Johns et al. BMC Public Health 2011, 11(Suppl 2):S3 http://www.biomedcentral.com/1471-2458/11/S2/S3 Page 7 of 9 Figure 5 A/H1N1 epi curve, timeline for outbreaks and clusters among U.S. service members and beneficiaries. Health Command (Provisional) investigated an outbreak of Group A Streptococcus at Fort Leonard Wood, Missouri. An adenovirus type B14 was investigated at the U.S. Coast Guard Training Center in Cape May, N.J. Both outbreaks took place in March 2009 and were supported by the laboratory at NHRC. Overall, the AFHSC-GEIS global disease surveillance network response remained strong through the end of the first wave and well into the second fall wave of the pandemic. At that point, efforts across the network pri- marily shifted from outbreak response to systematic sur- veillance (monitoring and representative sampling) of affected sites, along with more complex characterization of the viruses and close tracking of the global circulation patterns of all influenza viruses. Non-respiratory, emerging infectious disease outbreaks The AFHSC-GEIS EID surveillance program includes five program pillars or disease focus areas: respiratory diseases, febrile and vector-borne illnesses, enteric diseases, sexually transmitted infections and antimicrobial resistant organisms. Outbreaks involving all five pathogen/illness categories occurred in the one-year timeframe of this report. Global surveillance network partners responded to 20 outbreaks involving non-respiratory EIDs where the disease agents were identified, including four dengue fever, four cholera, three viral hepatitis, two gastrointestinal syn- drome, and one each of Campylobacter, chikungunya, Cyclospora, malaria, Norovirus, rickettsiosis, Rift Valley fever, Salmonella typhi and syphilis. Additionally, partners conducted individual outbreak investigations of conjuncti- vitis and viral hemorrhagic syndrome, while one response activity examined bites from vampire bats. Overall, these response activities took place in 14 countries. From May to September 2009, a diarrheal disease out- break occurred in western Nepal, with reports of nearly 70,000 patients treated and over 350 deaths. The National Public Health Laboratory of the Ministry of Health and Population for Nepal requested assistance from the Walter Reed/AFRIMS Research Unit Nepal (WARUN) in deter- mining the etiology. WARUN received 158 stool samples from eight districts in western Nepal; 45 percent from