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To the Editor: White-nose syndrome (WNS) is an emerging fungal disease in bats that was first described near Albany, New York, USA, in February 2006 (1). The causative agent, Geomyces destructans, is a psychrophilic (cold-loving) fungus that infects the skin of bats and leads to depletion of their fat stores during hibernation (2). WNS has caused dramatic cumulative mortality rates (up to 99%) in some winter hibernacula and has killed millions of bats among 6 cave-roosting species in 19 central and eastern US states and 4 Canadian provinces (3). In addition, the fungus has been identified in 2 additional US states, although bat deaths have not been associated with it. No evidence has been found that WNS is transmitted from bats to humans, although humans may play a role in translocation of the fungus between caves (4,5). Current surveillance for WNS is time- and labor-intensive. Wildlife personnel typically enter caves, inspect hibernacula, and collect bats with clinically compatible signs for testing (4). In July 2010, the National Park Service (NPS) Office of Public Health proposed an expanded WNS surveillance strategy that involved using opportunistic sampling of bats already submitted to state public health laboratories for rabies testing; the bats submitted include species known to be susceptible to WNS. The pilot study focused on the region around Mammoth Cave National Park, the world’s longest known cave system and home to 13 bat species (2 endangered), in south-central Kentucky (6). At the time of initial discussions, Kentucky was WNS-free, but the bordering state of Tennessee had recently reported its first WNS cases in spring 2010 in a cave system located

Background Japanese encephalitis (JE) vaccine is recommended for travelers to Asia whose itineraries increase their risk of exposure to JE virus. The numbers of travelers with such itineraries and the proportion of those who receive JE vaccine are unknown. We performed a survey to estimate the proportion of US travelers to Asia who receive JE vaccine according to the Advisory Committee on Immunization Practices (ACIP) recommendations. Methods We surveyed US residents ≥18 years old departing on 38 flights to Asia selected through a stratified random sample of all direct flights to JE-endemic countries from three US airports. We asked participants about planned itineraries and activities, sources of travel health information, JE vaccination status, and potential barriers to vaccination. Participants planning to spend ≥30 days in Asia or at least half of their time in rural areas were defined as “higher JE risk” travelers for whom vaccination should have been considered. Results Of 2,341 eligible travelers contacted, 1,691(72%) completed the survey. Among these 1,691 participants, 415 (25%) described itineraries for which JE vaccination should have been considered. Of these 415 higher JE risk travelers, only 47 (11%) reported receiving ≥1 dose of JE vaccine. Of the 164 unvaccinated higher JE risk travelers who visited a health care provider before their trip, 113 (69%) indicated that they had never heard of JE vaccine or their health care provider had not offered or recommended JE vaccine. Conclusions A quarter of surveyed US travelers to Asia reported planned itineraries for which JE vaccination should have been considered. However, few of these at-risk travelers received JE vaccine.