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If my own body was putting forth the high frequency energy purchase cheap cleocin gel line skin care test, it could be bled off and diverted into the ground with a correct size capacitor generic 20gm cleocin gel otc acne 12 weeks pregnant. But ridiculous kept ringing in my ears and I tried an- 1 The dermatron was invented decades ago and made famous by Dr buy 20 gm cleocin gel acne x-ray treatments. If this was truly a resonance phenomenon I should be able to add a capacitance to this circuit and see the resonance destroyed buy cheap cleocin gel 20gm on line acne 911 zit blast reviews. I raised the frequency gradually, from 1,000 to 10,000 to 100,000 to 1,000,000 Hz. But one last look at my generator reminded me that it could reach 2,000,000 Hz and I was just at 1,000,000. A year later I purchased a better frequency generator to search for the upper end of my bandwidth. Any frequency be- tween 1,562,000 and 9,457,000 Hz could be added to the circuit and produce resonance. It seemed obvious, then, that the human body broadcasts electrically, just like a radio station, but over a wide band of frequencies and very low voltages, which is why it has not been detected and measured until now. I was determined to find a bandwidth for other living things: I found them for flies, beetles, spiders, fleas, ants. They were between 1,000,000 Hz and 1,500,000 Hz; cockroaches were highest amongst insects I tested. Much narrower, and near the top end of the same range it had when living, but distinctly present. But if dead things had a resonant bandwidth, then maybe a prepared microscope slide of a dead creature could be used, and my trips to the garden and telephone calls to abattoirs (for meat parasites) could cease. My first slide was of the human intestinal fluke, a huge parasite, scourge of humanity. I had just found it to be present in the liver (not in- testine) of every cancer sufferer I saw. The entire catalog of biological supply companies, hundreds of specimens of viruses, bacteria, parasites, molds, and even toxins, were now available to re- search with this new technique! If a person were to hold on to the frequency generator while it was generating 434,000 Hz, what would happen to the adult fluke, if you were infected with it? I tested this plan that same week on myself, not with the fluke but with Salmonella bacteria and Giardia and Herpes that I carried chronically. Within three weeks I had reliable data re- garding the necessary level of electrical treatment. It is not as if you had to use house current which would kill you, along with the parasite. Selective Electrocution In twenty minutes (three minutes at six different frequencies) a whole family could get rid of this parasite. Cancer cases showed that in a few hours the universal cancer marker, ortho- phospho-tyrosine could be banished from their bodies by killing this same parasite. Most cases of pain got immediate relief if I could identify the correct “bug” and have its frequency found by the next office visit. This seemed to be absolute proof that living things had an essential high frequency output of some kind of energy. If I could kill something as large as an Ascaris worm or intestinal fluke, then perhaps I could kill something even larger, like an earthworm or flea, something I could see with my own eyes in- stead of having to imagine its demise inside my body. Ten minutes at a frequency chosen near the top of their broadcast range seemed to anesthetize them. There was no need to experiment, though, because the parasites we want to kill have characteristic frequencies that do not overlap the characteristic frequencies of a human. Find the resonant frequency of a bacterium, virus or parasite using a slide or dead bit. Treat the living invaders inside the human body with this frequency and in a matter of minutes they are no longer transmitting their own bandwidths—they are dead or sick and will be removed by our white blood cells. Perhaps the department of defense would use this knowledge and develop super high voltage de- vices to kill people (“enemies”) somewhere in the world. Possibly a way could be found to shield yourself from frequencies harmful to humans by wearing a choke (inductor) coil which suppresses these frequencies. Meanwhile, people must be alerted that they can safely kill their invaders and heal their chronic illnesses. Invaders that have been increasing exponentially due to lowered immunity in recent decades. Remember, though, that the true challenge is not to kill our invaders but to regain our health and immunity. The ship of “progress”, of increasingly complex, processed foods and products, must be turned around and simplicity become our goal. Or will daily parasite and pathogen electrocution become another crutch that makes us just enough better that we can continue a detri- mental lifestyle? Perhaps it is the same energy as the Asian chi; perhaps it is merely related to it. Perhaps it is the energy that runs along the meridians discovered eons ago by Asian practitioners. Perhaps it is the energy that faith healers and religious teachers know how to harness, perhaps not. Perhaps it is the energy that psychics perceive and that drives occult phenomena, perhaps not. What is truly amazing is that ordinary persons have discov- ered such energy well ahead of scientists. Persons using the “art” of kinesiology, pendulums, radionics, dousing rods and many other forms of “strange energy” have no doubt harnessed a part of this bioradiation. It is a tribute to the generally high intelligence of common people and to their open-mindedness that they discovered this energy, in spite of opposition from scientists of today. Over a century ago the scientists of Europe proposed the existence of a “life force” called “élan vitale. Young scientists, (including myself) were systematically taught to scorn this idea. Of course we were also taught that a good scientist was unemo- tional, does not scorn ideas, has a completely open mind, and does not rule something out until it is disproved to their satis- faction. The youthfulness of college years is so susceptible to prejudices of all kinds, and the desire for acceptance is so great, that special effort needs to be made to teach neutrality. I was indeed inspired with the phrase “search for truth” but then promptly led down the path of “search for acceptance. Only its frequency was noticed and caught (modulated) in such a way as to be measurable. These amazing properties are due to the capacitive and inductive properties of objects all around us, including our- selves.
Remove all the metal in your dentalware immediately order cleocin gel 20 gm with amex skin care guru, replacing with composite (see Dental Cleanup 20 gm cleocin gel sale skin care urdu, page 409) order cleocin gel 20 gm without prescription acne antibiotics. Hopefully buy cleocin gel 20gm free shipping skin care with ross, your immune system is still strong enough to clear the bacteria growing around the metal and in pockets in the jaw. Three kinds of Shigella are readily obtainable on slides: Shigella dysenteriae, Shigella flexneri, Shigella sonnei. Nana Hughes, 48, had numbness of the whole right arm, hand and right side of her head; it was particularly bad in the last four months. She started on the parasite program, stopped using nail polish, and stopped all detergents for dishes or laundry. Maria Santana, 45, had numbness in both arms; they would tingle and “go to sleep” a lot. She went off all commercial body products, did a kidney cleanse and killed parasites. She had diffi- culty getting rid of Prosthogonimus but in two months she had everything cleaned up. Her legs, arms, sleep problem, urinary tract problems were all gone and she could focus on her last problem, digestion. Candy Donaldson, 44, had numbness from her shoulder to the wrist of one arm, it started a year ago. She was advised to stop caffeine use and switch to milk (her calcium level was low: 9. She decreased the phosphate in her diet (meat, nuts, grains, soda pop) and started the kidney cleanse. When the gas leak was fixed, both her lithium and vanadium toxicity disap- peared. In six weeks she had also killed parasites and her periods became regular for the first time. After four months she had done three liver cleanses and suddenly her numbness improved. If cleaning cavitations brings you immediate improvement you know that these bacteria were part of the problem. Have them checked again if problems return; dental bacteria are noto- rious for returning. If kidney cleansing makes it worse for a day and then better, you know kidney bacteria are partly responsible. If liver cleanses (page 552) make matters worse for a day and then better, you know bacteria are entrenched in the liver. Depression All persons I have seen with clinical depression had small roundworms in the brain. The usual worms are hookworms (Ancylostoma), Ascaris of cats and dogs, Trichinellas and Strongyloides. Although it is commonly believed that hookworms penetrate the skin when walking barefoot on earth, this appears to be a negligible route. Letting little children clean up after their own bowel movements is even more hazardous. If no- body suffers from depression, you can use bleach (stored in the garage) to disinfect the stool, otherwise use alcohol (50% grain alcohol). Other family members should be cleared of these four worms on the same day or as close to it as possible. In the depressed person, the microscopic parasites travel immediately to the brain. In others, they may simply reside in the intestine or lungs or liver, or other organs. Depression, even of long standing, can lift within days after the brain finally has its territory to itself. Look in the mirror and smile at yourself for your success in vanquishing your invaders. Manic Depression This variety of depression is associated with Strongyloides, as the main parasite in the brain. Strongyloides is the same worm that causes migraines and other severe types of recurrent headache. The amazing truth is that some family members do not get infected with it or at least do not get brain symptoms! It is very difficult to eradicate Strongyloides in a whole family and thereby let the depressed person get well. You must also stop even washing your face in chlorinated water (use a pure carbon filter system). Of course, there should be no bleach container in the house, even when tightly closed; nor should bleached clothing be worn. Humans, it seems, must lick fingers with the same compulsion that cows lick their noses and cats lick their rears. The single, most significant advance in human hygiene would most assuredly be stopping the hand to mouth habit. Together with the new pollutants, solvents, and heavy metals, parasites will overtake us unless we change. Although you may be free of manic depression in a day, reinfecting yourself weeks later will attack your brain like a hurricane; it has not yet healed, the routes are open. She was parasitized by intestinal flukes (in the intestine), dog whipworm, Strongyloides and human liver flukes. She set to work again, leaving no detail undone, because she could remember how good it felt to be free of depression (not drugged out of it). Three months later she still had Strongyloides (she had a cat) but she did her first liver cleanse anyway. She substituted 4 ornithine and 2 ginseng capsules daily (more if tension was not relieved) for Prozac and cured her problem. But in less than three months, when only half her clean-up chores were done, she was already saying positive things about her job. When he switched back to plain tap water (filtered in small quantities) the depression lifted in a week and he was no longer crying over anything. Only one of her two dogs had Strongyloides (saliva test) and the cat was free of them also. She was full of cesium (from drinking refrigerator water) and vanadium (from a gas leak). In two months she had accomplished the impossible: all pets and herself were free of Strongyloides, they had repaired three gas leaks and her depression was just a memory.
Leukoedema has normal consistency on palpation 20 gm cleocin gel with amex skin care 8 year old, and it should not be confused with leukoplakia or lichen planus cheap cleocin gel 20gm amex skin care routine for dry skin. Normal Oral Pigmentation Melanin is a normal skin and oral mucosa pigment produced by melanocytes order genuine cleocin gel on line acne on temples. However buy cleocin gel 20 gm without a prescription acne 30 years old, areas of dark discoloration may often be a normal finding in black or dark- skinned persons. However, the degree of pigmen- tation of skin and oral mucosa is not necessarily significant. In healthy persons there may be clini- cally asymptomatic black or brown areas of vary- ing size and distribution in the oral cavity, usually on the gingiva, buccal mucosa, palate, and less often on the tongue, floor of the mouth, and lips (Fig. The pigmentation is more prominent in areas of pressure or friction and becomes more intense with aging. Clinically, there are many small, slightly raised whitish-yellow spots that are well circumscribed and rarely Congenital Lip Pits coalesce, forming plaques (Fig. They occur Congenital lip pits represent a rare developmental most often in the mucosal surface of the upper lip, malformation that may occur alone or in combina- commissures, and the buccal mucosa adjacent to tion with commissural pits, cleft lip, or cleft the molar teeth in a symmetrical bilateral pattern. Clinically, they present as bilateral or They are a frequent finding in about 80% of unilateral depressions at the vermilion border of persons of both sexes. There is no satisfactory explana- tion for the occurrence of oral hair although a developmental anomaly is the most likely possibil- ity. The presence of oral hair and hair follicles may offer an explana- tion for the rare occurrence of keratoacanthoma intraorally. The differential diagnosis should be made from traumatically implanted hair and the presence of hair in skin grafts after surgical procedures in the oral cavity. Ankyloglossia Cleft Palate Ankyloglossia, or tongue-tie, is a rare develop- Cleft palate is a developmental malformation due mental disturbance in which the lingual frenum is to failure of the two embryonic palatal processes short or is attached close to the tip of the tongue to fuse. Rarely, the condition may occur as a exhibit a defect at the midline of the palate that result of fusion between the tongue and the floor may vary in severity (Fig. The malfor- sents a minor expression of cleft palate and may mation may cause speech difficulties. Surgical clipping of the frenum cor- Cleft palate may occur alone or in combination rects the problem. Early surgical correction is recom- usually involves the upper lip and very rarely the mended. The incidence of cleft lip alone or in combination with cleft palate varies from 0. Plastic surgery as early as possible corrects the esthetic and functional problems. Developmental Anomalies Bifid Tongue Torus Palatinus Bifid tongue is a rare developmental malforma- Torus palatinus is a developmental malformation tion that may appear in complete or incomplete of unknown cause. The inci- deep furrow along the midline of the dorsum of dence of torus palatinus is about 20% and appears the tongue or as a double ending of the tip of the in the third decade of life, but it also may occur at tongue (Fig. It may coexist with shape may be spindlelike, lobular, nodular, or the oro-facial digital syndrome. The exostosis is benign and consists of bony tissue covered with normal mucosa, although it may become ulcerated if traumatized. Because of its slow growth, the Double Lip lesion causes no symptoms, and it is usually an Double lip is a malformation characterized by a incidental finding during physical examination. It may be congenital, but it may be anticipated if a total or partial denture is can also occur as a result of trauma. Developmental Anomalies Torus Mandibularis Fibrous Developmental Malformation Torus mandibularis is an exostosis covered with Fibrous developmental malformation is a rare normal mucosa that appears on the lingual sur- developmental disorder consisting of fibrous over- faces of the mandible, usually in the area adjacent growth that usually occurs on the maxillary alveo- to the bicuspids (Fig. Bilateral exostoses cal painless mass with a smooth surface, firm to occur in 80% of the cases. Clinically, it is an asymptomatic growth that Commonly, the malformation develops during the varies in size and shape. Surgical excision is required if Multiple exostoses are rare and may occur on the mechanical problems exist. Clinically, they appear as multiple asymptomatic small nodular, bony elevations below the mucco- labial fold covered with normal mucosa (Fig. Developmental Anomalies Facial Hemiatrophy Masseteric Hypertrophy Facial hemiatrophy, or Parry-Romberg syndrome, Masseteric hypertrophy may be either congenital is a developmental disorder of unknown cause or functional as a result of an increased muscle characterized by unilateral atrophy of the facial function, bruxism, or habitual overuse of the mas- tissues. Clinically, masseteric The disorder becomes apparent in childhood and hypertrophy appears as a swelling over the girls are affected more frequently than boys in a ascending ramus of the mandible, which charac- ratio of 3:2. In addition to facial hemiatrophy, teristically becomes more prominent and firm epilepsy, trigeminal neuralgia, eye, hair, and when the patient clenches the teeth (Fig. Hemiatrophy of the tongue and the lips are the most common oral manifestations (Fig. The differential diagnosis includes true lipodystro- phy, atrophy secondary to facial paralysis, facial hemihypertrophy, unilateral masseteric hypertro- phy, and scleroderma. It is progressive until The differential diagnosis includes white sponge early adulthood, remaining stable thereafter. Histopathologic examination they are found in the buccal mucosa and the establishes the diagnosis. Gingival Fibromatosis The differential diagnosis includes leukoplakia, lichen planus, leukoedema, pachyonychia con- Gingival fibromatosis is transmitted as an auto- genita, congenital dyskeratosis, hereditary benign somal dominant trait. It usually appears by the intraepithelial dyskeratosis, and mechanical tenth year of life in both sexes. Histopathologic examination is with minimal or no inflammation and normal or helpful in establishing the diagnosis. The upper gingiva are more severely affected Hereditary Benign Intraepithelial and may prevent the eruption of the teeth. Dyskeratosis The differential diagnosis should include gingival hyperplasia due to phenytoin, nifedipine, and cy- Hereditary benign intraepithelial dyskeratosis is a closporine, and gingival fibromatosis, which may genetic disorder inherited as an autosomal domi- occur as part of other genetic syndromes. The ocular lesion pre- sents as a gelatinous plaque covering the pupil partially or totally and may cause temporary 3. Hereditary benign intraepithelial dyskeratosis, white lesions on the buccal mucosa. Pachyonychia Congenita Dyskeratosis Congenita Pachyonychia congenita, or Jadassohn-Lewan- Dyskeratosis congenita, or Zinsser-Engman- dowsky syndrome, is an autosomal dominant dis- Cole syndrome, is a disorder probably inherited as ease. It is characterized by symmetrical thickening a recessive autosomal and X-linked trait. The oral mucosal lesions are almost always pres- 25), hyperhidrosis, dermal and mucosal bullae, ent as thick and white or grayish-white areas that blepharitis (Fig. These lesions appear at birth or shortly there- rent blisters that rupture, leaving a raw ulcerated after. The differential diagnosis should include leuko- Atrophy of the oral mucosa is the result of re- peated episodes. Finally, leukoplakia and squa- plakia, lichen planus, white sponge nevus, dys- keratosis congenita, hereditary benign intra- mous cell carcinoma may occur (Fig. Laboratory tests somewhat helpful for diagnosis are the blood cell examination and low serum gamma globulin levels. Dyskeratosis congenita, leukoplakia and verrucous carcinoma of the dorsal surface of the tongue.
In developed countries the main risk factors for cancers of the oral cavity purchase cheapest cleocin gel acne 4 months postpartum, pharynx and oesophagus are alcohol and tobacco cheap cleocin gel online acne 415 blue light therapy 38 led bulb, and up to 75% of such cancers are attributable to these two lifestyle factors (5) purchase cleocin gel 20 gm otc acne 2015 heels. Overweight and obesity are established risk factors specifically for adenocarcinoma (but not squamous cell carcinoma) of the oesophagus (6--8) cleocin gel 20 gm mastercard acne 5 benzoyl peroxide cream. In developing countries, around 60% of cancers of the oral cavity, pharynx and oesophagus are thought to be a result of micronutrient deficiencies related to a restricted diet that is low in fruits and vegetables and animal products (5, 9). There is also consistent evidence that consuming drinks and foods at a very high temperature increases the risk for these cancers (10). Nasopharyngeal cancer is particularly common in South-East Asia (11), and has been clearly associated with a high intake of Chinese-style salted fish, especially during early childhood (12, 13), as well as with infection with the Epstein-Barr virus (2). Until about 20 years ago stomach cancer was the most common cancer in the world, but mortality rates have been falling in all industrialized countries (14) and stomach cancer is currently much more common in Asia than in North America or Europe (11). Infection with the bacterium Helicobacter pylori is an established risk factor, but not a sufficient cause, for the development of stomach cancer (15). Diet is thought to be important in the etiology of this disease; substantial evidence suggests that risk is increased by high intakes of some traditionally preserved salted foods, especially meats and pickles, and with salt per se, and that risk is decreased by high intakes of fruits and vegetables (16), perhaps because of their vitamin C content. Further prospective data are needed, in particular to examine whether some of the dietary associations may be partly confounded by Helicobacter pylori infection and whether dietary factors may modify the association of Helicobacter pylori with risk. Colorectal cancer incidence rates are approximately ten-fold higher in developed than in developing countries (11), and it has been suggested that diet-related factors may account for up to 80% of the differences in rates between countries (17). The best established diet- 96 related risk factor is overweight/obesity (8) and physical activity has been consistently associated with a reduced risk of colon cancer (but not of rectal cancer) (8, 18). These factors together, however, do not explain the large variation between populations in colorectal cancer rates. There is almost universal agreement that some aspects of the ‘‘westernized’’ diet are a major determinant of risk; for instance, there is some evidence that risk is increased by high intakes of meat and fat, and that risk is decreased by high intakes of fruits and vegetables, dietary fibre, folate and calcium, but none of these hypotheses has been firmly established. International correlation studies have shown a strong association between per capita consumption of meat and colorectal cancer mortality (19), and a recent systematic review concluded that preserved meat is associated with an increased risk for colorectal cancer but that fresh meat is not (20). However, most studies have not observed positive associations with poultry or fish (9). Overall, the evidence suggests that high consumption of preserved and red meat probably increases the risk for colorectal cancer. As with meat, international correlation studies show a strong association between per capita consumption of fat and colorectal cancer mortality (19). However, the results of observational studies of fat and colorectal cancer have, overall, not been supportive of an association with fat intake (9, 21). Many case--control studies have observed a weak association between the risk of colorectal cancer and high consumption of fruits and vegetables and/or dietary fibre (22, 23), but the results of recent large prospective studies have been inconsistent (24--26). Furthermore, results from randomized controlled trials have not shown that intervention over a 3--4 year period with supplemental fibre or a diet low in fat and high in fibre and fruits and vegetables can reduce the recurrence of colorectal adenomas (27--29). It is possible that some of the inconsistencies are a result of differences between studies in the types of fibre eaten and in the methods for classifying fibre in food tables, or that the association with fruits and vegetables arises principally from an increase in risk at very low levels of consumption (30). On balance, the evidence that is currently available suggests that intake of fruits and vegetables probably reduces the risk for colorectal cancer. Recent studies have suggested that vitamins and minerals might influence the risk for colorectal cancer. Some prospective studies have suggestedthat a high intake of folate from diet or vitamin supplements is associated with a reduced risk for colon cancer (31--33). Another promising hypothesis is that relatively high intakes of calcium may reduce the risk for colorectal cancer; several observational studies have supported this hypothesis (9, 34), and two trials have indicated that supplemental calcium may have a modest protective effect on the recurrence of colorectal adenomas (29,35). Approximately 75% of cases of liver cancer occur in developing countries, and liver cancer rates vary over 20-fold between countries, being much higher in sub-Saharan Africa and South-East Asia than in North America and Europe (11). The major risk factor for hepatocellular carcinoma, the main type of liver cancer, is chronic infection with hepatitis B, and to a lesser extent, hepatitis C virus (36). Ingestion of foods contaminated with the mycotoxin, aflatoxin is an important risk factor among people in developing countries, together with active hepatitis virus infection (13, 37). Excessive alcohol consumption is the main diet-related risk factor for liver cancer in industrialized countries, probably via the development of cirrhosis and alcoholic hepatitis (5). Cancer of the pancreas is more common in industrialized countries than in developing countries (11, 38). Some studies have suggested that risk is increased by high intakes of meat, and reduced by high intakes of vegetables, but these data are not consistent (9). Heavy smoking increases the risk by around 30-fold, and smoking causes over 80% of lung cancers in developed countries (5). Numerous observational studies have found that lung cancer patients typically report a lower intake of fruits, vegetables and related nutrients (such as b-carotene) than controls (9, 34). The only one of these factors to have been tested in controlled trials, namely b-carotene, has, however, failed to produce any benefit when given as a supplement for up to 12 years (40--42). The possible effect of diet on lung cancer risk remains controversial, and the apparent protective effect of fruits and vegetables may be largely the result of residual confounding by smoking, since smokers generally consume less fruit and vegetables than non-smokers. In public health terms, the overriding priority for preventing lung cancer is to reduce the prevalence of smoking. Breast cancer is the second most common cancer in the world and the most common cancer among women. Incidence rates are about five times higher in industrialized countries than in less developed countries and Japan (11). Much of this international variation is a result of differences in established reproductive risk factors such as age at menarche, parity and age at births, and breastfeeding (43, 44), but differences in dietary habits and physical activity may also contribute. In fact, age at menarche is partly determined by dietary factors, in that restricted dietary intake during childhood and adolescence leads to delayed menarche. Adult height, also, is weakly positively associated with risk, and is partly determined by dietary factors during childhood and adolescence (43). Estradiol and perhaps other hormones play a key 98 role in the etiology of breast cancer (43), and it is possible that any further dietary effects on risk are mediated by hormonal mechanisms. The only dietary factors which have been shown to increase the risk for breast cancer are obesity and alcohol. Obesity increases breast cancer risk in postmenopausal women by around 50%, probably by increasing serum concentrations of free estradiol (43). Obesity does not increase risk among premenopausal women, but obesity in premenopausal women is likely to lead to obesity throughout life and therefore to an eventual increase in breast cancer risk. For alcohol, there is now a large body of data from well-designed studies which consistently shows a small increase in risk with increasing consumption, with about a 10% increase in risk for an average of one alcoholic drink every day (45). The mechanism for this association is not known, but may involve increases in estrogen levels (46). The results of studies of other dietary factors including fat, meat, dairy products, fruits and vegetables, fibre and phyto-estrogens are incon- clusive (9, 34, 47, 48). Endometrial cancer risk is about three-fold higher in obese women than in lean women (8, 49), probably because of the effects of obesity on hormone levels (50). Some case--control studies have suggested thatdietshighin fruitsandvegetablesmayreduceriskandthatdietshighin saturated or total fat may increase risk, but the amount of available data is limited (9).
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Poliomyelitis may be on the verge of worldwide eradication: only 7 countries remained endemic at end 2002 (Afghanistan buy genuine cleocin gel on-line skin care 45 years old, Egypt order discount cleocin gel online acne qui se deplace et candidose, India purchase cleocin gel mastercard skin care 1006, Niger cheap cleocin gel 20gm without a prescription acne zits, Nigeria, Pakistan, Somalia). The greatest risks of polio are now on the Indian subcontinent (89% of cases in 2002) and in West Africa (10% of cases in 2002). Although wild poliovirus transmission has ceased in the majority of countries, importation remains a threat. A large outbreak of poliomyelitis occurred in 1992–1993 in the Netherlands among members of a religious group that refuse immunization. The virus was also found among members of a related religious group in Canada, although no cases occurred. Imported wild poliovirus has recently caused paralytic cases in countries as diverse as Algeria, Bulgaria, Burkina Faso, Georgia, Ghana, the Islamic Republic of Iran, Lebanon, Togo and Zambia. With the exception of rare imported cases, the few cases of poliomyelitis recognized in industrialized countries, until recent changes in immunization policy, were caused by vaccine virus strains. In tropical countries, a less pro- nounced seasonal peak occurred in the hot and rainy season. In the few remaining endemic countries, 80%–90% of cases are under 3 and virtually all cases are under 5. Clusters of susceptible persons, including groups that refuse immunization, minority populations, migrants and other unregistered children, nomads, refugees and urban poor are at high risk. Reservoir—Humans, most frequently people with inapparent infec- tions, especially children. Mode of transmission—Primarily person-to-person spread, princi- pally through the fecal-oral route; virus is detectable more easily and for a longer period in feces than in throat secretions. Where sanitation levels are high, pharyngeal spread may be relatively more important. In rare instances, milk, foodstuffs and other materials contaminated with feces have been incriminated as vehicles. No reliable evidence of spread by insects exists; water and sewage are rarely implicated. Incubation period—Commonly 7–14 days for paralytic cases; reported range of 3 to possibly 35 days. Period of communicability—Not precisely deﬁned, but transmis- sion is possible as long as the virus is excreted. Poliovirus is demonstrable in throat secretions as early as 36 hours and in feces 72 hours after exposure to infection in both clinical and inapparent cases. Virus typically persists in the throat for approximately 1 week and in feces for 3–6 weeks. Susceptibility—Susceptibility to infection is universal; paralysis occurs in only about 1% of infections. The rate of paralysis among infected nonimmune adults is higher than that among nonimmunized infants and young children. Type-speciﬁc immunity, apparently of lifelong duration, follows both clinically recognizable and inapparent infections. Second attacks are rare and result from infection with a poliovirus of a different type. Intramuscular injections, trauma or surgery during the incubation period or prodromal illness may provoke paralysis in the affected extrem- ity. The signiﬁcance of these cases with regard to the possibility of eventually stopping poliomyelitis immunization is under review and studies are in place to look for instances in developing countries. No secondary cases were associated with long-term excretors of vaccine-derived polioviruses. More troublesome have been epidemics of poliomyelitis caused by vaccine-derived polio viruses, which are often recombinants with other neurovirulent enteric viruses capa- ble of spreading through populations. These viruses become manifest in non-vaccinated or incompletely vaccinated indi- viduals. These campaigns should be conducted during the cool, dry season to achieve maximum effect. On the attainment of a high level of control in a country, targeted house-to-house mop-up immunization campaigns in high-risk areas are recommended to interrupt the ﬁnal chains of transmission. With progress towards the international goal of eradica- tion, the risk proﬁle of paralytic poliomyelitis is changing, particularly in industrialized and high/middle income coun- tries. Results of virus culture of stools, demo- graphic information, immunization history, clinical examina- tion and examination for residual paralysis after 60 days will be covered in supplemental reports. Nonparalytic cases are also reported to the local health authority, Class 2 (see Reporting). In communities with modern and adequate sewage disposal systems, feces and urine can be discharged directly into sewers without preliminary disinfection. Epidemic measures: In any country, a single case of poliomy- elitis must now be considered a public health emergency, requiring an extensive supplementary immunization response over a large geographic area. Disaster implications: Overcrowding of nonimmune groups and collapse of the sanitary infrastructure pose an epidemic threat. Planning a large-scale immunization response must begin immediately and, if epidemiologically appropriate, in coordi- nation with bordering countries. Primary isolation of the virus is often best accomplished in a laboratory designated to be part of the Global Polio Eradication Laboratory Network. Once a wild poliovirus is isolated, molecular epidemiology can often help trace the source. An independent international commission has certiﬁed that no locally acquired cases of polio have occurred in the Americas since August 1991. Identiﬁcation—Acute generalized chlamydial disease with variable clinical presentations; fever, headache, rash, myalgia, chills and upper or lower respiratory tract disease are common. Respiratory symptoms are often mild when compared with the extensive pneumonia demonstrable by X-ray examination. Cough is initially absent or nonproductive; when present, sputum is mucopurulent and scant. Pleuritic chest pain and splenomegaly occur infrequently; pulse may be slow in relation to temperature. Encephalitis, myocarditis and thrombophlebitis are occa- sional complications; relapses may occur. Although usually mild or moderate, human disease can be severe, especially in untreated elderly persons. The diagnosis may be suspected in patients with appropriate symptoms, a history of exposure to birds and elevated or increasing antibody titres to chlamydial antigens in sera collected 2–3 weeks apart. Isolation of the infectious agent from sputum, blood or postmortem tissues in mice, eggs or cell culture, under safe laboratory conditions only, conﬁrms the diagnosis. Recovery of the agent may be difﬁcult, especially if the patient has received broad-spectrum antibiotics.