Outbreak of Cholera Associated with Crab Brought from an Area with Epidemic Disease

Abstract

From 31 March through 3 April 1991, 8 New Jersey residents developed severe, watery diarrhea after eating crabmeat brought back in the suitcase of a traveler to Ecuador. Stool cultures yielded toxigenic Vibrio cholerae O1, serotype Inaba, biotype El Tor from 4 persons, and vibriocidal antibody titers were > or = 1:640 in 7 persons, indicating recent infection with Vibrio cholerae O1. Eating crab was statistically associated with illness (P = .006); however, no leftover crabmeat was available for testing. All 8 patients fully recovered and no cases of secondary transmission were reported. This was the first reported incident of cholera in the continental United States associated with food transported from an area with epidemic disease. Discouraging the transport of perishable souvenir seafood may prevent further outbreaks.

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

“…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].…”

Cholera: Foodborne transmission and its prevention

“…time) [34], and undercooked crabs [1,2,6,8,34,35], prawns [36] and squid [37]. During outbreak investigations, V. cholerae O1 has been isolated from implicated seafood [1,8], from freshly collected seafood [31,33], and from samples of seafood purchased in local markets [34, 381. Several factors make seafood an important vehicle for cholera transmission: 1.…”

“…In January 1991, the pandemic appeared in Latin America, which had been free of cholera for the previous 100 years. Within 3 years, every country in the Americas but Uruguay and the Carribean island nations had reported cases, and so far, three outbreaks have occurred in the United States due to contaminated foods brought in by travellers [1][2][3]. In 1994, Europe reported a more than 30-fold increase in cholera cases over 1993 [4].…”

Cholera in the United States, 1965-1991

“…Vibrio cholerae 01 was isolated from the stool of 39 (93%) of the 42 casepatients; all isolates were biotype El Tor, 16 (41%) were serotype Inaba, and 23 (59%) were serotype Ogawa. Only one isolate from a case of foreign-acquired cholera has had the VcA-3 bacteriophage associated with the strain from the US Gulf Coast.2122 This isolate was cultured from a woman who returned to New Jersey after traveling to Cancún, Mexico, where she had eaten incompletely cooked seafood of unknown type.…”

“…40 Physicians should report suspected cases of cholera to their local and state health departments so that appropriate investigation and prevention measures may be pursued. Accepted for publication August 16,1993 …”