Worldwide, the incidence of<unk>  is low. In 2015, the incidence was approximately .07 individuals per 100,000. The overall annual case fatality rate for<unk>  ranges between 5 and 10%. The annual case fatality rates for patients younger than 5 or older than 40 years of age tend to be higher, ranging up to 20%.<unk>  most commonly affects children under the age of 5 years and adults over 70 years of age. This is primarily due to the higher chance that patients in these age groups have not had a vaccination or booster. The incidence of<unk>  is highest in developing countries due to the lack of comprehensive vaccination; developing countries to which<unk>  is endemic include Indonesia, Thailand, Laos, and many other countries in Asia, the South Pacific, Middle East, Haiti, Dominican Republic, South America, and Eastern Europe.<unk>  tends to be very rare in developed, industrialized countries. The majority of cases in developed countries involve travelers from<unk> -endemic countries or patients from developed countries who were not vaccinated or did not receive the appropriate boosters.
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