Cholera — A Possible Endemic Focus in the United States

Abstract

In September and October 1978, after a case of cholera had been discovered in southwestern Louisiana, 10 more Vibrio cholerae O-Group 1 infections were detected in four additional clusters. All 11 infected persons had recently eaten cooked crabs from five widely separated sites in the coastal marsh, and a matched-triplet case-control study showed a significant relation between cholera and eating such crabs (P = 0.007). V. cholerae O1 was isolated from estuarine water, from fresh shrimp, from a leftover cooked crab from a patient's refrigerator, and from sewage in six towns, including three without identified cases. All isolates in Louisiana and an isolate from a single unexplained case in Texas in 1973 were biotype El Tor and serotype inaba; they were hemolytic and of a phage type unique to the United States--suggesting that the organism persisted undetected along the Gulf Coast for at least five years.

Genetic diversity among toxigenic and nontoxigenicVibrio choleraeO1 isolated from the Western Hemisphere

“…Before 1986, most of the cholera cases caused by toxigenic Gulf Coast isolates were associated with consumption of undercooked crab and shrimp dishes [1,2,23]. The first cholera case clearly correlated with raw oyster consumption occurred in 1986 [41], followed by additional cases associated with eating raw oysters in 1986 and 1988 [12].…”

“…Unexpectedly, in 1973, an isolated case of cholera caused by Vibrio cholerae O1 occurred in Texas in a patient who had eaten seafood [1]. This case was followed by an outbreak in Louisiana in 1978 [2], two sporadic cases in Texas in 1981 [3,4], and an outbreak on an oil-drilling platform on a bayou near the Texas coast in 1981 [5]. Since 1981 additional patient isolates have been obtained from Mexico in 1982 [6]; from Maryland in 1984 [7]; and from another outbreak in Louisiana in 1986 [8,9].…”

Epidemic cholera in Ecuador: multidrug–resistance and transmission by water and seafood

“…Raw fish have been implicated previously in outbreaks in Guam and Kiribati (formerly the Gilbert Islands) [11,12], and contaminated crab, oysters, and shrimp harvested from the Gulf of Mexico have been the principal sources of cholera infections in the United States [13,14]. During 1991, cholera outbreaks affecting 11 persons in New York and New Jersey were associated with crab brought from Ecuador in travellers' luggage [15,16].…”

“…During 1991, cholera outbreaks affecting 11 persons in New York and New Jersey were associated with crab brought from Ecuador in travellers' luggage [15,16]. In laboratory experiments using V. cholerae 0 1-contaminated live crabs, crabs boiled for less than 10 min or 8 Epidemic cholera in Ecuador 9 steamed for less than 30 min still harboured viable V. cholerae 0 1 [13]. In Ecuador and other areas where cholera is present, seafood, particularly crab, should be eaten well cooked and while still hot.…”

Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003–2006: analysis of a time series

“…Nevertheless, it has also been shown to resist suboptimal conditions through specific associations of the bacterium with aquatic plants 10 or animals such as oysters, crabs and copepods. [11][12][13][14] As a result, the pathogen can persist for longer periods in aquatic habitats. Weather conditions such as an increase in environmental or sea surface temperatures favour plankton bloom.…”