain. A common complication of Lassa Fever is deafness. Lassa Fever can occur all year long, but most cases occur from January to May.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
LEPTOSPIROSIS in Israel, the West Bank and Gaza
Feb. '19 - Human cases and/or fatalities due to Leptospirosis have been reported in Israel in recent months. Cases have been linked to seven water sites, six of which are closed to the public. These include: waterways of Gilabun (Jilbon), Majrase, Meshushim, Yarden (Jordan) Park, Yehudiya, Zakhi, and Zavitan.
Leptospirosis is spread through contact of urine from infected animals and/or contact with water, soil or food contaminated with the urine of infected animals. According to the CDC, leptospirosis can cause a wide range of symptoms, including fever, vomiting, jaundice, diarrhea, rash, abdominal pain, muscle and head aches. However, some may not exhibit symptoms at all. If not treated, Leptospirosis can lead to kidney damage, meningitis, liver failure, respiratory distress, and even death.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
MUMPS in Australia, Canada, Scotland, United Kingdom, United States of America
Feb. '19 - Mumps outbreaks have been reported in the following locations: USA, Australia (Western Australia), and UK: Scotland.
Mumps is caused by a virus that usually spreads through saliva and can lead to inflammation of the brain and other organs. It is recommended that you receive an adult booster if you haven't had mumps and have only had your childhood immunizations.
A mumps outbreak is currently ongoing in Canada. While the source of the outbreak is unknown, some previous outbreaks have been traced to international travelers.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
POLIO in Afghanistan, Democratic Republic of Congo, Guinea, Iraq, Kenya, Madagascar, Niger, Nigeria, Pakistan, Papua New Guinea, Somalia, Syria
Feb. '19 - CDC and WHO recommend that all international travelers be fully vaccinated against polio. Additionally, adults should receive a one-time booster dose of polio vaccine if traveling to a polio-affected country.
The following countries reported polio cases in the past year: Afghanistan, Iraq, Niger, Nigeria, Pakistan, Somalia and Syria.
The WHO has released temporary vaccination recommendations for the following countries: Afghanistan, Democratic Republic of the Congo, Kenya, Madagascar, Nigeria, Pakistan, Papua New Guinea, Somalia, and Syria.
According to the CDC, anyone staying in any of the polio-affected countries for more than 4 weeks may be required to show proof of polio vaccination when departing the country; in these instances polio vaccine must be received between 4 weeks and 12 months prior to departure from the polio-affected country and should be documented in the yellow International Certificate of Vaccination in order to avoid delays in transit or forced vaccination in country.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
RABIES in Algeria, Bangladesh, China, Ghana, Haiti, India, Indonesia, Israel, the West Bank and Gaza, Malaysia, Nepal, Pakistan, Philippines, Tunisia, USA, Vietnam
Feb. '19 - Although the CDC says that rabies is a preventable viral disease, there are more than 55,000 human deaths per year from rabies worldwide. Canine rabies is most prevalent in South East Asia and Africa, while bat rabies predominates in South America. Cases are often under-reported. Bangladesh has the highest per capita rate of human deaths from rabies, which is 1 death in every 30,000 people. China averages more than 2,400 human deaths from rabies annually. According to China’s Ministry of Health, rabies is a huge problem in China and has the 2nd highest incidence rate in the world after India. Many human rabies deaths are attributed to the consumption of rabid dog meat in China. Roughly 36% of the world’s rabies deaths occur in India each year. India reports an estimated 25,000-30,000 human deaths from rabies annually. Rabies is a known issue in Indonesia, even in popular tourist destinations. Rabies is endemic in Nepal and Algeria. In Pakistan about 5,000 deaths are reported annually.
This year human cases and/or deaths due to rabies have been reported from the following countries: Ghana, India, Indonesia, Israel (Northern Golan), Haiti, Nepal, Philippines, Tunisia, Vietnam, and USA.
Travelers to these areas should consider the pre-exposure rabies prophylaxis vaccination series.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
TUBERCULOSIS in China, Estonia, India, Indonesia, Latvia, Lithuania, Myanmar (Burma), United Kingdom
Feb. '19 - According to the European Centre for Disease Prevention and Control (ECDPC) and WHO, 1000 people throughout Europe develop tuberculosis every day and multidrug-resistant TB continues to increase in the region; health officials are concerned that multi-drug resistant TB continues to be most prevalent in the 3 Baltic countries - Estonia, Latvia, and Lithuania. About 25 percent of the world’s multidrug-resistant tuberculosis (MDR-TB) cases occur in China. According to the Chinese Center for Disease Control and Prevention, it is estimated that nearly 120,000 new cases occur on Nov.nland China every year. Ranking second after China, 20 percent of the world's multidrug-resistant tuberculosis (MDR-TB) cases occur in India. For the first time ever 2 cases of extensively drug-resisitant (XDR-TB) tuberculosis were detected in India's Pune district last year. Indonesia and Myanmar follow China and India with the next highest figures of MDR-TB cases annually.
Tuberculosis (TB) is an infectious bacterial disease, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, infection with TB often causes no symptoms. However, the most common symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is usually treatable with a six-month course of antibiotics.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
TYPHOID FEVER in Pakistan
Feb. '19 - According to the CDC and WHO, multiple cases of drug-resistant typhoid have been identified in Pakistan. Travelers to the country, and other parts of Asia, should be vaccinated against typhoid before travel. Cases have been reported in travelers returning the the U.S. and UK.
Typhoid is a food and waterborne illness that can spread easily in areas with lower sanitation standards. Symptoms can be very severe. In the case of drug-resistant typhoid, treatment can be difficult. Vaccination is the best form of protection.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
JAPANESE ENCEPHALITIS in China, India, Malaysia, Nepal, Taiwan, Vietnam
Feb. '19 - According to the CDC, Japanese Encephalitis (JE) is the leading cause of viral encephalitis in Asia with an estimated 67,900 cases reported annually. It is transmitted to humans by mosquitoes that become infected with JE virus; mosquitoes become infected by feeding on domestic pigs and wild birds infected with the JE virus. Mild JE infections can occur without apparent symptoms other than fever and/or headache. Severe cases are marked by a quick onset of headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions and spastic paralysis.
Southeast Asia is endemic for Japanese Encephalitis virus. Malaysia and Taiwan reported several cases last year. The CDC estimates between 20 and 40 cases of JE are reported annually in Taiwan. Vietnam reported several hundred cases, including more than 30 fatalities, due to JE last year. China and Nepal also reported cases and/or deaths due to JE last year. Eastern China is endemic for JE. In India several cases have been reported this year in Gaya, including six deaths and more than 21 infections in children alone. According to health experts, cases of JE have increased about 5-fold in 5 years in India's northeast Assam state as a result of warming weather and changing rainfall. It's interesting to note, that in 2009 JE was recorded in only half of Assam's districts but is now seen in all of them.
Travelers are encouraged to consider JE vaccination prior to travel and to use mosquito repellents containing DEET on exposed skin and Permethrin on outer clothing.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
AVIAN INFLUENZA (H7N9) in China
Feb. '19 - According to the World Health Organization (WHO), several hundred cases of human infection with influenza A(H7N9) have been confirmed in China since March 2013, when the first human case was observed. Since then, cases have also been reported in Canada, Taiwan, and Malaysia where travelers had recently returned from China.
Symptoms include fever, cough, and shortness of breath. So far human infection with avian influenza (H7N9) has resulted in severe respiratory illness and in some cases death.
Sources Include: International Society for Infectious Diseases, Center for Disease Control, Pan American Health Organization and World Health Organization.
PLAGUE in Madagascar
Feb. '19 - From Aug. 23 through Jan. 11, over 500 cases of plague have been reported in Madagascar. Nearly 11% of those infected have died.
Bubonic plague occurs annually in Madagascar. But, this outbreak of plague pneumonia is occurring in geographically widespread areas, including in heavily populated cities. These include Antananarivo and Toamasina. New cases continue to be reported with over 300 cases of plague pneumonia and 135 of bubonic plague.
Bubonic plague is spread through bites of infected fleas while plague pneumonia (or pneumonic plague) spread through inhaling contaminated droplets from untreated plague sources. Symptoms of both include headache, fever and chills. Bubonic plague is characterized by painful, swollen lymph nodes. Pneumonic causes pneumonia and potentially shock and respiratory failure. Both plague types can lead to death.
In response to the outbreak, the local government is working to control fleas and is canceling mass gatherings. Be sure to use insect repellent and avoid contact with ill individuals, especially those with a cough or pneumonia.
Soucre: CDC
MONKEYPOX in Nigeria
Feb. '19 - As of September 2018, health officials in Nigeria have reported more than 100 confirmed cases of monkeypox, including multiple deaths. As of October 2018, three cases of monkeypox have been reported in travelers to the United Kingdom (2) and Israel (1), including one to GeoSentinel (a global travel surveillance network).
Monkeypox is spread through contact with an infected person or animal. Symptoms include fever, headache, muscle ache and a rash. The illness usually lasts for two to four weeks. The virus can be fatal in 10 percent of cases.
Travelers should wash hands regularly, avoid close contact with the sick or wild animals and do not touch eyes, nose or mouth unless you have recently washed your hands. If you feel sick, seek immediate medical attention.
Source: CDC
MIDDLE EAST RESPIRATORY SYNDROME (MERS) in Bahrain, Egypt, Iran, Iraq, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Malaysia, Oman, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, United Arab Emirates, Yemen
Feb. '19 - Since June 2017, nearly 2,000 cases of MERS (Middle East Respiratory Syndrome) have been identified in multiple countries in the Arabian Peninsula, including in travelers to the region. This has lead to some small outbreaks outside the Arabian Peninsula. In about one-third of the cases, the patients have died.
It is not clear how people contract MERS. However, evidence of transmission to humans from direct contact with camels has been steadily increasing. Most instances of person-to-person spread have occurred in healthcare workers and other close contacts (such as family members and caregivers) of people sick with MERS.
CDC does not recommend that travelers change their plans because of MERS.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
ZIKA VIRUS in Angola, Anguilla, Antigua & Barbuda, Argentina, Aruba, Bahamas, Barbados, Belize, Bolivia, Bonaire, Brazil, British Virgin Islands, British West Indies, Cape Verde, Cayman Islands, Chile, Colombia, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, Fiji Islands, French Guiana, Grenada, Guadeloupe, Guatemala, Guinea-Bissau, Guyana, Haiti, Honduras, Indonesia, Jamaica, Marshall Islands, Martinique, Mexico, Montserrat, New Caledonia, Nicaragua, Palau, Panama, Papua New Guinea, Paraguay, Peru, Puerto Rico, Sabah, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Samoa, Samoa (USA), Sao Tome & Principe, Singapore, Sint Maarten, Solomon Islands, St. Martin, Suriname, Tonga, Trinidad & Tobago, Turks & Caicos Islands, U.S. Virgin Islands, United States of America, USA, Venezuela
Feb. '19 - Zika fever was originally detected in Africa, however an increasing number of cases have been detected in the Americas. Brazil, Colombia, and the Caribbean have been the hardest hit so far, but the disease is spreading rapidly. On Dec. 31 2015, Puerto Rico reported its first case of the disease in a resident who had not traveled outside of the island.
Multiple cases have been detected in the United States in travelers from other regions. A few instances of local transmission are under investigation in Florida. Multiple cases of infant microcephaly have been reported in the U.S.
Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time.
Zika fever is a viral illness similar to dengue fever, yellow fever, and Japanese encephalitis. It is spread though mosquito bites and mosquitoes carrying the virus can bite during the day and at night. Symptoms of zika fever include high temperature, headache, red eyes, skin rash, muscle aches, and joint pains.
Those traveling to the South or Central America or the Caribbean should take extra precautions in order to avoid the mosquito-borne disease including using mosquito repellents, mosquito netting and protective clothing.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
RUBELLA in Japan
Feb. '19 - Japan is currently experiencing an ongoing rubella outbreak. Travelers to the region should ensure they have been vaccinated against infection.
Extra precautions are recommended for women who are pregnant or may become pregnant. Be sure to speak with a healthcare provider before your trip. Avoid travel if you are unprotected.
Rubella, also known as German measles, is highly contagious. The symptoms of rubella include a mild fever, rash, runny nose, sore throat and often swollen lymph nodes with aching joints. Rubella infection in pregnant women can cause serious birth defects or miscarriage. It is recommended that you receive an adult booster if you haven't had rubella and have only had your childhood immunizations.
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
DRUG-RESISTANT BACTERIA in Mexico
Feb. '19 - The CDC has reported multiple cases of pseudomonas bacterial infection among travelers returning from Mexico. The bacteria affects the blood and lungs, with severe cases leading to death.
The majority of cases have originated from the Grand View Hospital in Tijuana. Travelers are advised to avoid the hospital and forego any surgeries that may have been planned there.
SOURCE: CDC
HANTAVIRUS in Argentina, Panama
Feb. '19 - There are ongoing outbreaks of Hantavirus in the Chubut Province of Argentina and Los Santos Province of Panama. Both started in late 2018.
In Argentina, most cases have been reported in Epuyén, which is in Patagonia. In Panama, cases are centered around the souther Pacific coast.
Hantavirus is carried by rodents and passes to humans through close contact or droppings. It can be spread through contact with an infected person. Symptoms are generally flu-like, but serious cases can include respiratory issues.
Travelers are advised to avoid rodents, wash hands and clean areas where rodents or their droppings could be present.
SOURCE: CDC, WHO
RIFT VALLEY FEVER in Kenya
Feb. '19 - Heath officials in Kenya have confirmed an outbreak of Rift Valley Fever (RVF) in the counties of Wajir, Marsabit and Siaya.
The CDC recommends avoiding contact with animals and animal blood. Do not handle raw meat and wear protective gear when working with animals. While rare, RVF can spread through mosquitoes. Be sure to use repellents properly and regularly.
Symptoms of RVF are generally mild but can be serious in about 10 percent of cases. These include severe bleeding, brain swelling and eye disease. About one percent of cases end in death.
SOURCE: CDC
Sources Include: International Society for Infectious Diseases, Center for Disease Control and World Health Organization.
