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

  • D. Koo (a1), A Aragon (a2), V. Moscoso (a2), M. Gudiel (a2), L. Bietti (a2), N. Carrillo (a2), J. Chojoj (a2), B. Gordillo (a2), F. Cano (a3), D. N. Cameron (a4), J. G. Wells (a4), N. H. Bean (a5) and R. V. Tauxe (a1)
  • DOI:
  • Published online: 01 May 2009

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.

Corresponding author
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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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.

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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.R Tauxe , L Seminario , R Tapia , M Libel . The Latin American epidemic. In: IK Wachsmuth , PA Blake , O Olsvik , eds. Vibrio cholerae and cholera: Molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: 321–44.

10.GM Evins , DN Cameron , JG Wells The emerging diversity of the electrophoretic types of Vibrio cholerae in the western hemisphere. J Infect Dis 1995; 172: 173–9.

11.DL Swerdlow , ED Mintz , M Rodriguez Water-borne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet 1992; 340: 2833.

12.AA Ries , DJ Vugia , L Beingolea Cholera in Piura, Peru: a modern urban epidemic. J Infect Dis 1992; 166: 1429–33.

14.ED Mintz , T Popovic , PA Blake . Transmission of Vibrio cholerae Ol. In: IK Wachsmuth , PA Blake , O Olsvik , eds. Vibrio cholerae and cholera: Molecular to global perspectives. Washington, DC: American Society for Microbiology, 1994: 345–56.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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