2008 Georgia data summary: vibrio infections [2008]

2008 Georgia Data Summary
VIBRIO INFECTIONS

VIbrio Quick Fact: Vibrio Infections are often transmitted through ingestion of raw or undercooked seafood.

OVERVIEW
Infections caused by Vibrio species are largely classified into 2 distinct groups: Vibrio cholera infection and noncholera Vibrio infections. The clinical and epidemiologic characteristics of the diverse species can vary dramatically.
Noncholera Vibrio Infections:
Vibrio infections typically manifest as a gastrointestinal illness characterized by watery diarrhea, nausea, vomiting, abdominal cramping, fever and headache. In immunocompromised patients and persons with liver disease, infections of the gastrointestinal tract or contaminated wounds (causing tissue necrosis) with V. vulnificus can result in septicemia and shock. Many Vibrio organisms are halophilic (salt requiring) and prefer marine and brackish environments. They exist in deepsea salt water and coastal brackish water and can be found in raw or undercooked fish and shellfish (e.g. oysters, crabs, and shrimp). The mode of transmission of Vibrio infections is from ingestion of raw or undercooked seafood or contaminated water. Also, transmission may occur from an exposed wound to contaminated seawater. The incubation period of the noncholera Vibrio infections are usually 12-24 hours.
Vibrio cholerae infections:
Cholera is an infection of the intestine caused by the bacterium Vibrio cholerae. Between 1817 and 1911, six worldwide cholera outbreaks resulted in hundreds of thousands of deaths. The bacterium responsible for the seventh pandemic, now in progress, is known as V. cholerae O1, biotype El Tor. Another serotype associated with cholera outbreaks is O139. Other serogroups of V. cholerae have been reported in the United States and Georgia; these are referred to "non-O1, non-O139 V. cholerae". These serotypes may also cause a choleralike illness. Cholera is very rare in the United States and most of the cases are linked to eating seafood from the Gulf Coast; outbreaks do not typically occur. Humans are the primary reservoir and environmental reservoirs are likely copepods and other zooplankton in brackish rivers and coastal estuaries. The mode of transmission of cholera is through contaminated seafood or water. The
incubation period is usually 2-3 days.

SURVEILLANCE
All Georgia physicians, laboratories and other health care providers are required by law to report both labconfirmed and clinical diagnoses of cases of Vibrio infections.
Public health staff interviews every Vibrio case with a standardized CDC form to facilitate centralized data collection in the event of an outbreak and obtain pertinent information in case a trace back is warranted.
In 2008, 10 cases (53%) of Vibrio infections were due to the consumption of raw seafood (oysters, crab and fish).
There are several species of Vibrio found in Georgia. Cultures should be sent to the Georgia Public Health Laboratory for species determination (Table 1).
Table 1

NONCHOLERA VIBRIO SPECIES IN GEORGIA, 2008

Species

#

1 Parahaemolyticus

5

2 Vulnificus

4

3 Alginolyticus

3

4 Mimicus

1

5 Fluvalis

1

Unknown

4

Active Surveillance for Vibrio infections is conducted
through FoodNet, a component of the Emerging
Infections Program (EIP). For more information, please
visit: http://health.state.ga.us/eip/ http://www.cdc.gov/foodnet/

INCIDENCE
Noncholera Vibrio Infections:
In 2008, there were 18 cases of noncholera Vibrio infections reported in Georgia for a rate of 0.19 cases/100,000 populations (Figure 1).

Vibrio cholerae infections:
In 2008, there was one case of Vibrio cholerae (serogroup Non-O1) reported in Georgia for a rate of 0.01 cases/100,000 populations (Figure 2)

Figure 1

Figure 4

Cases

Noncholera Vibrio Infections, 2008

30

0.35

25

0.3

20

0.25

0.2 15
0.15

10

0.1

5

0.05

0

0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Cases

Rate

Figure 2

Cases

Vibrio cholera ( Non-O1, Non-O139) Infections, 2008

6

0.07

5

0.06

0.05 4
0.04 3
0.03
2 0.02

1

0.01

0

0.00

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Cases

Rate

Rate Per 100,000

DEMOGRAPHICS
Noncholera Vibrio Infections:
In 2008, of the reported cases with known race and ethnicity, 82% of cases were White, 12% of cases were Black and 6% were Asian (Figure 3). The highest cases reported were in the age group 60+ and infections were mostly seen in Males (Figure 4).

Rate Per 100,000 Cases

All Reported Cases of Noncholera Vibrio With Know n Gender/Age, 2008
6 5
4 3 2 1 0
5-<10 10-<18 18-<30 30-<40 40-<50 50-<60 60+ Age Group

Female Male

IMPACT AND PREVENTION OF VIBRIO INFECTIONS
In 2008, one reported case died from a Vibrio infection. In Georgia, approximately of all Vibrio deaths are due to Vibrio vulnificus, including the death reported in 2008. Vibrio infections often occur during the summer months. It is important to obtain adequate travel history to and from endemic areas and food consumption data to assist efforts in product trace-back and to prevent outbreaks. Recent travel to and from cholera-endemic areas of the world is the source for most cases of Vibrio cholerae (serotypes O1 and O139). If severe disease is not treated, rapid dehydration, acidosis, circulatory collapse, hypoglycemia (in children), renal failure, and death can occur. In addition, avoid consuming undercooked raw seafood, especially oysters, for the prevention of Vibrio infections. For more information on oyster safety, please
visit: www.safeoysters.org.

Vibrio cholerae infections:
In 2008, there was one case of Vibrio cholerae (NonO1) and the infection was seen in a Male.

Figure 3

Noncholera Vibrio Infections by

Race/Ethnicity, 2008

A SIA N 6%

B LA CK

12 %

For more information:
http://health.state.ga.us/epi/foodborne http://health.state.ga.us/pdfs/epi/gers/Jul07GER.pdf

A SIA N B LA CK WHITE

WHITE 82%