EPIDEMIC CHOLERA IN GUATEMALA, 1993 - TRANSMISSION OF A NEWLY INTRODUCED EPIDEMIC STRAIN BY STREET VENDORS

Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemal a ranked third in the hemisphere in reported cases of cholera. We cond ucted a case-control study with two age-, sex-, and neighbourhood-matc hed controls per patient in periurban Guatemala City. Twenty six patie nts hospitalized for cholera and 52 controls were enrolled. Seven (47% ) of 15 stool cultures obtained after admission yielded toxigenic Vibr io cholerae O1. All seven were resistant to furazolidone, sulfisoxazol e, and streptomycin, and differed substantially by pulsed-held gel ele ctrophoresis from tile 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% confide nce 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 ite ms remained significantly associated with illness in multivariate anal ysis (OR = 6.5, CI = 1.4-31). Illness was not associated with drinking municipal tap water, Maintaining water safety is important, but slowi ng the epidemic in Guatemala City and elsewhere may also require impro vement in street vendor food handling and hygiene.