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
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.
Shandera WX, Hafkin B, Martin DL, et al. Persistence of
cholera
in the United States. Am J Trop Med Hyg 1983;32:812-7.
Johnston JM, Martin DL, Perdue J, et al. Cholera on a Gulf
Coast
oil rig. New Engl J Med 1983;309:523-6.
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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