TABLE 7.2.

Epidemiology and Preventive Strategies for Other Diseases With Regional Distribution

Disease (Pathogen)	Mode(s) of Transmission	Geographic Distribution	Risk Activities/At-Risk Groups	Preventive Strategies
African trypanosomiasis (sleeping sickness) (Trypanosoma brucei)46	Vectorborne: tsetse fly (Glossina spp.)	Focal areas of central Africa, West Africa, eastern and southeastern Africa	Rural travel with outdoor exposure	•Wear long clothing of medium-weight material in neutral colours (tsetse flies are attracted to bright or dark colors, especially blue, and can bite through lightweight clothing) •Use insect repellent
Cutaneous larva migrans (Ancylostoma spp.)	Direct contact with soil or sand contaminated with dog or cat hookworm larvae	Widespread in tropical areas, especially the Caribbean	Walking barefoot	•Wear shoes when walking on sand or soil •Use barriers such as towels or mats when seated on the ground
Cutaneous (or mucocutaneous) leishmaniasis47 (Leishmania spp.)	Vectorborne: Sandflies (genus Phlebotomus)	Africa, Asia, the Middle East, Mediterranean countries, Central and South America	Adventure travelers, military personnel, researchers	•Personal protective measures against sandfly bites (especially between dusk and dawn)
Histoplasmosis48 (Histoplasma spp.)	Inhalation of contaminated dust/soil	United States, Central and South America, Africa, Asia	Visiting bat caves, spelunking, activities that disturb soil Immunosuppressed travelers	•Those with risk factors (immunosuppression) should avoid contact with bird or bat droppings, avoid exploring caves, and avoid activities that generate dust
Leptospirosis49	Direct contact with infected animals Ingestion of or direct contact with water, mud, soil, or vegetation that has been contaminated with animal urine	Worldwide, particularly in tropical or subtropical regions	Freshwater swimming, rafting, kayaking, canoeing, fishing, hunting, caving, hiking, trail biking, contact with floodwater	•Avoid swimming or wading in water that may be contaminated •Cover all cuts or abrasions with waterproof dressings •Doxycycline chemoprophylaxis may be considered in some cases
Melioidosis50	Contact with contaminated soil (direct contact or inhalation of aerosolized particles)	Southeast Asia, northern Australia	Outdoor activities during periods of wind and rain, activities involving direct contact with soil	•Avoid direct contact with soil •Those with risk factors (diabetes, chronic lung disease, chronic kidney disease, chronic alcoholism) should stay indoors during periods of heavy wind and rain
Murine typhus51	Vectorborne: fleas (carried by rats and mice)	Worldwide, particularly in tropical or subtropical regions	Outdoor activities, contact with rats or mice	•Personal protective measures against fleas
Myiasis (Cochliomyia hominivorax, Dermatobia hominis, others)52	Penetration of skin by fly larvae (may be deposited on clothing or carried to humans by a biting mosquito)	Tropical areas in Africa and Latin America	Outdoor activities	•Iron clothing after line drying •Cover skin with clothing and use insect repellent •Stay in screened accommodation and use mosquito nets
Schistosomiasis53	Contact with contaminated fresh water	Sub-Saharan Africa (majority of exposures), Southern Africa and some areas of North Africa, the Middle East, South America, the Caribbean, and Southeast Asia (Mekong River region)	Swimming, bathing, or wading in rivers, lakes, ponds, or seasonally flooded areas	•Avoid swimming or wading in fresh water
Scrub typhus54 (Orientia tsutsugamushi)	Vectorborne: mites (chiggers)	South and Southeast Asia and the Pacific (including northern Australia)	Campers, trekkers, visitors to rice paddies	•Personal protective measures against mites (e.g., long pants and long sleeves, tucking pant legs into socks or boots, insect repellents)
Spotted fever group rickettsiosis54 NB: >10 species including Rickettsia africae (African tickbite fever) and R. rickettsii (Rocky Mountain spotted fever)	Vectorborne: Ticks	Worldwide, but with species-specific distributions Majority of exposures in sub-Saharan Africa	Travel to game parks, outdoor activities, late summer season travel	•Personal protective measures against ticks (e.g., long pants and long sleeves, tucking pant legs into socks or boots, insect repellents) •Tick check of skin at the end of the day