Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk

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

“…Such contamination could easily overwhelm the chlorine. Studies in Peru and Calcutta have suggested that boiling water before drinking and storing water in a narrow-mouthed, capped container decreases the risk of cholera transmission [7,8,[17][18][19]. Our investigation did not document the type of container used to store boiled water, but having boiled water in the house at the time of inspection was protective.…”

“…Public health officials had to decide on preventive measures based on knowledge of how cholera spread in previous epidemics and on anecdotal information. This investigation and parallel investigations in Peru provided the first information from controlled studies about the most important modes and vehicles of transmission for cholera in Latin America [7][8][9]. Identification of specific modes of cholera transmission allows control measures and education to be more focused and, presumably, more effective.…”

“…Orange juice is normally sufficiently acidic to kill vibrios, therefore this association may be a marker for another street vendor item. This risk was not found in Trujillo, Peru, because street vendors had been banned before the investigation began [8]. In Piura, Peru, however, consuming beverages from street vendors also was associated with cholera [7].…”

“…Although seafood eaten raw may have played an important role in the early part of the epidemic in Peru, it was almost immediately suspect, and the public was warned by the Minister of Health against consuming seafood raw. The public complied, and subsequent case-control studies were unable to evaluate the role of seafood because few patients or controls were eating raw seafood when the studies were conducted [7,8].…”

“…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.…”