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Cholera Associated with an International Airline Flight, 1992

On February 19, 1992, the Los Angeles County Health Department and the California Department of Health Services received reports that Vibrio cholerae O1 had been isolated from stool cultures of five persons with diarrhea who became ill after traveling on the same international airline flight. The flight, Aerolineas Argentinas flight 386, departed from Buenos Aires, Argentina, on the afternoon of February 14; stopped in Lima, Peru, for passengers to disembark and board; and landed in Los Angeles later that evening. On arrival in Los Angeles, the flight had 336 passengers and 20 crew members.

As of February 26, 31 persons on the flight had culture-confirmed V. cholerae infection: 10 in Los Angeles County, eight in other parts of California, nine in Nevada, three in Japan, and one in Argentina; one person died. Fifty-four other passengers have reported diarrheal illness.

Studies to determine the mode of transmission and to characterize the strains are in progress.

Reported by: L Mascola, MD, M Tormey, MPH, D Ewert, MPH, S Fannin, MD, Los Angeles County Health Dept; T Prendergast, MD, San Bernadino County Health Dept; H Meyers, MD, Orange County Health Care Agency; M Ginsberg, MD, San Diego Dept of Health; F Taylor, MD, San Francisco Dept of Public Health; S Abbott, SB Werner, MD, Infectious Diseases Br, GW Rutherford, MD, State Epidemiologist, California Dept of Health Svcs. O Ravenholt, MD, L Empey, Clark County Health Dept; D Kwalick, MD, R Salcido, MPH, D Brus, DVM, State Epidemiologist, Div of Health, Nevada State Dept of Human Resources. Div of Field Epidemiology, Epidemiology Program Office; Div of Quarantine, National Center for Prevention Svcs; Enteric Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Until this outbreak, only 20 cases of cholera in the United States had been related to the Latin American epidemic that began in January 1991. This outbreak demonstrates that clinicians should suspect cholera in persons with severe watery diarrhea and that this suspicion should be increased in persons returning from areas with cholera (1). An outbreak of cholera in Australia in 1972 was also associated with an international airline flight (2).

Culture of rectal swabs on thiosulfate-citrate-bile salts-sucrose (TCBS) medium should be requested for any patient suspected to have cholera. Patients with cholera have substantial ongoing fluid losses that need to be replaced; frequent monitoring is necessary to ensure that hydration is adequate. All but severely dehydrated persons can be managed with oral rehydration solution (ORS) (1). If a patient is severely dehydrated or if ORS is not available, intravenous therapy with Ringer's lactate solution should be administered. Antibiotics with demonstrated effectiveness in reducing the duration of illness include doxycycline, tetracycline, trimethoprim-sulfamethoxazole, and furazolidone. Because secondary transmission in the United States is rare, prophylactic antibiotic treatment of contacts is not advised. Household contacts of persons with cholera should receive instructions about proper handwashing and should seek medical care if they develop diarrhea in the week following illness onset in the index patient. Public health authorities should ensure that patients' feces are disposed of through proper sewage treatment or a functioning septic tank.

Persons who were on this flight should contact their health departments if they have not yet been contacted. In the United States, all suspected and confirmed cases of cholera should be reported immediately to the local or state health department. Health departments and ministries of health with information on passengers should contact CDC's Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (telephone (404) 639-2206), or the Los Angeles County Health Department (telephone (213) 725-5411 or (213) 725-5413).

References

  1. CDC. Update: cholera-Western Hemisphere, and recommendations for treatment of cholera. MMWR 1991;40:562-5.

  2. Sutton RG. An outbreak of cholera in Australia due to food served in flight on an international aircraft. Journal of Hygiene, Cambridge, 1974;72:441-51.

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