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Epidemiologic Notes and Reports Toxigenic Vibrio cholerae 01 Infections -- Louisiana and Florida

Four cases of cholera acquired in Louisiana and one case acquired in Florida have been detected since mid-August 1986. All five patients were hospitalized with severe diarrhea and had stool cultures yielding toxigenic Vibrio cholerae 01, serotype Inaba.

The four Louisiana patients had onset between August 8 and September 9; they lived in New Orleans and three towns south and west of New Orleans. The single confirmed case in Florida occurred in a woman from California who arrived in Miami on August 18 and became ill with diarrhea on August 24. The patients had no known common source exposures, and the vehicles of transmission are still under investigation, but all had eaten seafood within 5 days before onset of symptoms. The Louisiana patients had eaten crabs and shrimp from multiple sites along the Louisiana coast of the Gulf of Mexico. The Florida patient had eaten raw oysters; their source is being traced. Reported by L McFarland, DrPH, Chief, Epidemiology Section, J Mathison, MD, State Epidemiologist, HB Bradford, PhD, Director of Laboratory Sciences, Louisiana Dept of Health and Human Resources; MH Wilder, MD, Acting State Epidemiologist, W Riley, PhD, Miami Regional Laboratory, C Shank, Jacksonville Central Laboratory, Florida Dept of Health and Rehabilitative Svcs; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, Div of Field Svcs, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Although the vehicles of transmission for these cases are as yet unknown, the patients' exposures to seafood have been of particular interest because seafood has been an important vehicle for cholera in several countries, including the United States. Toxigenic V. cholerae 01, serotype Inaba, biotype El Tor, appears to have an environmental reservoir on the U.S. Gulf Coast, and domestically acquired cases of cholera with identical organisms were detected in 1973, 1978, 1981, and 1984 (1-4). Almost all of the cases occurred during the summer and fall. The vehicles of transmission implicated in those instances were boiled or steamed crabs and rice that was contaminated after being boiled. V. cholerae 01 has been shown to survive in crabs boiled for 8 minutes, but not in crabs boiled for 10 minutes (1).

Toxigenic V. cholerae 01 multiplies readily in a variety of foods. Foodborne cholera is prevented by the same measures that are routinely stressed in prevention of other bacterial foodborne diseases: thorough cooking of any possibly contaminated foods, preventing contamination of foods after cooking, and storing foods that are not eaten soon after cooking at temperatures too low (below 4 C) or too high (above 60 C) to permit multiplication of the organism. Waterborne cholera is prevented by chlorination of water supplies. The disease is rarely, if ever, spread by person-to-person contact.

Cholera can be confirmed by stool culture, preferably on thiosulfate-citrate-bile salts-sucrose (TCBS) agar. If V. cholerae is isolated from stool, the isolate should be serogrouped and assayed for cholera toxin production; arrangements for this testing can be made through state public health laboratories. Cases of cholera should be reported immediately to state epidemiologists.

References

  1. Blake PA, Allegra DT, Snyder JD, et al. Cholera--a possible endemic focus in the United States. New Engl J Med 1980;302:305-9.

  2. Shandera WX, Hafkin B, Martin DL, et al. Persistence of cholera in the United States. Am J Trop Med Hyg 1983;32:812-7.

  3. Johnston JM, Martin DL, Perdue J, et al. Cholera on a Gulf Coast oil rig. New Engl J Med 1983;309:523-6.

  4. Lin FYC, Morris JG, Kaper JB, et al. Persistence of cholera in the United States: Isolation of Vibrio cholerae 01 from a patient with diarrhea in Maryland. J Clin Microbiol 1986;23:624-6.



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