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Epidemiologic Notes and Reports Cholera in a Tourist Returning from Cancun, Mexico -- New Jersey

A 31-year-old woman had onset of a diarrheal illness on June 15, 1983, 4 days after arriving in Cancun, an island on the coast of the Yucatan Peninsula of Mexico. She returned to the United States on June 18 and, on the same day, had onset of chills, fever, and myalgia. The next day her temperature rose to 39.4 C (103 F), and she had onset of nausea and vomiting. On June 21, she was admitted to a New Jersey hospital because of persistent diarrhea, fever, myalgia, and dehydration; she had lost 10 pounds. On the day after admission, she had onset of sore throat, cough, and laryngitis. The dehydration was treated with intravenous fluids, and she recovered and was discharged on June 30. Hemolytic Vibrio cholerae O-group 1, biotype El Tor, serotype Inaba was isolated from her stool. The organism was toxigenic in a Y-1 adrenal cell assay and in an enzyme-linked immunosorbent assay for cholera toxin. The patient reported having eaten a variety of foods, including incompletely cooked seafood and raw vegetables, but the source of her infection is unknown. Reported by E Hedrick, A Klainer, MD, J Martin, MD, Morristown Memorial Hospital, Morristown, WE Parkin, DVM, State Epidemiologist, New Jersey State Dept of Health; Secretaria de Salubridad y Asistencia, Mexico; Pan American Health Organization, Washington, DC; Field Svcs Div, Epidemiology Program Office, Center for Prevention Svcs, Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Toxigenic V. cholerae O1 causes cholera. The patient's respiratory symptoms and high fever are not typical of cholera and were probably caused by a concurrent infection.

This is the first case of cholera apparently acquired in a Western Hemisphere country other than the United States since before 1900. Thirty toxigenic V. cholerae O1 infections (excluding laboratory-associated cases) acquired in the United States were identified between 1973 and 1981; all 30 resulted from exposures in Louisiana and Texas near the coast of the Gulf of Mexico (1-3). Isolates from cases acquired in the United States were hemolytic and of the same biotype and serotype as the isolate from the present case; phage typing and molecular genetic analysis will be done to determine if the strains are identical.

The risk to tourists traveling to Cancun should be very slight, since, despite extensive travel by Americans to areas with endemic cholera (such as India, Indonesia, Thailand, and the Philippines), only 10 cases of cholera in U.S. travelers were reported during the first 20 years of the cholera pandemic that began in 1961 (4). There is no evidence of any other cholera cases in Mexico. An investigation is in progress, and a surveillance system for V. cholerae O1 and other vibrios is being established. Persons visiting Cancun need not take any unusual precautions, but should follow the usual recommendations to travelers to prevent diarrheal disease (5): 1) Drink boiled or chemically treated water, canned or bottled carbonated beverages (including carbonated bottled water and soft drinks); beer and wine should also be safe, 2) Avoid raw or incompletely cooked seafood, and eat only foods that have been cooked well and are still hot and fruits that have been peeled by the traveler. Cholera vaccine is not recommended. Physicians and laboratories should be aware that use of a special culture medium, such as thiosulfate citrate bile salts sucrose agar, will greatly enhance detection of Vibrio species in stools.

References

  1. Blake PA, Allegra DT, Snyder JD, Barrett TJ, et al. Cholera--a possible endemic focus in the United States. N Engl J Med 1980;302:305-09.

  2. CDC. Cholera--Texas. MMWR 1981;30:389-90.

  3. CDC. Cholera on a Gulf Coast oil rig--Texas. MMWR 1981;30:589-90.

  4. Snyder JD, Blake PA. Is cholera a problem for U.S. travelers? J Am Med Asso 1982;247:2268-69.

  5. CDC. Health Information for International Travel 1982:91-95.

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