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US cholera epidemic linked to Hispaniola epidemic
Newton AE. Emerg Infect Dis. 2011;doi:10.3201/eid1711.110808.
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CDC officials reported 23 cases of cholera in the United States — all associated with recent travel to Hispaniola or with consumption of seafood from Haiti; no secondary transmission was reported in the United States.
“Cholera is rare in the US (annual average 6 cases),” according to Anna E. Newton, MPH, and colleagues at the CDC. “Since epidemic cholera began in Hispaniola in 2010, a total of 23 cholera cases caused by toxigenic Vibrio cholerae O1 have been confirmed in the US. Twenty-two case-patients reported travel to Hispaniola and one reported consumption of seafood from Haiti.”
Newton and colleagues pooled data from the CDC Cholera and Other Vibrio Illness Surveillance System to investigate characteristics of confirmed US cases and evaluate demographic, clinical, and epidemiologic information, including food and water exposures associated with cholera, travel history and vaccination status.
The first case was confirmed on Oct. 21, 2010 in Haiti, on Oct. 31, 2010 in the Dominican Republic, and the first US case was confirmed on Nov. 15, 2010 in a resident who had traveled to Haiti and returned to Florida.
A total of 23 cholera cases associated with the Hispaniola epidemic had been confirmed as of April 4, 2011. Twenty culture-confirmed cases matched the Haiti isolate outbreak pattern by pulsed-field gel electrophoresis, the other three were confirmed by serologic testing.
The majority of cases (n=10) were among patients from Florida, followed by four cases from Massachusetts, four from New York City, one from Kansas, one from Michigan, one from North Carolina, one from Virginia, and one from Texas. Illness onset dates ranged from Oct. 23, 2010 to Feb. 2, 2011; median age was 38 years (range, 9–84 years); and 43% were female patients, according to the report.
Thirteen patients reported recent travel to Haiti for an average of 7 days (range, 2–54 days), and nine to Dominican Republic for an average of 4 days. One patient reported no recent travel, but consumed cooked conch brought to the US from Haiti by relatives, the researchers reported.
Six patients had illness onset before returning to the United States, five had illness onset on the day of return, and 12 had illness onset between days 1-11, after return. Overall, 39% were hospitalized; 30% sought care at an ED; and none died.
“Echoing the Latin American cholera epidemic in the 1990s, the number of US cholera cases has increased after the cholera epidemic in Hispaniola,” the researchers wrote. “Travelers to cholera-affected areas should be aware of the risk and should follow prevention measures to avoid infection. In particular, travelers visiting friends or relatives may be at higher risk for travel-associated infection. Few case-patients had received cholera prevention education (educational materials available at www.cdc.gov/cholera/index.html). Until cholera in Haiti and Dominican Republic resolves, clinicians, microbiologists, and public health workers in the United States should be prepared for more cases in travelers returning from Hispaniola.”
Disclosures: The researchers report no relevant financial disclosures.
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