Epidemiologic Notes and Reports
Importation of Cholera from Peru
On April 9, 1991, a U.S. physician attending a conference
in Lima, Peru, had onset of diarrhea. He reported a maximum of
eight watery stools in 24 hours and experienced no other
symptoms except moderate weakness. The diarrhea lasted 5 days.
After arriving in Peru on April 5, he had eaten all his meals,
including a cold crab meat appetizer 2 days before onset of
illness, in his hotel or at events catered solely for the
conference participants. He also consumed ice and municipal
water that the hotel reported had been purified. Culture of a
stool sample obtained on April 11, after his return to the
United States, yielded toxin-producing Vibrio cholerae O1,
serotype Inaba, biotype El Tor. His family did not accompany
him to Peru and has remained well.
Reported by: JA Wilber, MD, State Epidemiologist, Georgia Dept
of Human Resources. Enteric Diseases Br, Div of Bacterial and
Mycotic Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note:
An epidemic of cholera is occurring in Peru, Ecuador, and
Colombia, and there is potential for spread to other
countries. Although the risk for cholera is small for U.S.
residents traveling in cholera-infected areas (1), some U.S.
travelers nonetheless may become infected (2). The best
protection is provided by scrupulous adherence to
recommendations to prevent traveler's diarrhea (3,4);
particularly, raw seafood and potentially contaminated water
should be avoided. Optimally, travelers should drink only
water that they have treated (e.g., by adding iodine or
boiling) themselves. In addition, ice, which may be made from
contaminated water, should be avoided. Commercially bottled
water has transmitted cholera (5), but carbonated bottled
water has a low pH and permits only brief survival of V.
cholerae O1.
Most V. cholerae O1 infections cause no symptoms or only
mild to moderate diarrhea, but in a small proportion of cases
the illness can be life-threatening. Travelers who develop
severe watery diarrhea or diarrhea and vomiting during or
following travel to an area with known cholera should seek
medical attention immediately. Treatment of cholera with
proper oral and, if indicated, intravenous rehydration is
simple and highly effective.
The risk for secondary transmission of cholera in the
United States is extremely small (2).
References
Snyder JD, Blake PA. Is cholera a problem for US travelers?
JAMA 1982;247:2268-9.
CDC. Update: cholera outbreak--Peru, Ecuador, and Colombia.
MMWR 1991;40:225-7.
CDC. Cholera--Peru, 1991. MMWR 1991;40:108-10.
CDC. Health information for international travel, 1990.
Atlanta: US Department of Health and Human Services, Public
Health Service, 1990; DHHS publication no. (CDC)90-8280.
Blake PA, Rosenberg ML, Florencia J, Bandeira Costa J,
Quintino LDP, Gangarosa EJ. Cholera in Portugal, 1974. II.
Transmission by bottled mineral water. Am J Epidemiol
1977;105:344-8.
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