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
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.
CDC. Cholera--Texas. MMWR 1981;30:389-90.
CDC. Cholera on a Gulf Coast oil rig--Texas. MMWR
1981;30:589-90.
Snyder JD, Blake PA. Is cholera a problem for U.S. travelers?
J
Am Med Asso 1982;247:2268-69.
CDC. Health Information for International Travel 1982:91-95.
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