Notes from the Field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016
Weekly / September 15, 2017 / 66(36);961–962
Victoria Hall, DVM1,2; Carlota Medus, PhD2; George Wahl, MPH2; Alida Sorenson, MPH3; Melanie Orth2; Monica Santovenia, MS4; Erin Burdette, MPH4; Kirk Smith, DVM, PhD2 (View author affiliations)View suggested citation
Views equals page views plus PDF downloads
- pdf icon [PDF]
On August 20, 2016, the Minnesota Department of Health (MDH) was notified of a case of Vibrio cholerae infection. The isolate was identified as serogroup O1, serotype Inaba at MDH. CDC determined that the isolate was nontoxigenic. The patient was a previously healthy woman, aged 43 years, with history of gastric bypass surgery. On August 16, she experienced profuse watery diarrhea, vomiting, abdominal cramps, and headache. On August 18, she sought care and submitted the stool specimen that yielded the V. cholerae isolate. She reported no recent travel. However, she had consumed ceviche made with raw shrimp and raw oysters at restaurant A on August 14, 49 hours before illness onset. Her husband had a similar illness with a similar incubation period after eating the same foods at restaurant A.
On August 22, MDH sanitarians visited restaurant A and obtained tags and invoices for oyster and shrimp products; the oysters were a product of the United States, and the shrimp was a product of India. Sanitarians also gathered patron contact information and credit card receipts for August 12–14. Two additional patrons reported experiencing a gastrointestinal illness that met the case definition of three or more episodes of watery stool in a 24-hour period within 5 days of eating at restaurant A; one reported eating ceviche and oysters at restaurant A. Review of complaints to the MDH foodborne illness hotline revealed a previous complaint from two persons who reported experiencing watery diarrhea after eating raw shrimp ceviche (but no oysters) at restaurant A on August 2. These persons did not provide stool specimens, but their gastrointestinal illnesses met the case definition, resulting in a total of six cases, including one laboratory-confirmed case. No other V. cholerae O1 Inaba cases were reported in the United States during this outbreak.
The Minnesota Department of Agriculture facilitated sampling of shrimp at the distributor from the same lots served at restaurant A on August 14, and most likely during August 2–13, and sent them to the Food and Drug Administration for culture. Shrimp samples yielded V. cholerae non-O1, non-O139, but V. cholerae O1 was not isolated. In response to the outbreak results, restaurant A placed consumer warnings on their menus about the risks of consuming raw or undercooked food items and identified raw menu items for consumers. Restaurant A also focused on other actions that might facilitate reduction of V. cholerae, including appropriate freezing of food items, and allowing raw food items to soak in lime juice before being served, rather than serving the items immediately after adding lime juice (1,2).
V. cholera has over 150 serogroups and has been identified in a wide range of aquatic life, including seafood (3). Whereas multiple serogroups can cause vibriosis, only serogroups O1 and O139 that also contain the cholera toxin are classified as causes of cholera (4). Previous studies have documented the presence of nontoxigenic V. cholerae O1 from environmental and shrimp samples in India and Southeast Asia (5–7).
This outbreak of domestically acquired, nontoxigenic V. cholerae infections, likely from shrimp consumption, included the first V. cholerae O1 case identified in a nontraveler in Minnesota since active surveillance for Vibrio began in 1996. Since 1996, MDH has detected 26 V. cholerae infections, 21 (81%) of which were non-O1, non- O139, and five of which were O1. Among the four O1 type cases identified before the current outbreak, all patients had a recent travel history to Micronesia or India. This outbreak demonstrates the importance of investigating all seafood eaten by patients with vibriosis. In addition, investigators should include nontoxigenic V. cholerae as a possible etiology of domestic foodborne outbreaks, particularly when foods eaten include those from V. cholerae O1–endemic areas.
Karen Wong, Cheryl Tarr, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Heidi DeBeck, Food and Drug Administration; Minnesota Department of Health, Team Diarrhea.
Conflict of Interest
No conflicts of interest were reported.
Corresponding author: Victoria Hall, email@example.com, 651-201-5193.
1Epidemic Intelligence Service, CDC; 2Minnesota Department of Health; 3Minnesota Department of Agriculture; 4Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
- Nascumento DR, Vieira RH, Almeida HB, Patel TR, Iaria ST. Survival of Vibrio cholerae 01 strains in shrimp subjected to freezing and boiling. J Food Prot 1998;61:1317–20. CrossRefexternal icon PubMedexternal icon
- Mata L, Vives M, Vicente G. Extinction of Vibrio cholerae in acidic substrata: contaminated fish marinated with lime juice (ceviche). Rev Biol Trop 1994;42:479–85. PubMedexternal icon
- Faruque SM, Albert MJ, Mekalanos JJ. Epidemiology, genetics, and ecology of toxigenic Vibrio cholerae. Microbiol Mol Biol Rev 1998;62:1301–14. PubMedexternal icon
- Kaper JB, Morris JG Jr, Levine MM. Cholera. Clin Microbiol Rev 1995;8:48–86. PubMedexternal icon
- Gopal S, Otta SK, Kumar S, Karunasagar I, Nishibuchi M, Karunasagar I. The occurrence of Vibrio species in tropical shrimp culture environments; implications for food safety. Int J Food Microbiol 2005;102:151–9. CrossRefexternal icon PubMedexternal icon
- Dalsgaard A, Huss HH, H-Kittikun A, Larsen JL. Prevalence of Vibrio cholerae and Salmonella in a major shrimp production area in Thailand. Int J Food Microbiol 1995a;28:101–13. CrossRefexternal icon PubMedexternal icon
- Dalsgaard A, Echeverria P, Larsen JL, Siebeling R, Serichantalergs O, Huss HH. Application of ribotyping for differentiating Vibrio cholerae non-O1 isolated from shrimp farms in Thailand. Appl Environ Microbiol 1995b;61:245–51. PubMedexternal icon
Suggested citation for this article: Hall V, Medus C, Wahl G, et al. Notes from the Field: Vibrio cholerae Serogroup O1, Serotype Inaba — Minnesota, August 2016. MMWR Morb Mortal Wkly Rep 2017;66:961–962. DOI: http://dx.doi.org/10.15585/mmwr.mm6636a6external icon.
MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.
Questions or messages regarding errors in formatting should be addressed to firstname.lastname@example.org.