AUCH Medical Directors Peer Group

Official Utah Department of Health and Human Services Alert Title: Surveillance for travelers returning with cholera 

17 days ago

Official Utah Department of Health and Human Services Alert

HAN #: 11182022-01

Title: Surveillance for travelers returning with cholera

Since January 2022, a marked rise in cholera infections has occurred worldwide, with large outbreaks in Haiti, Malawi, and Syria, and a total of 29 countries reporting cases. Cholera vaccine shortages have led international health organizations to temporarily suspend two-dose campaigns for outbreak response in favor of single-dose vaccinations to preserve global stockpiles.

 

After more than 3 years with no cases of cholera reported in Haiti, in October 2022, national authorities began reporting confirmed cholera cases spreading across the country. As of November 15, 9,317 suspected cases and 174 deaths have been reported from 9 of Haiti’s 10 departments. Medical treatment facilities in the Port-au-Prince metropolitan area, the outbreak epicenter, are approaching capacity.

 

A traveler could arrive in the United States with cholera at any time. Although no cases have been reported in the United States in 2022 among travelers returning from Haiti, eight cases have been reported among travelers returning from Pakistan, Iraq, and Bangladesh. Sustained community transmission in the United States is unlikely due to reliable water, sanitation, and hygiene (WASH) infrastructures. However, without treatment, cholera can result in death within hours. Cholera is often not considered as a possible cause of watery diarrhea among returning U.S. travelers, which can result in delayed treatment and death (JAMA 1994;272:1203).

 

People who develop watery diarrhea within 5 days after being in any country where cholera is occurring should seek medical care immediately and inform the clinician about their travel history. Physicians evaluating patients with acute onset of watery diarrhea should obtain a travel history, consider cholera in patients returning from affected regions, and obtain a stool specimen for Vibrio cholerae testing. Physicians should treat people with watery diarrhea with appropriate rehydration therapies, including Ringer’s lactate for severe dehydration, and oral rehydration solutions (ORS) or low-sugar oral electrolyte solutions for mild to moderate dehydration. Pharmacies and medical facilities should have an ample supply of these rehydration products. If they are not available, patients should drink broth or water. They should not use drinks with a high sugar content, such as juice, soft drinks, or sports drinks, because that could worsen diarrhea.

 

Clinical laboratory staff who detect a possible Vibrio cholerae infection using a culture-independent diagnostic test should quickly culture (within 3 days) the original specimen on appropriate media, inform the state public health laboratory staff if Vibrio cholerae is detected, and send the isolate (or CIDT-positive sample, if unable to culture) to the state public health laboratory using appropriate shipping conditions. 

 

Below are links to cholera information for public health and medical professionals, and health promotion materials. 

 

Resource links:

Cholera is classified as an immediately notifiable disease in Utah. Cases should be reported to your local health department or the Utah Department of Health and Human Services at 1-888-EPI-UTAH (1-888-374-8824). 

Office of Communicable Diseases

Utah Department of Health and Human Services

Office: 801.538.6191 Fax: 801.538.9923

epi@utah.gov

epi.health.utah.gov

PO Box 142104

Salt Lake City, UT 84114-2104

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