ARTICLE - CHOLERA TRAVELERS

CDC: TRAVELERS TO HAITI ARE BRINGING CHOLERA TO UNITED STATES
(Medscape) - By Megan Brooks

Since mid-October, health officials in Haiti have been battling a cholera outbreak that has now spread to the Dominican Republic and Florida, US federal health officials from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, reported today.

The cholera strains in the Dominican Republic and Florida are "indistinguishable from the strain causing the Haiti outbreak," the CDC reports in the December 24 edition of the Morbidity and Mortality Weekly Report.

"Several confirmed cases in the Dominican Republic and all confirmed US cases were among travelers from Haiti," the CDC reports.

"Additional cases of cholera in travelers from Haiti are likely to occur in the US, the Dominican Republic and elsewhere," the CDC cautions.

To date, there has been "limited" secondary spread in the Dominican Republic, and no transmission to household contacts has been reported in the United States.

Transnational Spread of Cholera
The Haiti cholera outbreak was first confirmed on October 21, 2010, by the Haitian National Public Health Laboratory. By November 19, the outbreak was widespread in the country, and by December 17, a total of 121,518 cases of cholera, resulting in 63,711 hospitalizations and 2591 deaths, had been reported, according to the CDC.

In the Dominican Republic, as December 18, a total of 399 suspected cases of cholera were reported. Laboratory testing in 327 of these cases confirmed cholera in 59, finding Vibrio cholerae O1 serotype Ogawa.

In the United States, as of December 18, the Florida Department of Health has investigated 13 cases of suspected cholera. V cholerae O1 serotype Ogawa was isolated from stool specimens in 5 patients, all of whom developed symptoms either while in Haiti or on arrival in Florida from Haiti.

Isolates from 4 confirmed cases in the Dominican Republic and all 5 Florida cases were sent to the CDC for confirmation and additional characterization. All were confirmed as toxigenic V cholerae O1, serotype Ogawa, biotype El Tor, and matched the Haiti outbreak strain on pulsed-field gel electrophoresis.

"Transnational spread of cholera is not uncommon," the CDC notes in the article. They point out that 29 of 51 (57%) of US cholera cases reported to the CDC between 2000 and 2008 were associated with international travel.

Action Points
The CDC recommends that travelers who develop watery diarrhea within 5 days of returning from cholera-affected areas see their healthcare provider and report their travel histories.
"When cholera is suspected, rehydration should be initiated immediately, a stool specimen should be collected for culture of Vibrio cholerae, and the appropriate public health authorities should be notified," the CDC advises.

Neither cholera vaccine nor chemoprophylaxis is indicated for US travelers to Haiti, the agency notes. However, the potential role of cholera vaccines for populations in Haiti and other countries is currently being evaluated by the CDC, the Haitian Ministry of Public Health and Population, the Pan American Health Organization, and other organizations.