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