Phylogeny of Zika Virus in Western Hemisphere, 2015.

regions that are ill-equipped to manage imported cu-taneous leishmaniasis has resulted in outbreaks in Turkey and Lebanon (5,6). Our findings emphasize the importance of contempo-raneous disease tracking to identify human populations at highest disease risk. To ameliorate the current cutaneous leishmaniasis crisis, particularly during the winter when cases start to appear, accurate disease monitoring and strategic training of persons based within refugee camps (medical staff, aid workers, volunteers, and military personnel) needs to be prioritized. Moreover, clinicians and other medical personnel residing in refugee-hosting countries must be suitably trained to diagnose cutaneous leish-maniasis because other local diseases (e.g., sarcoidosis and cutaneous tuberculosis) can have similar manifestations. Along with vector and rodent control, new cutaneous leish-maniasis outbreaks should be managed by prompt diagnosis and treatment, which are even more pertinent given that L. tropica–associated cutaneous leishmaniasis typically is resistant to several treatment regimens. In summary, the coexistence of sand fly populations and Leishmania spp. within refugee camps, together with the considerable influx of persons who already have cutaneous leishmaniasis, create a dangerous cocktail that can lead to an outbreak unprecedented in modern times. References 1. Hotez PJ. Vaccine science diplomacy: expanding capacity to prevent emerging and neglected tropical diseases arising from Islamic State (IS)–held territories. To the Editor: Zika virus belongs to the genus Flavi-virus, family Flaviviridae, and is transmitted by Aedes spp. mosquitoes. Clinical signs and symptoms of human infection include fever, headache, malaise, maculopapular rash, and conjunctivitis. Zika virus was first isolated in 1947 from the blood of a febrile sentinel rhesus monkey during a study of yellow fever in the Zika Forest of Uganda (1). During the next 20 years, Zika virus isolates were obtained primarily from East and West Africa during arbovirus surveillance studies in the absence of epidemics. During those 20 years, cases of Zika virus infection were detected sporadically; however, given the clinical similarity of Zika and dengue virus infections and the extensive cross-reactivity of Zika virus antibodies with dengue viruses, it is possible that Zika virus was associated with epidemics that were incorrectly attributed to dengue viruses. Beginning in 2007, substantial Zika virus outbreaks were reported first in Yap Island (Federated States of Micronesia), then in French Polynesia, and then in other Pacific Islands (2–4). Genetic studies have revealed that Zika virus has evolved into 3 distinct genotypes: West African (Nigeri-an cluster), East African (MR766 prototype cluster), and Asian. It has been postulated that …