Epidemiology of paragonimiasis in Korea.

In Korea, soybean-sauce soaked freshwater crabs (kejang) have been a favorite delicacy when eating a bowl of rice. This traditional food has been a main source of human paragonimiasis. Until the late 1960s, human paragonimiasis had been prevalent; at least two million people had contracted the infection as determined by intradermal tests. About 40% of these were egg positive. In the turmoil of the green revolution and industrialization in the 1970s/1980s, ecological damage occurred widely. In many streams, populations of snail and crustacean hosts were reduced to levels almost of extinction. Population reduction of the intermediate hosts was followed by lowered endemicity. Attitudes of people, changed during the period, also reduced chances of paragonimiasis. Survey data in the 1990s indicated that prevalence of human paragonimiasis has lowered to about one 100th of that in the early 1970s. In a referral system, however, about one hundred clinical cases have been diagnosed annually by antibody test (ELISA), undertaken for clinical differentiation from tuberculosis. At least 10% of freshwater crabs sold in local markets are infected with the metacercariae. Paragonimiasis control has benefited in Korea mainly by the untoward effects of water pollution. To place P. westermani infections as enzootic, health education and surveillance systems should have a priority.