REPORTED CHOLERA IN THE UNITED-STATES, 1992-1994 - A REFLECTION OF GLOBAL CHANGES IN CHOLERA EPIDEMIOLOGY

Objective.-To describe US cholera surveillance data from 1992 to 1994 and the domestic impact of the epidemics of Vibrio cholerae O1 in Lati n America and V cholerae O139 in Asia. Design, Setting, and Participan ts.-Retrospective review of surveillance data from all cases of choler a reported to the Centers for Disease Control and Prevention (CDC) fro m January 1, 1992, through December 31, 1994, in the United States and its territories. Main Outcome Measures.-Clinical, epidemiologic, and laboratory surveillance data. Results.-From 1992 through 1994, 160 cas es of cholera were reported to CDC by 20 states and 1 territory. This is a marked increase: only 136 cases were reported from 1965 through 1 991. Outbreaks affecting 75 passengers on an airplane from Latin Ameri ca and 5 passengers on a cruise ship in Southeast Asia accounted for 5 0% of cases. Vibrio cholerae O139 caused 6 cases (4%). The proportion of V cholerae O1 isolates resistant to at least 1 antimicrobial agent rose from 3% in 1992 to 93% in 1994. Of 158 patients whose location of exposure was known, 151 (96%) acquired infection abroad (125 in Latin America, 26 in Asia). Of 105 persons whose reason for travel was know n, 31 (30%) were US residents who had returned to their country of ori gin to visit family or friends, and 65 (62%) were non-US residents vis iting the United States from cholera-affected countries. The cholera r ate among persons arriving in the United States from cholera-affected regions was 0.27 case per 100 000 air travelers, not substantially inc reased from earlier estimates. Conclusions.-Cholera has increased in t he United States since 1991, reflecting global changes in cholera epid emiology, and is now primarily travel associated and antimicrobial res istant. Most travelers were not traditional tourists; reaching them wi th prevention measures may be difficult. The risk of cholera to the in dividual traveler remains extremely low.