title: Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood.
abstract: To determine risk factors for cholera in an epidemic-disease area in South America, a case-control investigation was performed in Guayaquil, Ecuador, in July 1991. Residents > 5 years old who were hospitalized for treatment of acute, watery diarrhoea and two matched controls for each were interviewed regarding sources of water and food, and eating, drinking, and hygienic habits. Interviewers inspected homes of case-patients and controls to document water treatment, food-handling, and hygienic practices. Faecal specimens and shellfish were cultured for Vibrio cholerae O 1. Isolates were tested for susceptibility to a variety of antimicrobial agents. Drinking unboiled water (odds ratio [OR] = 4.0, confidence interval [CI] = 1.8-7.5), drinking a beverage from a street vendor (OR = 2.8, CI = 1.3-5.9), eating raw seafood (OR = 3.4, CI = 1.4-11.5), and eating cooked crab (OR = 5.1, CI = 1.4-19.2) were associated with illness. Always boiling drinking water at home (OR = 0.5, CI = 0.2-0.9) was protective against illness. The presence of soap in either the kitchen (OR = 0.3, CI = 0.2-0.8) or bathroom (OR = 0.4, CI = 0.2-0.9) at home was also protective. V. cholerae O 1 was recovered from a pooled sample of a bivalve mollusc and from 68% of stool samples from case-patients. Thirty-six percent of the isolates from stool specimens were resistant to multiple antimicrobial agents. Specific prevention measures may prevent transmission through these vehicles in the future. The appearance of antimicrobial resistance suggests the need for changes in current methods of prevention and treatment.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333.
authors.forename: J T
authors.initials: JT
authors.lastname: Weber
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Cañizares
authors.forename: A
authors.initials: A
authors.lastname: Semiglia
authors.forename: I
authors.initials: I
authors.lastname: Gomez
authors.forename: R
authors.initials: R
authors.lastname: Sempértegui
authors.forename: A
authors.initials: A
authors.lastname: Dávila
authors.forename: K D
authors.initials: KD
authors.lastname: Greene
authors.forename: N D
authors.initials: ND
authors.lastname: Puhr
authors.forename: D N
authors.initials: DN
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001628:Beverages; D016022:Case-Control Studies; D002648:Child; D002771:Cholera / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial / Q000235:genetics; D004484:Ecuador / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005516:Food Microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012758:Shellfish / Q000382:microbiology*; D014734:Vibrio cholerae / Q000187:drug effects / Q000235:genetics; D014871:Water Microbiology; D014881:Water Supply / Q000592:standards