Epidemiology and Infection

Research Article

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

D. Kooa1 c1, A Aragona2, V. Moscosoa2, M. Gudiela2, L. Biettia2, N. Carrilloa2, J. Chojoja2, B. Gordilloa2, F. Canoa3, D. N. Camerona4, J. G. Wellsa4, N. H. Beana5 and R. V. Tauxea1

a1 Preventive Medicine Residency Program, Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, GA

a2 Ministry of Health, Guatemala

a3 Instituto de Nutricion de Centroamerica y Panama, Guatemala City, Guatemala

a4 Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, GA

a5 Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, Atlanta, GA

SUMMARY

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.

(Accepted August 15 1995)

Correspondence:

c1 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.

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.

‡ Requests for reprints: Robert V. Tauxe, MD, MPH, Acting Chief, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop A-38. Atlanta, GA 30333.

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