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These data indicated the importance of reporting data stratified by both sex and age since collapsing the data over all ages would have masked some of the male-female differences. To target preventive measures appropriately, assessment of gender by age is important for dengue because biological or gender-related factors can change over the human lifespan and gender-related factors may differ across countries.

Recently, reports of syphilis have increased rapidly in Japan, with most cases being men who have sex with women and young women who have sex with men.

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The International Health Regulations (IHR) 2005 present a challenge and opportunity for global surveillance and control of infectious diseases. This article examines the opportunity for regional networks to address this challenge. Two regional infectious disease surveillance networks, established in the Mekong Basin and the Middle East, are presented as case studies. The public-private partnerships in the networks have led to an upgrade in infectious disease surveillance systems in capacity building, purchasing technology equipment, sharing of information, and development of preparedness plans in combating avian influenza. These regional networks have become an appropriate infrastructure for the implementation of the IHR 2005.

ObjectiveTo establish seasonal and alert thresholds and transmission intensity categories for influenza to provide timely triggers for preventive measures or upscaling control measures in Cambodia.MethodsUsing Cambodia’s influenza-like illness (ILI) and laboratory-confirmed influenza surveillance data from 2009 to 2015, three parameters were assessed to monitor influenza activity: the proportion of ILI patients among all outpatients, proportion of ILI samples positive for influenza and the product of the two. With these parameters, four threshold levels (seasonal, moderate, high and alert) were established and transmission intensity was categorized based on a World Health Organization alignment method. Parameters were compared against their respective thresholds.ResultsDistinct seasonality was observed using the two parameters that incorporated laboratory data. Thresholds established using the composite parameter, combining syndromic and laboratory data, had the least number of false alarms in declaring season onset and were most useful in monitoring intensity. Unlike in temperate regions, the syndromic parameter was less useful in monitoring influenza activity or for setting thresholds.ConclusionInfluenza thresholds based on appropriate parameters have the potential to provide timely triggers for public health measures in a tropical country where monitoring and assessing influenza activity has been challenging. Based on these findings, the Ministry of Health plans to raise general awareness regarding influenza among the medical community and the general public. Our findings have important implications for countries in the tropics/subtropics and in resource-limited settings, and categorized transmission intensity can be used to assess severity of potential pandemic influenza as well as seasonal influenza.

Lymphoproliferative disorders (LPD) occasionally develop in individuals with immune deficiencies such as immunosuppressive conditions and autoimmune diseases (AID). Key words: lymphoproliferative disorders; autoimmune disease; Epstein-Barr virusLymphoproliferative disorders (LPD) occasionally develop in individuals with immune deficiencies such as immunosuppressive conditions and autoimmune diseases (AID). Information has accumulated on LPD in immunosuppressive conditions. In the recent World Health Organization (WHO) classification, prior immunosuppressive diseases to the LPD are categorized into primary immune disorders, human immunodeficiency virus (HIV) infection, iatrogenic immunosuppression in patients receiving solid organ or bone marrow allografts, and iatrogenic immunosuppression associated with methotrexate (MTX). 1 Individuals affected by AID, such as rheumatoid arthritis (RA) and dermatomyositis (DM), develop LPD at a frequency of 2.0 -5.5 times higher than in the general population. 2-4 These LPD were primarily B cell in nature and those with T cell phenotype comprise approximately 5% of cases in Western countries. 1 Information on LPD developing in other kinds of AID such as systemic lupus erythematosus (SLE), progressively systemic scleroderma (PSS) and autoimmune hemophilic anemia (AIHA), however, is limited.Methotrexate (MTX) is administered in patients with AID, especially RA, to suppress the hyperimmune state. This in turn might induce immunosuppression and provide a basis for the development of LPD. 5,6 This disease occasionally shows a polymorphous pattern of proliferation, Epstein-Barr virus (EBV)-association, and complete regression after withdrawal of MTX. 7 Posttransplantation LPD (PT-LPD) and LPD in AID seems to share a common feature of employment of immunosuppressive therapy and development of LPD. In addition, an increased risk of LPD in patients with RA was reported even in the absence of MTX therapy. 8 Hence, LPD in patients with AID might include a heterogeneous background of lymphoid proliferations.In our study, the clinicopathologic features and virus conditions in 53 cases of LPD developing in AID were analyzed, and the results were compared to those in LPD with different backgrounds of immunosuppression with a review of the pertinent literature. PATIENTS AND METHODSFifty-three patients with AID in whom LPD developed were selected for the current study: 13 through the review of Japanese journals, 31 through the "Annual of Pathological Autopsy Cases in Japan (1978 -1997)" and 9 through consultation case files in the Department of Pathology, Osaka University. They were admitted to the hospitals during the period from 1997-2002. Histological specimens obtained by biopsy (36 cases) or autopsy (17 cases) were fixed in 10% formalin and routinely processed for paraffinembedding. Histologic sections cut at 4 m were stained with H&E and an immunoperoxidase procedure. All of the histologic

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