transmitted by fleas normally associated
with rats; person-to-person airborne transmission also possible; recent
plague epidemics occurred in areas of Asia, Africa, and South America
associated with rural areas or small towns and villages; manifests as
fever, headache, and painfully swollen lymph nodes; disease progresses
rapidly and without antibiotic treatment leads to pneumonic form with a
death rate in excess of 50%.

Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection
may also result from exposure to infected animal blood or tissue;
geographic distribution includes Africa, Asia, the Middle East, and
Eastern Europe; sudden onset of fever, headache, and muscle aches
followed by hemorrhaging in the bowels, urine, nose, and gums;
mortality rate is approximately 30%.

Rift Valley fever - viral disease affecting domesticated animals and
humans; transmission is by mosquito and other biting insects; infection
may also occur through handling of infected meat or contact with blood;
geographic distribution includes eastern and southern Africa where
cattle and sheep are raised; symptoms are generally mild with fever and
some liver abnormalities, but the disease may progress to hemorrhagic
fever, encephalitis, or ocular disease; fatality rates are low at about
1% of cases.

Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated
with urban environments, similar to Dengue Fever; characterized by
sudden onset of fever, rash, and severe joint pain usually lasting 3-7
days, some cases result in persistent arthritis.

water contact diseases acquired through swimming or wading in
freshwater lakes, streams, and rivers:

Leptospirosis - bacterial disease that affects animals and humans;
infection occurs through contact with water, food, or soil contaminated
by animal urine; symptoms include high fever, severe headache,
vomiting, jaundice, and diarrhea; untreated, the disease can result in
kidney damage, liver failure, meningitis, or respiratory distress;
fatality rates are low but left untreated recovery can take months.

Schistosomiasis - caused by parasitic trematode flatworm Schistosoma;
fresh water snails act as intermediate host and release larval form of
parasite that penetrates the skin of people exposed to contaminated
water; worms mature and reproduce in the blood vessels, liver, kidneys,
and intestines releasing eggs, which become trapped in tissues
triggering an immune response; may ma