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MMWR – Morbidity and Mortality Weekly Report

1. Human Paragonimiasis After Eating Raw or Undercooked Crayfish — Missouri, July 2006−September 2010

Jacqueline Lapine
Communications Director
Missouri Department of Health and Senior Services
(573) 751-6062

Paragonimiasis is a parasitic disease caused by Paragonimus trematodes (lung flukes). Humans become infected by eating raw or undercooked crayfish or freshwater crabs. Only six paragonimiasis cases were reported in the United States during 1965−2007. Because of a report of three cases, enhanced surveillance in Missouri identified nine cases of paragonimiasis during July 2006 to September 2010. All patients had eaten raw or undercooked crayfish from rivers in Missouri, while canoeing or camping, within 4 months of illness onset. Health-care providers should consider paragonimiasis and inquire about eating raw or undercooked crayfish among patients with unexplained fever, cough, eosinophilia, and pleural effusion or other chest radiographic abnormalities. Persons involved in recreation along streams and rivers, especially campers and canoeists, should avoid eating uncooked crayfish.

2. Nonpolio Enterovirus and Human Parechovirus Surveillance — United States, 2006–2008

CDC Division of News and Electronic Media
(404) 639-3286

Non-polio enteroviruses and parechoviruses are associated with mild to serious conditions, including aseptic meningitis, encephalitis, neonatal systemic enteroviral disease, and acute flaccid paralysis. In the United States, infections caused by non-polio enteroviruses and parechoviruses are most likely to occur during the summer and fall. In 2006-2008, the five most frequently detected enteroviruses were coxsackievirus B1, echovirus 6, echovirus 9, echovirus 18, and coxsackievirus A9. In 2007, coxsackievirus B1 was the predominant serotype detected and was implicated in an outbreak of serious neonatal infections in the U.S. Understanding trends in enterovirus and human parechovirus circulation can help clinicians decide when to test for these infections that are associated with meningitis, encephalitis, and neonatal sepsis. Timelier reporting of data to CDC could help public health officials recognize outbreaks associated with these pathogens.

3. Progress Toward Poliomyelitis Eradication — India, January 2009–October 2010

CDC Division of News and Electronic Media
(404) 639-3286

India is one of the last four countries that have never stopped poliovirus transmission. In 2010, the number of total wild polio virus (WPV) type 1 and type 3 cases in India has reached historical lows. However, there are pockets of children who have not been fully vaccinated: one of them being children of migrant subpopulations. Polio cases in India have historically centered in Uttar Pradesh and Bihar, two northern states known to have low childhood immunization coverage, large migrant and remote populations, and high population density. There are three types of wild polio virus (WPV). Type 2 was eradicated in 1999. In January–October 2010, the number of total WPV type 1 (WPV1) and type 3 (WPV3) cases in India has reached historical lows with a 78 percent decrease in WPV1 cases and 96 percent decrease in WPV3 cases compared to the same period in 2009. There was simultaneous absence of reported WPV1 cases in Uttar Pradesh and Bihar for more than eight months from November 2009 to August 2010, which is unprecedented. After mostly using vaccines directed against one or the other WPV type in mass immunization campaigns for children in India, the introduction in January 2010 of bivalent oral poliovirus vaccine, which covers both WPV1 and WPV3, has likely been a large contributor to reduction in WPV1 and WPV3 cases. Successful interruption of all WPV transmission in India will require maintaining high levels of immunity in Uttar Pradesh and Bihar and additional efforts directed towards children missed during mass immunization campaigns in migrant subpopulations. To mitigate risks and reach the goal of interrupting all wild poliovirus transmission, India is strengthening routine childhood vaccination and immunization campaign coverage, particularly among migrant subpopulations, and maintaining high levels of immunity in Uttar Pradesh and Bihar.



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