September 1989

Cholera in LouisianaWidening Spectrum of Seafood Vehicles

Author Affiliations

From the Division of Field Services, Epidemiology Program Office, Centers for Disease Control, US Public Health Service, Department of Health and Human Services, Atlanta, Ga (Drs Lowry and Gunn); Louisiana Department of Health and Hospitals, Office of Public Health, New Orleans (Drs Lowry, McFarland, Bradford, Lynch, and Mathison, and Ms Peltier); and Division of Bacterial Diseases, Centers for Disease Control, Atlanta, Ga (Drs Pavia, Blake, Barrett, and Quan). Dr Lowry is now with the Stanford (Calif) University School of Medicine.

Arch Intern Med. 1989;149(9):2079-2084. doi:10.1001/archinte.1989.00390090115023

• The largest cholera outbreak in the United States in over a century occurred in Louisiana from August through October 1986. Eighteen persons in 12 family clusters had stool culture or serologic evidence of infection with toxigenic Vibrio cholerae 0-group 1. Thirteen of these persons had severe diarrhea, and 4 required intensive care unit treatment. Although all 18 survived, 1 96-year-old woman with suspected cholera died shortly after hospital admission. A case-control study showed that case-patients were more likely than neighborhood control subjects to have eaten cooked crabs or cooked or raw shrimp during the week before illness. Case-patients who ate crabs were more likely than control subjects who ate crabs to have undercooked and mishandled the crabs after cooking. A third vehicle from the Gulf waters, raw oysters, caused V cholerae 01 infection in two persons residing in Florida and Georgia. All three seafood vehicles came from multiple sources. Stool isolates from the Louisiana case-patients were genetically identical to other North American strains isolated since 1973, but differ from African and Asian isolates. While crabs are the most important vehicle for V cholerae 01 infection in the United States, shrimp and oysters from the Gulf coast can also be vehicles of transmission. A persisting reservoir of V cholerae 01 along the Gulf coast may continue to cause sporadic cases and outbreaks of cholera in Gulf states and in states importing Gulf seafood.

(Arch Intern Med. 1989;149:2079-2084)