Epidemiologic Notes and Reports
Toxigenic Vibrio cholerae O1 Infection Acquired in Colorado
On August 17, 1988, a 42-year-old man was treated for profuse
watery
diarrhea, vomiting, and dehydration at an emergency room in Rifle,
Colorado. On August 15, he had eaten approximately 12 raw oysters
from
a new oyster-processing plant in Rifle. Approximately 36 hours
after
eating the oysters, he had sudden onset of symptoms and passed 20
stools during the day before seeking medical attention. Stool
culture
subsequently yielded toxigenic Vibrio cholerae O1, biotype El Tor,
serotype Inaba. The patient had no underlying illness, was not
taking
medications, and had not traveled outside the region during the
month
before onset.
The oysters had been harvested on August 8, 1988, in a bay off the
coast of Louisiana. Approximately 1000 bushels (200,000 oysters)
arrived by refrigerator truck at the plant in Rifle on August 11.
The
patient purchased three dozen of these oysters on August 15.
During a 6-day period, eight other persons shared the oysters
purchased by the patient. None became ill. Although one of seven
tested
had a vibriocidal antibody titer of 1:640, none had elevated
antitoxic
antibody titers, and none had V. cholerae O1 isolated from stool.
Physicians and local health departments were asked to notify the
Colorado Department of Health about similar cases, but none were
reported.
The oyster-processing plant in Rifle began operation in May 1988
and
functioned as a wet-storage unit. The Gulf oysters were reportedly
harvested from approved waters, trucked to Colorado, and placed in
recirculating disinfected artificial seawater baths for a variable
number of days before packaging for market. These oysters were
probably
the vehicle of infection for the case of cholera.
Reported by: M Doran, P Shillam, RE Hoffman, MD, State
Epidemiologist,
Colorado Dept of Health. LM McFarland, DrPH, Louisiana Dept of
Health
and Hospitals. Div of Field Svcs, Epidemiology Program Office;
Enteric
Diseases Br, Div of Bacterial Diseases, Center for Infectious
Diseases,
CDC.
Editorial Note
Editorial Note: VcA-3 phage typing showed that the organism is
identical to all others associated with an endemic focus known to
have
been present in the Gulf of Mexico since 1973 (1-3). This is the
third
reported case of toxigenic V. cholerae O1 apparently acquired from
oysters shipped interstate in the United States (4) and is the
first
case known to have been acquired in Colorado during this century.
This report suggests that V. cholerae O1 may persist in oysters
for
many days after harvest. Several different Vibrio species
previously
have been associated with infections related to consumption of raw
oysters (5). Since this case occurred, five additional
oyster-related
cases of cholera have been reported by five other states from
August to
October 1988. Thorough cooking remains he best method to prevent
acquisition of infectious diseases from raw shellfish.
References
Blake PA, Allegra DT, Snyder JD, et al. Cholera--a possible
endemic
focus in the United States. N Engl J Med 1980;302:305-9.
2.CDC. Toxigenic Vibrio cholerae O1 infections--Louisiana and
Florida.
MMWR 1986;35:606-7.
3.CDC. Cholera in Louisiana--update. MMWR 1986;35:687-8.
4.Pavia AT, Campbell JF, Blake PA, Smith JDL, McKinley TW, Martin
DL.
Cholera from raw oysters shipped interstate (Letter). JAMA
1987;258:2374.
5.Blake PA. Vibrios on the half shell: what the walrus and the
carpenter didn't know. Ann Intern Med 1983;99:558-9.
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