However, our data is limited to address this question; only seven students had been previously vaccinated, of whom four were confirmed cases. Previous reports have also failed to demonstrate such protection.26 The difference between the high attack rate among this group

of medical students and the much lower secondary attack rate in household contacts after their return home supports the idea that the transmission dynamics of pandemic influenza A(H1N1) virus can vary widely, depending on the level and duration of interpersonal Nutlin-3a solubility dmso contact and the rigor of preventive measures. The low incidence of secondary cases in our study might signal that the application of preventive measures helped to decrease disease transmission. LDK378 datasheet Similarly intensive preventive interventions in sites such as airports, tourist resorts, and military camps might reduce secondary transmission of influenza. Infection of close-knit groups of travelers, such as students, businessmen, peacekeepers, and tour groups, likely facilitates intense transmission and spread of influenza virus.27 Better understanding the dynamics of diffusion of influenza virus in such groups could help design and support relevant preventive measures, including the recommendation of influenza vaccination before traveling. The emergence of a new influenza virus may involve changes in the epidemiological pattern of the virus. The

investigation of outbreaks such as that described here, especially at the beginning of an epidemic, is important because it may allow early detection of possible changes. The authors wish to thank all sixth-year medical students of the Clinic Campus, University of Barcelona for their collaboration. We thank S. Polbach for assistance in data collection and M. Domenech for her invaluable very cooperation in managing the outbreak. The authors state that they have no conflicts of interest to declare. “
“Fourteen cases of toxoplasmosis in immunocompetent travelers who visited high prevalence countries are described. This represents the first series of toxoplasmosis

in returned travelers from North America, substantiating the need to consider toxoplasmosis in returned travelers who present with non-specific symptoms, especially fever, lymphadenopathy, and fatigue. International travel has become much more common in the last decade, with over 60 million travelers originating from the United States alone each year. Many are traveling to areas where diseases have a higher prevalence and conditions are more favorable for primary exposure to those diseases than in their home country. One such infectious organism is Toxoplasma gondii, an obligate intracellular protozoan with a widely variable worldwide prevalence, which can have a diverse spectrum of presentation depending on the immune status of the patient, the clinical setting, and virulence of the organism.