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Cholera in the United States, 1965-1991Risks at Home and Abroad
J. Todd Weber, MD;
William C. Levine, MD;
David P. Hopkins, MD;
Robert V. Tauxe, MD
Arch Intern Med. 1994;154(5):551-556.
Abstract
Objective
To assess risks for cholera in the United States.
Design
Review of published reports of cholera outbreaks and sporadic cases and Centers for Disease Control and Prevention (CDC) memoranda and laboratory reports.
Patients
Persons with symptomatic laboratorydiagnosed cholera treated in the United States and territories.
Results
From 1965 through 1991,136 cases of cholera were reported. Fifty-three percent of the patients were hospitalized and three persons died (case-fatality rate, 0.02). Ninety-three infections were acquired in the United States and 42 overseas; for one case the source was unknown. Domestically acquired cholera was largely related to the endemic Gulf Coast focus of Vibrio cholerae 01(56 cases). The major domestic food vehicle was shellfish, particularly crabs harvested from the Gulf of Mexico or nearby estuaries. In 1991,14 (54%) of 26 domestically acquired cases were caused by food from Ecuador (n=11) and Thailand (n=3). During 1991, the first cases of cholera in travelers returning from South America were reported. In 1991, the rate of cholera among air travelers returning from South America was estimated as 0.3 per 100 000; among air travelers returning from Ecuador, 2.6 per 100 000.
Conclusions
Cholera remains a small but persistent risk in the United States and for travelers. An endemic focus on the Gulf Coast, the continuing global pandemic, and the epidemic in South America make this likely to continue for years to come. Physicians should know how to diagnose and treat cholera and should report all suspected cases to their state health departments.
(Arch Intern Med. 1994;154:551-556)
Author Affiliations
From the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Dr Weber is now with the Seroepidemiology Branch, Division of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta. Dr Levine is now with the Epidemiology Research Branch, Division of Sexually Transmitted Diseases/Human Immunodeficiency Virus Prevention, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta.
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