Epidemiology and Infection

Research Article

An outbreak of cholera from food served on an international aircraft

J. Eberhart-Phillipsa1, R. E. Besssera1 c1, M. P. Tormeya2, D. Feikina3, M. R. Aranetaa2, J. Wellsa3, L. Kilmana4, G. W. Rutherforda5, P. M. Griffina3, R. Barona1 and L. Mascolaa2

a1 Epidemic Intelligence Service, Division of Field Services, Centers for Disease Control and Prevention

a2 Acute Communicable Disease Control Unit, County of Los Angeles Department of Health Services, 313 N. Figueroa Street, Room 231, Los Angeles, CA 90012

a3 Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention

a4 Public Health Laboratories, County of Los Angeles Department of Health Services

a5 Prevention Services, State of California Department of Health Services


In February 1992, an outbreak of cholera occurred among persons who had flown on a commercial airline flight from South America to Los Angeles. This study was conducted to determine the magnitude and the cause of the outbreak. Passengers were interviewed and laboratory specimens were collected to determine the magnitude of the outbreak. A case-control study was performed to determine the vehicle of infection. Seventy-five of the 336 passengers in the United States had cholera; 10 were hospitalized and one died. Cold seafood salad, served between Lima, Peru and Los Angeles, California, was the vehicle of infection (odds ratio, 11·6; 95% confidence interval, 3·3–44·5). This was the largest airline-associated outbreak of cholera ever reported and demonstrates the potential for airline-associated spread of cholera from epidemic areas to other parts of the world. Physicians should obtain a travel history and consider cholera in patients with diarrhoea who have travelled from cholera-affected countries. This outbreak also highlights the risks associated with eating cold foods prepared in cholera-affected countries.

(Accepted September 25 1995)


c1 Address for correspondence: Richard E. Besser, M.D., Department of Pediatrics, University of California, San Diego, 200 W. Arbor Drive (8454), San Diego, CA 92116.


† Author for reprints.