<P>As climate and infectious disease shifts continue, what changes need to occur in our health care systems in order to become more adaptive to these shifts? The key to identifying and responding to outbreaks is good surveillance information so that we can look for common sources of exposure and implement interventions to stop the outbreak. Most of our surveillance systems in the United States depend on reports from laboratories or health care providers to local and state health departments. While a doctor might be able to cure a single patient of a new infection, we may not realize that the patients illness is part of a larger outbreak until we gather data from disparate patient reports. As we experience new or resurging diseases, it is essential that our health care system supports regular and H?HFWLYHFRPPXQLFDWLRQEHWZHHQKHDOWKFDUH providers and public health practitioners, so that we can collect the data necessary to see the big picture and intervene to protect public health. As permafrost melts and glaciers retreat, how serious of a threat do extinct or unknown diseases reemerging from frozen dormancy pose? This is not my area of expertise, but anytime humans encroach on an unknown landscape, there is the potential to come into contact with unknown pathogens. We have seen that clearing the forest for agricultural purposes or entering the forest to hunt bush meat, for example, has created opportunities for spillover of new pathogens from their natural host into human populations. That said, my understanding is that it is highly unlikely that a virulent pathogen that can infect animals and humans will be unleashed from a melting ice sheet. Most viruses are very fragile and cannot exist outside of another living organism, so it is unlikely that there is a killer strain waiting to thaw out and cause a pandemic. PAGE 32 ACROSS THE DIVIDE Micah Hahn CHIKUNGUNYA VIRUS (CHIKV) Warmer temperatures and changes in rainfall patterns allow mosquitoes and other disease vectors to thrive at higher altitudes and new locations, leading to a spread of viruses like Chikungunya. 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