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Epidemic cholera in Guatemala, 1993: transmission of a newly introduced epidemic strain by street vendors*

Published online by Cambridge University Press:  15 May 2009

D. Koo*
Affiliation:
Preventive Medicine Residency Program, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, GA
A Aragon
Affiliation:
Ministry of Health, Guatemala
V. Moscoso
Affiliation:
Ministry of Health, Guatemala
M. Gudiel
Affiliation:
Ministry of Health, Guatemala
L. Bietti
Affiliation:
Ministry of Health, Guatemala
N. Carrillo
Affiliation:
Ministry of Health, Guatemala
J. Chojoj
Affiliation:
Ministry of Health, Guatemala
B. Gordillo
Affiliation:
Ministry of Health, Guatemala
F. Cano
Affiliation:
Instituto de Nutricion de Centroamerica y Panama, Guatemala City, Guatemala
D. N. Cameron
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, GA
J. G. Wells
Affiliation:
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, GA
N. H. Bean
Affiliation:
Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, GA
R. V. Tauxe
Affiliation:
Preventive Medicine Residency Program, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, GA
*
During the study author was stationed with the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases. CDC. Atlanta, GA. Corresponding author's current affiliation and address: Denise Koo, MD, MPH. Chief, Systems Operations and Information Branch, Division of Surveillance and Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop C-08, Atlanta, GA 30333.
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Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemala ranked third in the hemisphere in reported cases of cholera. We conducted a case-control study with two age-, sex-, and neighbourhood-matched controls per patient in periurban Guatemala City. Twenty-six patients hospitalized for cholera and 52 controls were enrolled. Seven (47%) of 15 stool cultures obtained after admission yielded toxigenic Vibrio cholerae Ol. All seven were resistant to furazolidone, sulfisoxazole, and streptomycin, and differed substantially by pulsed-field gel electrophoresis from the Latin American epidemic strain dominant in the hemisphere since 1991. In univariate analysis, illness was associated with consumption of left-over rice (odds ratio [OR] = 7·0, 95% confidence interval [CI] = 1·4–36), flavored ices (‘helados’) (OR = 3·6, CI = 1·1–12), and street-vended non-carbonated beverages (OR = 3·8, CI = 1·2–12) and food items (OR = 11·0, CI = 2·3–54). Street-vended food items remained significantly associated with illness in multivariate analysis (OR = 6·5, CI = 1·4–31). Illness was not associated with drinking municipal tap water. Maintaining water safety is important, but slowing the epidemic in Guatemala City and elsewhere may also require improvement in street vendor food handling and hygiene.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1996

Footnotes

*

Some of this information was previously presented at the 43rd annual Epidemic Intelligence Service Conference, April 1994, Atlanta, GA. and at the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy, 7 October 1994, Orlando, FL.

References

1.Tauxe, R, Seminario, L, Tapia, R, Libel, M. The Latin American epidemic. In: Wachsmuth, IK, Blake, PA, Olsvik, O, eds. Vibrio cholerae and cholera: Molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: 321–44.Google Scholar
2.Centers for Disease Control. Cholera–Peru, 1991. MMWR 1991; 40: 108–9.Google Scholar
3.Dean, AAD, Dean, AD, Burton, JH, Dicker, RC. Epi Info, Version 5: a word processing, database, and statistics program for epidemiology on microcomputers. Centers for Disease Control, Atlanta, GA 1990.Google Scholar
4.Hosmer, DW, Lemeshow, S. Applied logistic regression. New York: John Wiley & Sons, 1989.Google Scholar
5.Kay, BA, Bopp, CA, Wells, JG. Isolation and identification of V. cholerae Ol from fecal specimens. In: Wachsmuth, IK, Blake, PA, Olsvik, O, eds. Vibrio cholerae and cholera: Molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: –25.Google Scholar
6.Fields, PI, Popovic, T, Wachsmuth, K, Olsvik, O. Use of polymerase chain reaction for detection of toxigenic Vibrio cholerae Ol strains from the Latin American cholera epidemic. J Clin Microbiol 1992; 30: 2118–21.CrossRefGoogle Scholar
7.National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial disk susceptibility tests: Approved standard. Volume 10, 4th edn Villanova, PA: National Committee for Clinical Laboratory Standards, 1990; M2–A4.Google Scholar
8.Cameron, DN, Khambaty, FM, Wachsmuth, IK, Tauxe, RV, Barrett, TJ. Molecular characterization of Vibrio cholerae Ol strains by pulsed-field gel electrophoresis. J Clin Microbiol 1994; 32: 1685–90.CrossRefGoogle Scholar
9.Hitchings, AD, Hartman, PA, Dobb, ECT. Coliforms – Escherichia coli and its toxins. In: Vanderzant, C, Splittstoesser, DF, eds. Compendium of methods for the microbiological examination of foods. 3rd edn. Washington: American Public Health Association, 1992: 325–7.Google Scholar
10.Evins, GM, Cameron, DN, Wells, JG et al. The emerging diversity of the electrophoretic types of Vibrio cholerae in the western hemisphere. J Infect Dis 1995; 172: 173–9.CrossRefGoogle ScholarPubMed
11.Swerdlow, DL, Mintz, ED, Rodriguez, M et al. Water-borne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet 1992; 340: 2833.CrossRefGoogle Scholar
12.Ries, AA, Vugia, DJ, Beingolea, L et al. Cholera in Piura, Peru: a modern urban epidemic. J Infect Dis 1992; 166: 1429–33.CrossRefGoogle Scholar
13.Weber, JT, Mintz, ED, Cañizares, R et al. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect 1994; 112: 111.CrossRefGoogle ScholarPubMed
14.Mintz, ED, Popovic, T, Blake, PA. Transmission of Vibrio cholerae Ol. In: Wachsmuth, IK, Blake, PA, Olsvik, O, eds. Vibrio cholerae and cholera: Molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: 345–56.Google Scholar
15.Kolvin, JL, Roberts, D. Studies on the growth of Vibrio cholerae bio type El Tor and biotype classical in foods. J Hyg 1982; 89: 243–52.CrossRefGoogle Scholar
16.Felsenfeld, O. Notes on food, beverages and fomites contaminated with Vibrio cholerae. Bull WHO 1965; 33: 725–34.Google ScholarPubMed
17.Popovic, T, Olsvik, O, Blake, PA, Wachsmuth, K. Cholera in the Americas: foodborne aspects. J Food Protection 1992; 56: 811–21.CrossRefGoogle Scholar
18. Ministerio de Salud Pública y Asistencia Social. Departamento de vigilancia Epidemiológica. Boletin Epidemiológico Nacional. Susceptibilidad de Vibrio cholerae en Guatemala, 1993: 8: 8.Google Scholar
19.World Health Organization. Epidemic diarrhea due to Vibrio cholerae non-Ol. Wkly Epidemiol Rec 1993; 68: 141–2.Google Scholar
20.Centers for Disease Control and Prevention. Imported cholera associated with a newly described toxigenic Vibrio cholerae O139 strain – California, 1993. MMWR 1993; 42: 501–3.Google Scholar