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MMWR – Morbidity and Mortality Weekly Report

1. U.S.-Acquired Human Rabies with Symptom Onset and Diagnosis Abroad, 2012

Division of News & Electronic Media

This study documents the first reported case of human rabies acquired in the United States in which onset and diagnosis occurred abroad. On July 8, 2012, a 34 year old male U.S. citizen died of rabies in Switzerland after onset of symptoms in Dubai, United Arab Emirates. Public health investigations identified a potential bat contact approximately 12-13 weeks before he became ill. Fifty-nine persons were identified with potential contact with the patient while he was infectious and 23 persons have initiated post-exposure prophylaxis (PEP). This case highlights the need for international collaboration to identify, notify, assess, and provide prophylaxis to all those who had potential contact with a rabies infected individual.

2. Botulism From Drinking Prison-Made Illicit Alcohol — Utah 2011

Pam Davenport
Salt Lake Valley Health Department
Communications Manager

The association between botulism and pruno, an illicit alcoholic beverage often made by prisoners, is not well known, and cases of botulism from pruno might be under-recognized.  Awareness of this association will enable rapid identification and treatment of affected patients and control of the outbreak. This report documents an outbreak of severe illness with prolonged morbidity and great public expense that occurred in a prison from “pruno,” alcohol made illicitly by inmates.  The cost of the outbreak was around $500,000 and involved many hours of investigation as well as prompt treatment in the hospital. Long-term sequelae, even with prompt treatment, can still result. Timely identification of cases is critical to minimize morbidity, avert fatalities, and reduce the economic burden to states.

3. Update: Influenza Activity — United States and Worldwide, May 20–September 22, 2012

Division of News & Electronic Media

The United States experienced low levels of seasonal influenza activity from May 20 to September 22, 2012; however more seasonal influenza viruses were detected in the summer months of previous years. Influenza A (H3N2), 2009 influenza A (H1N1), and influenza B viruses were detected worldwide and in the United States. Since July 12, 306 cases of influenza A (H3N2) variant virus have been detected. Although neither the influenza virus strain(s) that will predominate nor the severity of influenza-related disease during the 2012–13 influenza season can be predicted, characterization of viral isolates from specimens submitted during the summer demonstrated that the vast majority were antigenically similar to the influenza vaccine strains in the Northern Hemisphere 2012–13 vaccine.

4. Progress Toward Poliomyelitis Eradication — Afghanistan and Pakistan, January 2011–August 2012

Division of News & Electronic Media

Afghanistan and Pakistan are two of the three remaining countries (the third is Nigeria) in which indigenous wild poliovirus (WPV) transmission has never been interrupted and remain a substantial threat to the Global Polio Eradication Initiative goal of a polio-free world. This report updates previous MMWR yearly reports and describes polio eradication activities and progress in Afghanistan and Pakistan during January 2011–August 2012, as of September 9, 2012.  During this time period, WPV type 1 transmission occurred in conflict-affected areas in the South Region of Afghanistan and in three groups of districts in Pakistan. In addition to transmission within each country, lab data confirms cross-border transmission resulting from substantial population movements. Positive environmental sewage samples in Pakistan, in areas with no recent confirmed cases, highlight unrecognized continued polio transmission. To achieve polio eradication, both Afghanistan and Pakistan might consider reviewing how their national emergency action plans address commitment, management, and oversight by provincial and district authorities, as well as cross-border transmission of WPV and the safety of vaccination teams in insecure areas.


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