Meningococcal Disease in US Military Personnel before and after Adoption of Conjugate Vaccine

years in Somalia: RVF outbreaks occurred during 1997– 1998 and 2006–2007 (6,7), and a dengue outbreak occurred during 1992–1993 (8). The current outbreak in Somalia could have been triggered by several factors, including circulation of CHIKV in neighboring Kenya (references 8,9 in online Technical Appendix) and heavy rains that led to flooding in southern and central Somalia beginning in January 2016 (reference 1 in online Technical Appendix). CHIKV has the potential to provoke explosive outbreaks in naive populations (9), so the current outbreak may greatly affect the economy and public health in Somalia. Systematic studies to understand the magnitude of the ongoing epidemic are needed. In the meantime, local public health stakeholders in Somalia and healthcare workers worldwide caring for travelers returning from Somalia should be aware that CHIKV is circulating in the country. This report confirms the importance of travel medicine services in performing early diagnosis of imported arboviral diseases, not only to thwart secondary transmission during periods of competent vector activity but also to help to detect or confirm virus circulation in previously unaffected countries.