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Epidemiologic Notes and Reports Importation of Cholera from Peru

On April 9, 1991, a U.S. physician attending a conference in Lima, Peru, had onset of diarrhea. He reported a maximum of eight watery stools in 24 hours and experienced no other symptoms except moderate weakness. The diarrhea lasted 5 days. After arriving in Peru on April 5, he had eaten all his meals, including a cold crab meat appetizer 2 days before onset of illness, in his hotel or at events catered solely for the conference participants. He also consumed ice and municipal water that the hotel reported had been purified. Culture of a stool sample obtained on April 11, after his return to the United States, yielded toxin-producing Vibrio cholerae O1, serotype Inaba, biotype El Tor. His family did not accompany him to Peru and has remained well. Reported by: JA Wilber, MD, State Epidemiologist, Georgia Dept of Human Resources. Enteric Diseases Br, Div of Bacterial and Mycotic Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

An epidemic of cholera is occurring in Peru, Ecuador, and Colombia, and there is potential for spread to other countries. Although the risk for cholera is small for U.S. residents traveling in cholera-infected areas (1), some U.S. travelers nonetheless may become infected (2). The best protection is provided by scrupulous adherence to recommendations to prevent traveler's diarrhea (3,4); particularly, raw seafood and potentially contaminated water should be avoided. Optimally, travelers should drink only water that they have treated (e.g., by adding iodine or boiling) themselves. In addition, ice, which may be made from contaminated water, should be avoided. Commercially bottled water has transmitted cholera (5), but carbonated bottled water has a low pH and permits only brief survival of V. cholerae O1.

Most V. cholerae O1 infections cause no symptoms or only mild to moderate diarrhea, but in a small proportion of cases the illness can be life-threatening. Travelers who develop severe watery diarrhea or diarrhea and vomiting during or following travel to an area with known cholera should seek medical attention immediately. Treatment of cholera with proper oral and, if indicated, intravenous rehydration is simple and highly effective.

The risk for secondary transmission of cholera in the United States is extremely small (2).

References

  1. Snyder JD, Blake PA. Is cholera a problem for US travelers? JAMA 1982;247:2268-9.

  2. CDC. Update: cholera outbreak--Peru, Ecuador, and Colombia. MMWR 1991;40:225-7.

  3. CDC. Cholera--Peru, 1991. MMWR 1991;40:108-10.

  4. CDC. Health information for international travel, 1990. Atlanta: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (CDC)90-8280.

  5. Blake PA, Rosenberg ML, Florencia J, Bandeira Costa J, Quintino LDP, Gangarosa EJ. Cholera in Portugal, 1974. II. Transmission by bottled mineral water. Am J Epidemiol 1977;105:344-8.

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