105 



CDC 



July 9, 1993/Vol. 42/No. 26 



MORBIDITY AND MORTAUTY WEEKLY REPORT 



501 Imported Cholera Associated with a Newly 



Described Toxigenic Vibrio cholerae 



0139 Strain — California, 1993 

 504 Smoking Cessation During Previous Year 



Among Adults — United Slates 

 507 Availability of Comprehensive Adolescent 



Health Services — United States, 1990 



516 Salmonella Serotype Tennessee in 

 Powdered Milk Products and Infant 

 Formula — Canada and United States 



517 Update: Hantavirus Infection — United 

 States 



Emerging Infectious Diseases 



Imported Cholera Associated with a Newly Described 

 Toxigenic Vibrio ciiolerae 0139 Strain — California, 1993 



Epidemics of cholera-like illness caused by a previously unrecognized organism 

 occurred recently in southern Asia ( 7 ). This report documents the first case of cholera 

 imported into the United States that was caused by this organism, the newly de- 

 scribed toxigenic Vibrio cholerae 0139 strain. 



On February 5, 1993, a 48-year-old female resident of Los Angeles County sought 

 care at a local outpatient health-care facility for acute onset of watery diarrhea and 

 back pain. A few hours before seeking medical care, she had returned to the United 

 States from a 6-week visit with relatives in Hyderabad, India. 



Her diarrheal illness began in India on February 4 and increased in severity while 

 she traveled to the United States. She reported a maximum of 10 watery stools per 

 day but no vomiting, visible blood or mucous in her stools, or documented fever. The 

 patient was prescribed trimethoprim-sulfamethoxazole without rehydration treatment 

 and recovered uneventfully. Duration of illness was approximately 4 days. No secon- 

 dary illness occurred among family members. 



When the patient sought medical care, the physician suspected cholera, and a cul- 



e of a stool specimen obtained from the patient at that time yielded colonies 

 suspected of being V. cholerae. This was confirmed by the Los Angeles County Public 

 Health Laboratory. The isolate was identified as V. cholerae non-01. The isolate pro- 

 duced cholera toxin by Y-1 adrenal cell assay and latex agglutination in the California 

 State Public Health Laboratory. Testing at CDC identified the isolate as toxigenic 

 V. cholerae serogroup 0139, resistant to trimethoprim-sulfamethoxazole. 



Before this illness, the patient had been in good health. In Hyderabad, she stayed 

 with relatives and did not travel outside the city. Although the source of her infection 

 was not confirmed, on January 30, the patient had eaten fried shrimp and prawns 

 purchased from a local market and prepared by relatives. She also recalled drinking a 

 half glass of unbottled water in Hyderabad on February 3. 



Reported by: M Tormey, MPH, L Mascola, MD, L Kilman, Los Angeles County Dept of Health 

 Svcs, Los Angeles; P Nagami, MD, Southern California Permanente Medical Group, Los Ange- 

 les; E DeBess, DVM, S Abbott, GW Rutherford, III, MD, State Epidemiologist, California Dept of 



U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Health Service 



