CDC issues health advisory about recent reports of fatal Vibrio vulnificus

Key takeaways:

• V. vulnificus infections on the eastern coast have increased eightfold from 1988 to 2018.
• Infection can occur when open wounds, cuts or scrapes are exposed to warm seawater containing the bacteria.

On Sept. 1, the CDC issued a health advisory concerning an increased rate of infections in the United States of a flesh-eating bacterium called Vibrio vulnificus.

“CDC is aware of an increase in Vibrio infections associated with warmer waters along Gulf Coast and Eastern Seaboard states,” the CDC Enteric Diseases Epidemiology Branch told Healio. “These infections can be very serious if not life-threatening in people who are at increased risk.”

Reported most often between May and October, V. vulnificus is a bacterium that can be found in warm saltwater or brackish water and infect open wounds on the skin. A halophilic vibrios that requires salt to survive, the bacteria can also be contracted by eating raw or undercooked seafood, according to the CDC webpage dedicated to Vibrio species causing vibriosis.

“Although uncommon, V. vulnificus infections are serious,” the CDC Enteric Diseases Epidemiology Branch told Healio. “Many people with this infection require intensive care or tissue removal, and about 1 in 5 people with this infection die — sometimes within 1 to 2 days.”

Cases are most commonly reported in the Gulf Coast states; however, V. vulnificus infections on the eastern coast of the U.S. have increased eightfold between 1988 to 2018.

According to the CDC, the U.S. has experienced higher than average coastal sea surface temperatures this summer due to frequent heat waves. This has coincided with reports of severe and fatal V. vulnificus infections in East Coast states including Connecticut, New York and North Carolina.

In Florida, 33 cases and seven deaths have been confirmed, which is comparable to the number of cases and deaths reported in 2020 and 2021 in the state, according to the Florida Department of Health (DOH), although the number is down from last year when Hurricane Ian caused an abnormally high amount of V. vulnificus cases at 74 with 17 deaths.

When wounds are exposed to contaminated sea water, the V. vulnificus infection will first manifest through skin breakdown and ulcers, according to the CDC. Eventually, the bacterium will invade the bloodstream, causing fever, chills, decreased blood pressure from septic shock and blistering lesions, all of which can lead to life-threatening complications and death.

According to the Florida DOH, once V. vulnificus infects the bloodstream, patients have a 50% chance of survival. Patients with pre-existing medical conditions such as chronic liver disease, kidney disease or any kind of weakened immune system are 80 times more likely to develop an infection in the bloodstream than healthy individuals and are therefore encouraged to wear protective footwear when swimming at beaches.

The CDC has recommended that doctors consider V. vulnificus as a possible cause of infected wounds that were exposed to coastal waters. The Florida DOH has also recommended that doctors have an increased suspicion of a V. vulnificus infection when a patient has a fever, stomach illness or shock following a wound exposure to seawater or ingesting raw or undercooked seafood.

The infection can only be diagnosed through stool, wound or blood cultures which should be sent to a local, state, territorial or tribal public health laboratory.

Once V. vulnificus symptoms present themselves, the CDC suggests prompt treatment with doxycycline 100 mg orally or intravenously twice a day for 7 to 14 days and a third-generation cephalosporin — such as ceftazidime 1 g to 2 g — intravenously or intramuscularly every 8 hours.

When a wound site is involved, careful attention should be given to the area with debridement of necrotic tissue and, in severe cases, more aggressive debridement, fasciotomy or limb amputation, the CDC recommended on its website.

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