primary amoebic meningoencephalitis (PAM), prompted a public-health investigation in conjunction with the Centers for Disease Control. PAM is a water-borne infection caused by an amoebic organism, Naegleria fowleri, that enters the brain through the nose, usually resulting in death. PAM is associated with swimming and water sports in freshwater bodies and inadequately chlorinated swimming pools. An increase of Naegleria fowleri may be seen with global climate change, given that PAM is more likely in warm water. Orange County, Fla. has had 16 cases of primary amoebic meningoencephalitis (PAM), in 47 years, of 32 PAM cases recorded in the state of Florida. As of 1990, about 200 cases of PAM had been reported worldwide; as of 2007, 132 cases had been reported in the U.S. PAM occurs throughout the world, including colder climates, such as the UK and Belgium. In 2007, PAM cases were also reported in Texas and Arizona. Water-borne diseases investigated by the Orange County Health Department, the Florida Department of Health and the CDC have also included Giardia, Cyclosporiasis and Cryptosporidiosis. Techniques for identifying Cyclosporiasis were first developed in central Florida. The Florida Department of Health in Orange County, the Florida Department of Health and the CDC advise swimmers and water sports enthusiasts to wear nose plugs when the ambient temperatures exceed 80 degrees when choosing to participate in freshwater activities. However, these have not been shown to prevent the disease. Avoiding fresh water during the hot season appears to be the safest practice. Naegleria fowlerii infection of young teenagers is best described as one of a number of very rare, "orphan diseases". Legionnaire's outbreak On March 14, 2008, a Legionella outbreak, involving two guests of a hotel in Orlando, was epidemiologically traced to possible inadequate chlorination of the pool spa. On March 20, a third guest was confirmed to have had the disease. On April 4, a fourth guest was confirmed to have had the disease. The Florida Department of Health in Orange County worked with management to assess guest rooms, indoor air quality (IAQ), heating, ventilation and A/C (HVAC) systems, and other variables. The hotel was partially closed for a weekend while individual room assessments took place. The rooms and air conditioning systems tested negative for the disease. The jacuzzi was the most likely source, though the first set of cultures, weeks after the possible exposures, was also negative. H1N1 pandemic influenza The department received focus