Published Date: 2003-12-08 23:50:00
Subject: PRO> Cholera, environmental isolate - Nicaragua (Tipitapa)
Archive Number: 20031208.3017
CHOLERA, ENVIRONMENTAL ISOLATE - NICARAGUA (TIPITAPA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon, 8 Dec 2003
From: ProMED-mail <email@example.com>
Source: Cronica.com (translated by Mod.JT) [edited]
Nicaragua is threatened by a cholera epidemic caused by the aggressive El
Tor strain of _Vibrio cholerae_, which was detected in the bodies of water
and humid areas of Tipitapa, to the north of the capital, announced the
Ministry of Health.
The same authority announced earlier the possibility of a new outbreak "at
any time" due to the deficient sanitary infrastructure, the lack of a
sewage system, and limited access to potable water in rural communities.
The health authorities of El Trapiche in Tipitapa continue strict
monitoring in this popular tourist destination to avoid the resurgence of
For 3 consecutive years no cases of cholera have been reported in
Nicaragua. Nevertheless, the deficient sanitary infrastructure could favor
a new outbreak. It was recommended that the population adopt measures of
hygiene when preparing and consuming foods, as well as to maintain
The Pan American Health Organization (PAHO) declared Central America free
of cholera last Fri, 5 Dec 2003. The last case in the region was registered
in Guatemala in 2002, as part of an outbreak causing at least 2300 deaths
in the decade 1991-2001.
[Because the WHO definition of "disease-free" relates to human cases rather
than environmental isolates, such a designation does not mean that the
potential for non-introduced cases is absent. Given potential problems
with poor water and sanitation in Central America's developing nations, the
potential for cases remains, especially related to eating poorly cooked
fish or shellfish. This continues to occur sporadically in the USA, along
the Gulf Coast.
In discussing the significance of environmental isolates of _V. cholerae_,
it is certainly possible that human isolates are being missed, although the
organism can survive in the environment. El Tor, indeed, may cause as many
as 20-100 asymptomatic infections for every symptomatic case. To reflect
on the Central America outbreak of cholera into the late 1990s, below is a
PAHO report related to cholera in the area before and in the wake of
"Guatemala is the most affected. The country has reported suspected and
confirmed cases of cholera during all of 1998. From 1 January through 30
October, 2530 cases were reported. Of these, 1174 were from October (before
Mitch). The weekly average in this period was 59. Beginning in Nov 1998,
the problem of cholera increased notably, and during the 4-week period 395,
530, 450, and 566 cases respectively were reported. A total of 1941 cases
were reported in November, a weekly average of 485. Of the 1941 cases in
Nov 1998, 383 were confirmed (19.4 percent). Through 2 Dec, the Ministry of
Public Health reported a total of 38 outbreaks and 33 deaths due to
cholera. The source of infection in almost all outbreaks was contaminated food.
Nicaragua was the 2nd most affected country, where like Guatemala, cholera
had been reported during all of 1998. Through 30 Oct 1998, 675 cases had
been reported; a weekly average of 16 cases. In the post-Mitch period
(November), 84, 170, 87, and 39 cases were reported for Epidemiological
Weeks 44-47 respectively. The weekly average following Mitch was 95 cases.
As in Guatemala but to a lesser degree, there was an increase in the number
of reported cases following Mitch. Contaminated food was also cited as the
principal source of infection.
In other Central American countries affected by Mitch, Belize reported
sporadic cases of cholera in 1998; a total of 12 cases through 30 October.
Following Mitch, 6 cases and 1 death occurred from an outbreak in Saint
Martin Village in the Cayo District. The source of infection in this
outbreak was drinking water contaminated with the cholera bacillus.
In Honduras through 30 October, no cases of cholera were reported.
Following Mitch, the Ministry of Health reported 18 suspected cases but
only one of these was bacteriologically confirmed.
Similarly, in El Salvador, no cases of cholera had been reported during the
first 10 months of 1998. Following Mitch, and as a result of cases
"imported" from Guatemala, 8 cases were confirmed. The Ministry of Health
recently reported that the one death was not caused by cholera."