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Prior sources of cholera continue to cause cases in US

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SAN DIEGO — Data presented today at the ID Week 2012 meeting indicate that most cholera cases reported in the United States are associated with the consumption of Gulf Coast seafood and travel to cholera-endemic countries between 2001 and 2010.

“Although cholera is rare in the United States, it continues to ravage populations in developing countries, most recently in Haiti, which experienced its first outbreak of cholera in October of 2010,” Anagha Loharikar, MD, of the CDC, said during a presentation here.

Loharikar and colleagues conducted a retrospective review of all laboratory-confirmed cholera cases reported in the United States between 2001 and 2011. The study included 111 patients with a mean age of 44 years across 27 states and two US territories.

Of the 81% of patients who had travel-associated illness, 53% reported travel to Asia.

Forty-four percent of patients traveled to Haiti and the Dominican Republic during the cholera epidemic in October 2010.

Of the 18% of patients who did not travel internationally within the 7 days before the onset of illness, 95% reported consumption of seafood, and 53% reported consumption of seafood from the Gulf Coast. Forty-seven percent of patients reported consuming raw seafood.

Ninety-nine percent were toxigenic Vibrio cholerae serogroup O1 isolates, of which, 21% were serotype Inaba; 79% Ogawa; and all were biotype El Tor.

The most commonly noted symptoms were diarrhea (98%), abdominal cramps (52%), vomiting (47%) and nausea (46%). Fifty-six patients were hospitalized; there were no mortalities. Acute renal failure occurred in 4%, cardiopulmonary arrest in 2% and shock in 1%.

“Domestically acquired cholera from other sources is rare, but still occurs,” Loharikar said. “Our report demonstrates that after the outbreak of cholera in Haiti, which spread to the Dominican Republic, we saw a dramatic increase in US cases, all associated with travel to or from Hispaniola. Until access to an improved health infrastructure is seen in Haiti, we expect to see more cases from Hispaniola and other areas of the Caribbean and Latin America as cholera spreads to neighboring areas.”

For more information:

Loharikar A. #653. Presented at: ID Week; Oct. 17-21, 2012; San Diego.

Disclosure: Loharikar reports no relevant financial disclosures.