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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 ,
A Aragon ,
V. Moscoso ,
M. Gudiel ,
L. Bietti ,
N. Carrillo ,
J. Chojoj ,
B. Gordillo ,
F. Cano  and
D. N. Cameron
...Show all authors
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
Information
Epidemiology & Infection , Volume 116 , Issue 2 , April 1996 , pp. 121 - 126
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.

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