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Cholera in the United States, 1965-1991: Risks at Home and Abroad

Cholera in the United States, 1965-1991: Risks at Home and Abroad Abstract Objective: To assess risks for cholera in the United States. Design: Review of published reports of cholera outbreaks and sporadic cases and Centers for Disease Control and Prevention (CDC) memoranda and laboratory reports. Patients: Persons with symptomatic laboratorydiagnosed cholera treated in the United States and territories. Results: From 1965 through 1991,136 cases of cholera were reported. Fifty-three percent of the patients were hospitalized and three persons died (case-fatality rate, 0.02). Ninety-three infections were acquired in the United States and 42 overseas; for one case the source was unknown. Domestically acquired cholera was largely related to the endemic Gulf Coast focus of Vibrio cholerae 01(56 cases). The major domestic food vehicle was shellfish, particularly crabs harvested from the Gulf of Mexico or nearby estuaries. In 1991,14 (54%) of 26 domestically acquired cases were caused by food from Ecuador (n=11) and Thailand (n=3). During 1991, the first cases of cholera in travelers returning from South America were reported. In 1991, the rate of cholera among air travelers returning from South America was estimated as 0.3 per 100 000; among air travelers returning from Ecuador, 2.6 per 100 000. Conclusions: Cholera remains a small but persistent risk in the United States and for travelers. An endemic focus on the Gulf Coast, the continuing global pandemic, and the epidemic in South America make this likely to continue for years to come. Physicians should know how to diagnose and treat cholera and should report all suspected cases to their state health departments.(Arch Intern Med. 1994;154:551-556) References 1. The cholera situation—New York . Public Health Rep. 1911;26:1133-1136. 2. Communicable Disease Center. Cholera—District of Columbia . MMWR Morb Mortal Wkly Rep. 1965;14:193-194. 3. Weissman JB, DeWitt WE, Thompson J, et al. A case of cholera in Texas, 1973 . Am J Epidemiol. 1975;100:487-498. 4. Blake PA, Allegra DT, Snyder JD, et al. Cholera: a possible endemic focus in the United States . N Engl J Med. 1980;302:305-309.Crossref 5. Goldberg S, Murphy JR. Molecular epidemiological studies of United States Gulf Coast Vibrio cholerae strains Infect Immun. 1983;42:224-230. 6. World Health Organization, Cholera in 1991 . Wkly Epidemiol Rec. (August 21) , 1992;67:253-260. 7. Center for Disease Control. Imported cholera—Guam . MMWR Morb Mortal Wkly Rep. 1977;26:302, 307. 8. Snyder JD, Blake PA. Is cholera a problem for US travelers? JAMA . 1982;247: 2268-2269.Crossref 9. U .S. International Air Travel Statistics . Cambridge, Mass: Research and Special Programs Administration, US Dept of Transportation; 1991:IIa1-IIa4. 10. Almeida RJ, Cameron DN, Cook WL, Wachsmuth IK. Vibriophage VcA-3 as an epidemic strain marker for the U.S. Gulf Coast Vibrio cholerae 01 clone . J Clin Microbiol. 1992;30:300-304. 11. Lowry PW, Pavia AT, McFarland LM, et al. Cholera in Louisiana: widening spectrum of seafood vehicles . Arch Intern Med. 1989;149:2079-2084.Crossref 12. Klontz KC, Tauxe RV, Cook WL, Riley WH, Wachsmuth IK. Cholera after the consumption of raw oysters . Ann Intern Med. 1987;107:846-848.Crossref 13. Pavia AT, Campbell JF, Blake PA, et al. Cholera from raw oysters shipped interstate . JAMA . 1987;258:2374.Crossref 14. Centers for Disease Control. Toxigenic Vibrio cholerae 01 infection acquired in Colorado . MMWR Morb Mortal Wkly Rep. 1989;38:19-20. 15. Johnston JM, Martin DL, Perdue J, et al. Cholera on a Gulf Coast oil rig . N Engl J Med. 1983:309;523-526.Crossref 16. Finelli L, Swerdlow D, Mertz K, Ragazzoni, Spitalny K. Outbreak of cholera associated with crab brought from an area with epidemic disease . J Infect Dis. 1992;166:1433-1435.Crossref 17. Centers for Disease Control. Cholera—New York . MMWR Morb Mortal Wkly Rep. 1991;40:516-518. 18. Centers for Disease Control. Cholera associated with imported frozen coconut milk—Maryland . MMWR Morb Mortal Wkly Rep. 1991;40:844-845. 19. Communicable Disease Center. Cholera—District of Columbia . MMWR Morb Mortal Wkly Rep. 1965;14:237-238. 20. Hawaii State Department of Health. Cholera confirmed in Hawaii . Commun Dis Rep. (October) /November/December 1991:1-2. 21. Centers for Disease Control. Cholera in a tourist returning from Cancun, Mexico— New Jersey . MMWR Morb Mortal Wkly Rep. 1983;32:357. 22. Blake PA, Wachsmuth K, Davis BR, et al. Toxigenic Vibrio cholerae 01 strain from Mexico identical to United States isolates . Lancet . 1983;2:912.Crossref 23. Center for Disease Control. Vibrio cholerae—Hawaii . MMWR Morb Mortal Wkly Rep. 1977;26:284. 24. Center for Disease Control. Follow-up on cholera in Indochinese refugees in the United States—California, Pennsylvania . MMWR Morb Mortal Wkly Rep. 1980;29:239. 25. Morris JG, West GR, Hoick SE, et al. Cholera among refugees in Rangsit, Thailand . J Infect Dis. 1982;145:131-133.Crossref 26. Centers for Disease Control. Importation of cholera from Peru . MMWR Morb Mortal Wkly Rep. 1991;40:258-259. 27. Merson MH, Martin WT, Craig JP, et al. Cholera on Guam, 1974 . Am J Epidemiol. 1977;105:349-361. 28. Haddock RL. Cholera in a Pacific island . J Diarrhoeal Dis Res. 1987;5:181-183. 29. Bart KJ, Huq Z, Khan M, Mosley WH. Seroepidemiologic studies during a simultaneous epidemic of infection with El Tor Ogawa and classical Inaba Vibrio cholerae . J Infect Dis. 1970;121:S17-S24.Crossref 30. Shandera WX, Hafkin B, Martin DL, et al. Persistence of cholera in the United States . Am J Trop Med Hyg. 1983;32:812-817. 31. Levine WC, Griffin PM. Vibrio infections on the Gulf Coast: results of first year of regional surveillance . J Infect Dis. 1993;167:479-483. 32. Tauxe RV, Puhr ND, Wells JG, Hargrett-Bean N, Blake PA. Antimicrobial resistance of Shigella isolates in the USA . J Infect Dis. 1990;162:1107-1111.Crossref 33. Ryan CA, Hargrett-Bean NT, Blake PA. Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel . Rev Infect Dis. 1989;11:1-8.Crossref 34. MacPherson DW, Tonkin M. Cholera vaccination: a decision analysis . Can Med Assoc J. 1992;146:1947-1952. 35. Feeley JC, Gangarosa EJ. Field trials of cholera vaccine . In: Ouchterlony 0, Holmgreb J, eds. Cholera and Related Diarrheas: Molecular Aspects of a Global Health Problem . New York, NY: S Karger AG; 1980:204-210. 36. Centers for Disease Control. Update: cholera—Western Hemisphere, and recommendations for treatment of cholera . MMWR Morb Mortal Wkly Rep. 1991; 40:562-565. 37. Centers for Disease Control and Prevention. Isolation of Vibriocholerae01 from oysters— Mobile Bay, 1991-1992 . MMWR Morb Mortal Wkly Rep. 1993;42:91-93. 38. DePaola A, Capers GM, Motes ML, et al. Isolation of Latin American epidemic strain of Vibrio cholerae 01 from US Gulf Coast . Lancet . 1992;339:624.Crossref 39. Swerdlow DL, Ries AA. Cholera in the Americas: guidelines for the clinician . JAMA . 1992;267:1495-1499.Crossref 40. Pal SC. Laboratory diagnosis . In: Barua D, Greenough WB III, eds. Cholera . New York, NY: Plenum Press; 1992:229-251. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cholera in the United States, 1965-1991: Risks at Home and Abroad

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420050107010
Publisher site
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Abstract

Abstract Objective: To assess risks for cholera in the United States. Design: Review of published reports of cholera outbreaks and sporadic cases and Centers for Disease Control and Prevention (CDC) memoranda and laboratory reports. Patients: Persons with symptomatic laboratorydiagnosed cholera treated in the United States and territories. Results: From 1965 through 1991,136 cases of cholera were reported. Fifty-three percent of the patients were hospitalized and three persons died (case-fatality rate, 0.02). Ninety-three infections were acquired in the United States and 42 overseas; for one case the source was unknown. Domestically acquired cholera was largely related to the endemic Gulf Coast focus of Vibrio cholerae 01(56 cases). The major domestic food vehicle was shellfish, particularly crabs harvested from the Gulf of Mexico or nearby estuaries. In 1991,14 (54%) of 26 domestically acquired cases were caused by food from Ecuador (n=11) and Thailand (n=3). During 1991, the first cases of cholera in travelers returning from South America were reported. In 1991, the rate of cholera among air travelers returning from South America was estimated as 0.3 per 100 000; among air travelers returning from Ecuador, 2.6 per 100 000. Conclusions: Cholera remains a small but persistent risk in the United States and for travelers. An endemic focus on the Gulf Coast, the continuing global pandemic, and the epidemic in South America make this likely to continue for years to come. Physicians should know how to diagnose and treat cholera and should report all suspected cases to their state health departments.(Arch Intern Med. 1994;154:551-556) References 1. The cholera situation—New York . Public Health Rep. 1911;26:1133-1136. 2. Communicable Disease Center. Cholera—District of Columbia . MMWR Morb Mortal Wkly Rep. 1965;14:193-194. 3. Weissman JB, DeWitt WE, Thompson J, et al. A case of cholera in Texas, 1973 . Am J Epidemiol. 1975;100:487-498. 4. Blake PA, Allegra DT, Snyder JD, et al. Cholera: a possible endemic focus in the United States . N Engl J Med. 1980;302:305-309.Crossref 5. Goldberg S, Murphy JR. Molecular epidemiological studies of United States Gulf Coast Vibrio cholerae strains Infect Immun. 1983;42:224-230. 6. World Health Organization, Cholera in 1991 . Wkly Epidemiol Rec. (August 21) , 1992;67:253-260. 7. Center for Disease Control. Imported cholera—Guam . MMWR Morb Mortal Wkly Rep. 1977;26:302, 307. 8. Snyder JD, Blake PA. Is cholera a problem for US travelers? JAMA . 1982;247: 2268-2269.Crossref 9. U .S. International Air Travel Statistics . Cambridge, Mass: Research and Special Programs Administration, US Dept of Transportation; 1991:IIa1-IIa4. 10. Almeida RJ, Cameron DN, Cook WL, Wachsmuth IK. Vibriophage VcA-3 as an epidemic strain marker for the U.S. Gulf Coast Vibrio cholerae 01 clone . J Clin Microbiol. 1992;30:300-304. 11. Lowry PW, Pavia AT, McFarland LM, et al. Cholera in Louisiana: widening spectrum of seafood vehicles . Arch Intern Med. 1989;149:2079-2084.Crossref 12. Klontz KC, Tauxe RV, Cook WL, Riley WH, Wachsmuth IK. Cholera after the consumption of raw oysters . Ann Intern Med. 1987;107:846-848.Crossref 13. Pavia AT, Campbell JF, Blake PA, et al. Cholera from raw oysters shipped interstate . JAMA . 1987;258:2374.Crossref 14. Centers for Disease Control. Toxigenic Vibrio cholerae 01 infection acquired in Colorado . MMWR Morb Mortal Wkly Rep. 1989;38:19-20. 15. Johnston JM, Martin DL, Perdue J, et al. Cholera on a Gulf Coast oil rig . N Engl J Med. 1983:309;523-526.Crossref 16. Finelli L, Swerdlow D, Mertz K, Ragazzoni, Spitalny K. Outbreak of cholera associated with crab brought from an area with epidemic disease . J Infect Dis. 1992;166:1433-1435.Crossref 17. Centers for Disease Control. Cholera—New York . MMWR Morb Mortal Wkly Rep. 1991;40:516-518. 18. Centers for Disease Control. Cholera associated with imported frozen coconut milk—Maryland . MMWR Morb Mortal Wkly Rep. 1991;40:844-845. 19. Communicable Disease Center. Cholera—District of Columbia . MMWR Morb Mortal Wkly Rep. 1965;14:237-238. 20. Hawaii State Department of Health. Cholera confirmed in Hawaii . Commun Dis Rep. (October) /November/December 1991:1-2. 21. Centers for Disease Control. Cholera in a tourist returning from Cancun, Mexico— New Jersey . MMWR Morb Mortal Wkly Rep. 1983;32:357. 22. Blake PA, Wachsmuth K, Davis BR, et al. Toxigenic Vibrio cholerae 01 strain from Mexico identical to United States isolates . Lancet . 1983;2:912.Crossref 23. Center for Disease Control. Vibrio cholerae—Hawaii . MMWR Morb Mortal Wkly Rep. 1977;26:284. 24. Center for Disease Control. Follow-up on cholera in Indochinese refugees in the United States—California, Pennsylvania . MMWR Morb Mortal Wkly Rep. 1980;29:239. 25. Morris JG, West GR, Hoick SE, et al. Cholera among refugees in Rangsit, Thailand . J Infect Dis. 1982;145:131-133.Crossref 26. Centers for Disease Control. Importation of cholera from Peru . MMWR Morb Mortal Wkly Rep. 1991;40:258-259. 27. Merson MH, Martin WT, Craig JP, et al. Cholera on Guam, 1974 . Am J Epidemiol. 1977;105:349-361. 28. Haddock RL. Cholera in a Pacific island . J Diarrhoeal Dis Res. 1987;5:181-183. 29. Bart KJ, Huq Z, Khan M, Mosley WH. Seroepidemiologic studies during a simultaneous epidemic of infection with El Tor Ogawa and classical Inaba Vibrio cholerae . J Infect Dis. 1970;121:S17-S24.Crossref 30. Shandera WX, Hafkin B, Martin DL, et al. Persistence of cholera in the United States . Am J Trop Med Hyg. 1983;32:812-817. 31. Levine WC, Griffin PM. Vibrio infections on the Gulf Coast: results of first year of regional surveillance . J Infect Dis. 1993;167:479-483. 32. Tauxe RV, Puhr ND, Wells JG, Hargrett-Bean N, Blake PA. Antimicrobial resistance of Shigella isolates in the USA . J Infect Dis. 1990;162:1107-1111.Crossref 33. Ryan CA, Hargrett-Bean NT, Blake PA. Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel . Rev Infect Dis. 1989;11:1-8.Crossref 34. MacPherson DW, Tonkin M. Cholera vaccination: a decision analysis . Can Med Assoc J. 1992;146:1947-1952. 35. Feeley JC, Gangarosa EJ. Field trials of cholera vaccine . In: Ouchterlony 0, Holmgreb J, eds. Cholera and Related Diarrheas: Molecular Aspects of a Global Health Problem . New York, NY: S Karger AG; 1980:204-210. 36. Centers for Disease Control. Update: cholera—Western Hemisphere, and recommendations for treatment of cholera . MMWR Morb Mortal Wkly Rep. 1991; 40:562-565. 37. Centers for Disease Control and Prevention. Isolation of Vibriocholerae01 from oysters— Mobile Bay, 1991-1992 . MMWR Morb Mortal Wkly Rep. 1993;42:91-93. 38. DePaola A, Capers GM, Motes ML, et al. Isolation of Latin American epidemic strain of Vibrio cholerae 01 from US Gulf Coast . Lancet . 1992;339:624.Crossref 39. Swerdlow DL, Ries AA. Cholera in the Americas: guidelines for the clinician . JAMA . 1992;267:1495-1499.Crossref 40. Pal SC. Laboratory diagnosis . In: Barua D, Greenough WB III, eds. Cholera . New York, NY: Plenum Press; 1992:229-251.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 14, 1994

References