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The secondary reference corresponded to the incidence reported during a focal epidemic in Burkina Faso during 2006, which reached 0.8% in one health centre [ 11].
After 35 years of tularemia surveillance with no cases reported, a focal epidemic was detected near the end of 1997 (2, 8 ).
Despite the fact that pneumococci are responsible for almost half of bacterial meningitis cases in the meningitis belt [ 22, 23] and cause meningitis with pronounced seasonality, no localised epidemic so far has been reported due to pneumococci, which suggests that the focal epidemic pattern is limited to meningococci.
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"Basically you're going to have very focal epidemics that are self-limited and burn out".
Focal epidemics occurred nearly every year in 1 or more of the meningitis belt countries, and large outbreaks occurred every 8 12 years [ 7, 8].
Sporadic, focal mini-epidemics may have played out and coalesced into what was construed as a single "plague" by outside observers.
The unstable nature of malaria makes the population non-immune and prone to focal and cyclical epidemics.
Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic's focal point.
Histologic examination of infected frogs on which necropsies were performed since the 1999 epidemic shows focal mild hyperplasia of the superficial epidermis associated with sporangia of B. dendrobatidis.
Six hundred occurred in the coastal city of Mananjary, and 96 occurred in the small village of Irondro at the crossroads between the towns of Mananjary, Manakara, and Ifanadiana, indicating that the area was a focal point of the epidemic (2 ).
The focal point of the epidemic in terms of mortality was India, with an estimated death toll range of 10 20 million, and a point estimate of population loss of 13.8 million for the British-controlled provinces [ 8, 20, 21].
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